(REPRINTED WITH ADOPTED AMENDMENTS)

 

Assembly Bill No. 44–Committee on Commerce and Labor

 

Prefiled January 26, 2001

 

(On Behalf of Legislative Committee on
Workers’ Compensation (NRS 218.5375))

 

____________

 

Referred to Committee on Commerce and Labor

 

SUMMARY—Makes various changes relating to responsibilities of insurers who provide industrial insurance. (BDR 53‑772)

 

FISCAL NOTE:            Effect on Local Government: No.

                                    Effect on the State: No.

 

~

 

EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.

 

AN ACT relating to industrial insurance; revising the provisions governing maintenance of files of claims at the office of an insurer; requiring insurers, organizations for managed care and certain employers to notify an injured employee if a medical bill submitted on his behalf is denied and that the injured employee has a right to appeal the denial; and providing other matters properly relating thereto.

 

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN

SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

 

1-1    Section 1. NRS 616B.021 is hereby amended to read as follows:

1-2    616B.021  1.  An insurer shall provide access to the files of claims in

1-3  its offices.

1-4    2.  [A file is] The physical records in a file concerning a claim filed in

1-5  this state may be kept at an office located outside this state if all records

1-6  in the file are accessible at offices located in this state on computer in a

1-7  microphotographic, electronic or other similar format that produces an

1-8  accurate reproduction of the original. Except as otherwise provided in

1-9  this subsection, the records in a file concerning a claim filed in this state

1-10  must be reproduced and available for inspection during regular business

1-11  hours within 24 hours after requested by the employee or his designated

1-12  agent, the employer or his designated agent [and] , or the administrator or

1-13  his designated agent. If a claim filed in this state has been closed, the

1-14  records in the file must be reproduced and available for inspection

1-15  during regular business hours within 7 calendar days after requested by

1-16  such persons.

2-1    3.  Upon request, the insurer shall make copies or other reproductions

2-2  of anything in the file and may charge a reasonable fee for this service.

2-3  Copies or other reproductions of materials in the file which are requested

2-4  by the administrator or his designated agent, or the Nevada attorney for

2-5  injured workers or his designated agent must be provided free of charge.

2-6    4.  [If a claim has been closed for at least 1 year, the insurer may

2-7  microphotograph or film any of its records relating to that claim. The

2-8  microphotographs or films must be placed in convenient and accessible

2-9  files.

2-10    5.] The administrator [shall] may adopt regulations concerning the:

2-11    (a) Maintenance of records in a file on current or closed claims; and

2-12    (b) Preservation, examination and use of records which have been

2-13  [microphotographed or filmed] stored on computer or in a

2-14  microphotographic, electronic or similar  format by an insurer . [; and

2-15    (c) Location of a file on a closed claim.

2-16    6.] 5. This section does not require an insurer to allow inspection or

2-17  reproduction of material regarding which a legal privilege against

2-18  disclosure has been conferred.

2-19    Sec. 2.  NRS 616B.027 is hereby amended to read as follows:

2-20    616B.027  1.  Every insurer shall [provide:

2-21    (a) An] :

2-22    (a) Provide an office in this state operated by the insurer or its third-

2-23  party administrator in which:

2-24      (1) A complete file of each claim is [kept;] accessible, in accordance

2-25  with the provisions of NRS 616B.021;

2-26      (2) Persons authorized to act for the insurer and, if necessary,

2-27  licensed pursuant to chapter 683A of NRS, may receive information related

2-28  to a claim and provide the services to an employer and his employees

2-29  required by chapters 616A to 617, inclusive, of NRS; and

2-30      (3) An employee or his employer, upon request, is provided with

2-31  information related to a claim filed by the employee or a copy or other

2-32  reproduction of the information from the file for that claim[.

2-33    (b) Statewide,] , in accordance with the provisions of NRS 616B.021.

2-34    (b) Provide statewide toll-free telephone service to [that] the office

2-35  maintained pursuant to paragraph (a) or accept collect calls from injured

2-36  employees.

2-37    2.  Each private carrier shall provide:

2-38    (a) Adequate services to its insured employers in controlling losses; and

2-39    (b) Adequate information on the prevention of industrial accidents and

2-40  occupational diseases.

2-41    Sec. 3.  Chapter 616C of NRS is hereby amended by adding thereto a

2-42  new section to read as follows:

2-43    1.  If an insurer, organization for managed care or employer who

2-44  provides accident benefits for injured employees pursuant to NRS

2-45  616C.265 denies payment for some or all of the services itemized on a

2-46  statement submitted by a provider of health care on the sole basis that

2-47  those services were not related to the employee’s industrial injury or

2-48  occupational disease, the insurer, organization for managed care or

2-49  employer shall, at the same time that it sends notification to the provider

3-1  of health care of the denial, send a copy of the statement to the injured

3-2  employee and notify the injured employee that it has denied payment.

3-3  The notification sent to the injured employee must:

3-4    (a) State the relevant amount requested as payment in the statement,

3-5  that the reason for denying payment is that the services were not related

3-6  to the industrial injury, and that, pursuant to subsection 2, the injured

3-7  employee will be responsible for payment of the relevant amount if he

3-8  does not, in a timely manner, appeal the denial pursuant to NRS

3-9  616C.305 and 616C.315 to 616C.385, inclusive, or appeals but is not

3-10  successful.

3-11    (b) Include an explanation of the injured employee’s right to request a

3-12  hearing to appeal the denial pursuant to NRS 616C.305 and 616C.315 to

3-13  616C.385, inclusive, and a suitable form for requesting a hearing to

3-14  appeal the denial.

3-15    2.  An injured employee who does not, in a timely manner, appeal the

3-16  denial of payment for the services rendered or, who appeals the denial

3-17  but is not successful, is responsible for payment of the relevant charges

3-18  on the itemized statement.

3-19    3.  To succeed on appeal, the injured employee must show that the:

3-20    (a) Services provided were related to the employee’s industrial injury

3-21  or occupational disease; or

3-22    (b) Insurer, organization for managed care or employer who provides

3-23  accident benefits for injured employees pursuant to NRS 616C.265 gave

3-24  prior authorization for the services rendered and did not withdraw that

3-25  prior authorization before the services of the provider of health care were

3-26  rendered.

3-27    Sec. 4.  NRS 616C.135 is hereby amended to read as follows:

3-28    616C.135  1.  A provider of health care who accepts a patient as a

3-29  referral for the treatment of an industrial injury or an occupational disease

3-30  may not charge the patient for any treatment related to the industrial injury

3-31  or occupational disease, but must charge the insurer. The provider of health

3-32  care may charge the patient for any [other unrelated services which are

3-33  requested in writing by the patient.] services that are not related to the

3-34  employee’s industrial injury or occupational disease.

3-35    2.  The insurer is liable for the charges for approved services related to

3-36  the industrial injury or occupational disease if the charges do not exceed:

3-37    (a) The fees established in accordance with NRS 616C.260 or the usual

3-38  fee charged by that person or institution, whichever is less; and

3-39    (b) The charges provided for by the contract between the provider of

3-40  health care and the insurer or the contract between the provider of health

3-41  care and the organization for managed care.

3-42    3.  If a provider of health care, an organization for managed care, an

3-43  insurer or an employer violates the provisions of this section, the

3-44  administrator shall impose an administrative fine of not more than $250 for

3-45  each violation.

3-46    Sec. 5.  This act becomes effective on July 1, 2001.

 

3-47  H