Senate Bill No. 209–Committee on Commerce and Labor
(On Behalf of Department of Business and
Industry—Attorney for Injured Workers)
February 20, 2001
____________
Referred to Committee on Commerce and Labor
SUMMARY—Makes various changes to provisions governing workers’ compensation benefits. (BDR 53‑616)
FISCAL NOTE: Effect on Local Government: No.
~
EXPLANATION
– Matter in bolded italics is new; matter
between brackets [omitted material] is material to be omitted.
Green numbers along left margin indicate location on the printed bill (e.g., 5-15 indicates page 5, line 15).
AN ACT relating to workers’ compensation; revising certain provisions governing eligibility for compensation for stress; allowing an employee who is injured or who contracts an occupational disease outside this state to receive compensation from the uninsured employers’ claim fund; removing the requirement that certain claims which are pending appeal and which have not been stayed must be paid in installments; revising certain provisions governing eligibility for reopening a claim; revising the provision governing the reduction of compensation for a permanent total disability when compensation in a lump sum for a permanent partial disability has already been paid; eliminating the requirement that a delay in payment of compensation must be unreasonable for administrative penalties to apply; 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 616C.180 is hereby amended to read as follows:
1-2 616C.180 1. Except as otherwise provided in this section, an injury
1-3 or disease sustained by an employee that is caused by stress is compensable
1-4 pursuant to the provisions of chapters 616A to 616D, inclusive, or chapter
1-5 617 of NRS if it arose out of and in the course of his employment.
1-6 2. Any ailment or disorder caused by any gradual mental stimulus, and
1-7 any death or disability ensuing therefrom, shall be deemed not to be an
1-8 injury or disease arising out of and in the course of employment.
1-9 3. An injury or disease caused by stress shall be deemed to arise out of
1-10 and in the course of employment only if the employee proves by clear and
1-11 convincing medical or psychiatric evidence that:
1-12 (a) He has a mental injury caused by extreme stress in time of danger;
2-1 (b) [The primary] A substantial contributing cause of the injury was an
2-2 event that arose out of and during the course of his employment; and
2-3 (c) The stress was not caused by his layoff, the termination of his
2-4 employment or any disciplinary action taken against him.
2-5 4. The provisions of this section do not apply to a person who is
2-6 claiming compensation pursuant to NRS 617.457.
2-7 Sec. 2. NRS 616C.220 is hereby amended to read as follows:
2-8 616C.220 1. The division shall designate one:
2-9 (a) Third-party administrator who has a valid certificate issued by the
2-10 commissioner pursuant to NRS 683A.085; or
2-11 (b) Insurer, other than a self-insured employer or association of self-
2-12 insured public or private employers,
2-13 to administer claims against the uninsured employers’ claim fund. The
2-14 designation must be made pursuant to reasonable competitive bidding
2-15 procedures established by the administrator.
2-16 2. An employee may receive compensation from the uninsured
2-17 employers’ claim fund if:
2-18 (a) He was hired in this state or he is regularly employed in this state;
2-19 (b) He suffers an accident or injury [in this state] which arises out of
2-20 and in the course of his employment;
2-21 (c) He files a claim for compensation with the division; and
2-22 (d) He makes an irrevocable assignment to the division of a right to be
2-23 subrogated to the rights of the injured employee pursuant to
2-24 NRS 616C.215.
2-25 3. If the division receives a claim pursuant to subsection 2, the division
2-26 shall immediately notify the employer of the claim.
2-27 4. For the purposes of this section, the employer has the burden of
2-28 proving that he provided mandatory industrial insurance coverage for the
2-29 employee or that he was not required to maintain industrial insurance for
2-30 the employee.
2-31 5. Any employer who has failed to provide mandatory coverage
2-32 required by the provisions of chapters 616A to 616D, inclusive, of NRS is
2-33 liable for all payments made on his behalf, including any benefits,
2-34 administrative costs or attorney’s fees paid from the uninsured employers’
2-35 claim fund or incurred by the division.
2-36 6. The division:
2-37 (a) May recover from the employer the payments made by the division
2-38 that are described in subsection 5 and any accrued interest by bringing a
2-39 civil action in district court.
2-40 (b) In any civil action brought against the employer, is not required to
2-41 prove that negligent conduct by the employer was the cause of the
2-42 employee’s injury.
2-43 (c) May enter into a contract with any person to assist in the collection
2-44 of any liability of an uninsured employer.
2-45 (d) In lieu of a civil action, may enter into an agreement or settlement
2-46 regarding the collection of any liability of an uninsured employer.
2-47 7. The division shall:
2-48 (a) Determine whether the employer was insured within 30 days after
2-49 receiving notice of the claim from the employee.
3-1 (b) Assign the claim to the third-party administrator or insurer
3-2 designated pursuant to subsection 1 for administration and payment of
3-3 compensation.
3-4 Upon determining whether the claim is accepted or denied, the designated
3-5 third-party administrator or insurer shall notify the injured employee, the
3-6 named employer and the division of its determination.
3-7 8. Upon demonstration of the:
3-8 (a) Costs incurred by the designated third-party administrator or insurer
3-9 to administer the claim or pay compensation to the injured employee; or
3-10 (b) Amount that the designated third-party administrator or insurer will
3-11 pay for administrative expenses or compensation to the injured employee
3-12 and that such amounts are justified by the circumstances of the claim,
3-13 the division shall authorize payment from the uninsured employers’ claim
3-14 fund.
3-15 9. Any party aggrieved by a determination regarding the
3-16 administration of an assigned claim or a determination made by the
3-17 division or by the designated third-party administrator or insurer regarding
3-18 any claim made pursuant to this section may appeal that determination
3-19 within 60 days after the determination is rendered to the hearings division
3-20 of the department of administration in the manner provided by NRS
3-21 616C.305 and 616C.315 to 616C.385, inclusive.
3-22 10. All insurers shall bear a proportionate amount of a claim made
3-23 pursuant to chapters 616A to 616D, inclusive, of NRS, and are entitled to a
3-24 proportionate amount of any collection made pursuant to this section as an
3-25 offset against future liabilities.
3-26 11. An uninsured employer is liable for the interest on any amount
3-27 paid on his claims from the uninsured employers’ claim fund. The interest
3-28 must be calculated at a rate equal to the prime rate at the largest bank in
3-29 Nevada, as ascertained by the commissioner of financial institutions, on
3-30 January 1 or July 1, as the case may be, immediately preceding the date of
3-31 the claim, plus 3 percent, compounded monthly, from the date the claim is
3-32 paid from the fund until payment is received by the division from the
3-33 employer.
3-34 12. Attorney’s fees recoverable by the division pursuant to this section
3-35 must be:
3-36 (a) If a private attorney is retained by the division, paid at the usual and
3-37 customary rate for that attorney.
3-38 (b) If the attorney is an employee of the division, paid at the rate
3-39 established by regulations adopted by the division.
3-40 Any money collected must be deposited to the uninsured employers’ claim
3-41 fund.
3-42 13. In addition to any other liabilities provided for in this section, the
3-43 administrator may impose an administrative fine of not more than $10,000
3-44 against an employer if the employer fails to provide mandatory coverage
3-45 required by the provisions of chapters 616A to 616D, inclusive, of NRS.
3-46 Sec. 3. NRS 616C.380 is hereby amended to read as follows:
3-47 616C.380 1. If a hearing officer, appeals officer or district court
3-48 renders a decision on a claim for compensation and the insurer or employer
3-49 appeals that decision, but is unable to obtain a stay of the decision[:
4-1 (a) Payment] , payment of that portion of an award for a permanent
4-2 partial disability which is contested must be made in installment payments
4-3 until the claim reaches final resolution.
4-4 [(b) Payment of the award must be made in monthly installments of 66
4-5 2/3 percent of the average wage of the claimant until the claim reaches
4-6 final resolution if the claim is for more than 3 months of past benefits for a
4-7 temporary total disability or rehabilitation, or for a payment in lump sum
4-8 related to past benefits for rehabilitation, such as costs for purchasing a
4-9 business or equipment.]
4-10 2. If the final resolution of the claim is in favor of the claimant, the
4-11 remaining amount of compensation for a permanent partial disability to
4-12 which the claimant is entitled may be paid in a lump sum if the claimant is
4-13 otherwise eligible for such a payment pursuant to NRS 616C.495 and any
4-14 regulations adopted pursuant thereto. If the final resolution of the claim is
4-15 in favor of the insurer or employer, any amount paid to the claimant in
4-16 excess of the uncontested amount must be deducted from any future
4-17 benefits related to that claim, other than medical benefits, to which the
4-18 claimant is entitled. The deductions must be made in a reasonable manner
4-19 so as not to create an undue hardship to the claimant.
4-20 Sec. 4. NRS 616C.390 is hereby amended to read as follows:
4-21 616C.390 1. If an application to reopen a claim to increase or
4-22 rearrange compensation is made in writing more than 1 year after the date
4-23 on which the claim was closed, the insurer shall reopen the claim if:
4-24 (a) A change of circumstances warrants an increase or rearrangement of
4-25 compensation during the life of the claimant;
4-26 (b) [The primary] A substantial contributing cause of the change of
4-27 circumstances is the injury or disease for which the claim was originally
4-28 made; and
4-29 (c) The application is accompanied by the certificate of a physician or a
4-30 chiropractor showing a change of circumstances which would warrant an
4-31 increase or rearrangement of compensation.
4-32 2. After a claim has been closed, the insurer, upon receiving an
4-33 application and for good cause shown, may authorize the reopening of the
4-34 claim for medical investigation only. The application must be accompanied
4-35 by a written request for treatment from the physician or chiropractor
4-36 treating the claimant, certifying that the treatment is indicated by a change
4-37 in circumstances and is related to the industrial injury sustained or
4-38 occupational disease contracted by the claimant.
4-39 3. If a claimant applies for a claim to be reopened pursuant to
4-40 subsection 1 or 2 and a final determination denying the reopening is issued,
4-41 the claimant [shall] may not reapply to reopen the claim until at least 1 year
4-42 after the date on which the final determination is issued.
4-43 4. Except as otherwise provided in subsection 5, if an application to
4-44 reopen a claim is made in writing within 1 year after the date on which the
4-45 claim was closed, the insurer shall reopen the claim only if:
4-46 (a) The application is supported by medical evidence demonstrating an
4-47 objective change in the medical condition of the claimant; and
5-1 (b) There is clear and convincing evidence that [the primary] a
5-2 substantial contributing cause of the change of circumstances is the injury
5-3 or disease for which the claim was originally made.
5-4 5. An application to reopen a claim must be made in writing within 1
5-5 year after the date on which the claim was closed if:
5-6 (a) The claimant was not off work as a result of the injury[;] or disease;
5-7 and
5-8 (b) The claimant did not receive benefits for a permanent partial
5-9 disability.
5-10 If an application to reopen a claim to increase or rearrange compensation is
5-11 made pursuant to this subsection, the insurer shall reopen the claim if the
5-12 requirements set forth in paragraphs (a), (b) and (c) of subsection 1 are
5-13 met.
5-14 6. If an employee’s claim is reopened pursuant to this section, he is not
5-15 entitled to vocational rehabilitation services or benefits for a temporary
5-16 total disability if, before his claim was reopened, he:
5-17 (a) Retired; or
5-18 (b) Otherwise voluntarily removed himself from the work force,
5-19 for reasons unrelated to the injury or disease for which the claim was
5-20 originally made.
5-21 7. One year after the date on which the claim was closed, an insurer
5-22 may dispose of the file of a claim authorized to be reopened pursuant to
5-23 subsection 5, unless an application to reopen the claim has been filed
5-24 pursuant to that subsection.
5-25 8. An increase or rearrangement of compensation is not effective
5-26 before an application for reopening a claim is made unless good cause is
5-27 shown. The insurer shall, upon good cause shown, allow the cost of
5-28 emergency treatment the necessity for which has been certified by a
5-29 physician or a chiropractor.
5-30 9. A claim that closes pursuant to subsection 2 of NRS 616C.235 and
5-31 is not appealed or is unsuccessfully appealed pursuant to the provisions of
5-32 NRS 616C.305 and 616C.315 to 616C.385, inclusive, may not be reopened
5-33 pursuant to this section.
5-34 10. The provisions of this section apply to any claim for which an
5-35 application to reopen the claim or to increase or rearrange compensation is
5-36 made pursuant to this section, regardless of the date of the injury or
5-37 accident or the date of disablement to the claimant. If a claim is reopened
5-38 pursuant to this section, the amount of any compensation or benefits
5-39 provided must be determined in accordance with the provisions of NRS
5-40 616C.425[.] or 617.445, as appropriate.
5-41 Sec. 5. NRS 616C.440 is hereby amended to read as follows:
5-42 616C.440 1. Except as otherwise provided in this section and NRS
5-43 616C.175, every employee in the employ of an employer, within the
5-44 provisions of chapters 616A to 616D, inclusive, of NRS, who is injured by
5-45 accident arising out of and in the course of employment, or his dependents
5-46 as defined in chapters 616A to 616D, inclusive, of NRS, is entitled to
5-47 receive the following compensation for permanent total disability:
5-48 (a) In cases of total disability adjudged to be permanent, compensation
5-49 per month of 66 2/3 percent of the average monthly wage.
6-1 (b) If there is a previous disability, as the loss of one eye, one hand, one
6-2 foot or any other previous permanent disability, the percentage of disability
6-3 for a subsequent injury must be determined by computing the percentage of
6-4 the entire disability and deducting therefrom the percentage of the previous
6-5 disability as it existed at the time of the subsequent injury, but such a
6-6 deduction for a previous award for permanent partial disability must [be] :
6-7 (1) Be made in a reasonable manner ; and [must not]
6-8 (2) Not be more than the sum of the total amount which was paid in
6-9 lump sum for the previous award for permanent partial disability[.] minus
6-10 any amount that was previously recouped by the insurer through a
6-11 deduction from an award of compensation for another type of disability.
6-12 (c) If the character of the injury is such as to render the employee so
6-13 physically helpless as to require the service of a constant attendant, an
6-14 additional allowance may be made so long as such requirements continue,
6-15 but the allowance may not be made while the employee is receiving
6-16 benefits for care in a hospital or facility for intermediate care pursuant to
6-17 the provisions of NRS 616C.265.
6-18 2. Except as otherwise provided in NRS 616B.028 and 616B.029, an
6-19 injured employee or his dependents are not entitled to accrue or be paid
6-20 any benefits for a permanent total disability during the time the injured
6-21 employee is incarcerated. The injured employee or his dependents are
6-22 entitled to receive such benefits when the injured employee is released
6-23 from incarceration if he is certified as permanently totally disabled by a
6-24 physician or chiropractor.
6-25 3. An employee is entitled to receive compensation for a permanent
6-26 total disability only so long as the permanent total disability continues to
6-27 exist. The insurer has the burden of proving that the permanent total
6-28 disability no longer exists.
6-29 4. If an employee who has received compensation in a lump sum for a
6-30 permanent partial disability pursuant to NRS 616C.495 is subsequently
6-31 determined to be permanently and totally disabled, the compensation for
6-32 the permanent total disability must be reduced as follows:
6-33 (a) If the employee has not received a minimum lump sum, the insurer
6-34 of the employee’s employer shall deduct from the compensation for the
6-35 permanent total disability an amount equal to the monthly installment rate
6-36 for awards for permanent partial disability until the insurer has deducted an
6-37 amount that equals the sum of the amount it has already paid out as a lump
6-38 sum[;] minus any amount that it has previously recouped through a
6-39 deduction from an award of compensation for another type of disability;
6-40 or
6-41 (b) If the employee received a minimum lump sum, the insurer of the
6-42 employee’s employer shall deduct from the compensation for the
6-43 permanent total disability an amount of not more than 10 percent of the
6-44 rate of compensation for a permanent total disability until the insurer has
6-45 deducted an amount equal to the sum of the amount it has already paid
6-46 out as a lump sum [is recovered.] minus any amount that it has
6-47 previously recouped through a deduction from an award of
6-48 compensation for another type of disability.
7-1 The provisions of this subsection are retroactive for all claims for
7-2 compensation for a permanent total disability remaining open on January 1,
7-3 2000.
7-4 Sec. 6. NRS 616D.120 is hereby amended to read as follows:
7-5 616D.120 1. Except as otherwise provided in this section, if the
7-6 administrator determines that an insurer, organization for managed care,
7-7 health care provider, third-party administrator or employer has:
7-8 (a) Through fraud, coercion, duress or undue influence:
7-9 (1) Induced a claimant to fail to report an accidental injury or
7-10 occupational disease;
7-11 (2) Persuaded a claimant to settle for an amount which is less than
7-12 reasonable;
7-13 (3) Persuaded a claimant to settle for an amount which is less than
7-14 reasonable while a hearing or an appeal is pending; or
7-15 (4) Persuaded a claimant to accept less than the compensation found
7-16 to be due him by a hearing officer, appeals officer, court of competent
7-17 jurisdiction, written settlement agreement, written stipulation or the
7-18 division when carrying out its duties pursuant to chapters 616A to 617,
7-19 inclusive, of NRS;
7-20 (b) Refused to pay or [unreasonably] delayed payment to a claimant of
7-21 compensation found to be due him by a hearing officer, appeals officer,
7-22 court of competent jurisdiction, written settlement agreement, written
7-23 stipulation or the division when carrying out its duties pursuant to chapters
7-24 616A to 616D, inclusive, or chapter 617 of NRS, if the refusal or delay
7-25 occurs:
7-26 (1) Later than 10 days after the date of the settlement agreement or
7-27 stipulation;
7-28 (2) Later than 30 days after the date of the decision of a court,
7-29 hearing officer, appeals officer or division, unless a stay has been granted;
7-30 or
7-31 (3) Later than 10 days after a stay of the decision of a court, hearing
7-32 officer, appeals officer or division has been lifted;
7-33 (c) Refused to process a claim for compensation pursuant to chapters
7-34 616A to 616D, inclusive, or chapter 617 of NRS;
7-35 (d) Made it necessary for a claimant to initiate proceedings pursuant to
7-36 chapters 616A to 616D, inclusive, or chapter 617 of NRS for compensation
7-37 found to be due him by a hearing officer, appeals officer, court of
7-38 competent jurisdiction, written settlement agreement, written stipulation or
7-39 the division when carrying out its duties pursuant to chapters 616A to
7-40 616D, inclusive, or chapter 617 of NRS;
7-41 (e) Failed to comply with the division’s regulations covering the
7-42 payment of an assessment relating to the funding of costs of administration
7-43 of chapters 616A to 617, inclusive, of NRS;
7-44 (f) Failed to provide or unreasonably delayed payment to an injured
7-45 employee or reimbursement to an insurer pursuant to NRS 616C.165; or
7-46 (g) Intentionally failed to comply with any provision of, or regulation
7-47 adopted pursuant to, this chapter or chapter 616A, 616B, 616C or 617 of
7-48 NRS,
8-1 the administrator shall impose an administrative fine of $1,000 for each
8-2 initial violation, or a fine of $10,000 for a second or subsequent violation.
8-3 2. Except as otherwise provided in chapters 616A to 616D, inclusive,
8-4 or chapter 617 of NRS, if the administrator determines that an insurer,
8-5 organization for managed care, health care provider, third-party
8-6 administrator or employer has failed to comply with any provision of this
8-7 chapter or chapter 616A, 616B, 616C or 617 of NRS, or any regulation
8-8 adopted pursuant thereto, the administrator may take any of the following
8-9 actions:
8-10 (a) Issue a notice of correction for:
8-11 (1) A minor violation, as defined by regulations adopted by the
8-12 division; or
8-13 (2) A violation involving the payment of compensation in an amount
8-14 which is greater than that required by any provision of this chapter or
8-15 chapter 616A, 616B, 616C or 617 of NRS, or any regulation adopted
8-16 pursuant thereto.
8-17 The notice of correction must set forth with particularity the violation
8-18 committed and the manner in which the violation may be corrected. The
8-19 provisions of this section do not authorize the administrator to modify or
8-20 negate in any manner a determination or any portion of a determination
8-21 made by a hearing officer, appeals officer or court of competent
8-22 jurisdiction or a provision contained in a written settlement agreement or
8-23 written stipulation.
8-24 (b) Impose an administrative fine for:
8-25 (1) A second or subsequent violation for which a notice of correction
8-26 has been issued pursuant to paragraph (a); or
8-27 (2) Any other violation of this chapter or chapter 616A, 616B, 616C
8-28 or 617 of NRS, or any regulation adopted pursuant thereto, for which a
8-29 notice of correction may not be issued pursuant to paragraph (a).
8-30 The fine imposed may not be greater than $250 for an initial violation, or
8-31 more than $1,000 for any second or subsequent violation.
8-32 (c) Order a plan of corrective action to be submitted to the administrator
8-33 within 30 days after the date of the order.
8-34 3. If the administrator determines that a violation of any of the
8-35 provisions of paragraphs (a) to (d), inclusive, of subsection 1 has occurred,
8-36 the administrator shall order the insurer, organization for managed care,
8-37 health care provider, third-party administrator or employer to pay to the
8-38 claimant a benefit penalty in an amount that is not less than $5,000 and not
8-39 greater than $25,000. To determine the amount of the benefit penalty, the
8-40 administrator shall consider the degree of physical harm suffered by the
8-41 injured employee or his dependents as a result of the violation of paragraph
8-42 (a), (b), (c) or (d) of subsection 1, the amount of compensation found to be
8-43 due the claimant and the number of fines and benefit penalties previously
8-44 imposed against the insurer, organization for managed care, health care
8-45 provider, third-party administrator or employer pursuant to this section. If
8-46 this is the third violation within 5 years for which a benefit penalty has
8-47 been imposed against the insurer, organization for managed care, health
8-48 care provider, third-party administrator or employer, the administrator shall
8-49 also consider the degree of economic harm suffered by the injured
9-1 employee or his dependents as a result of the violation of paragraph (a),
9-2 (b), (c) or (d) of subsection 1. Except as otherwise provided in this section,
9-3 the benefit penalty is for the benefit of the claimant and must be paid
9-4 directly to him within 10 days after the date of the administrator’s
9-5 determination. If the claimant is the injured employee and he dies before
9-6 the benefit penalty is paid to him, the benefit penalty must be paid to his
9-7 estate. Proof of the payment of the benefit penalty must be submitted to the
9-8 administrator within 10 days after the date of his determination unless an
9-9 appeal is filed pursuant to NRS 616D.140. Any compensation to which the
9-10 claimant may otherwise be entitled pursuant to chapters 616A to 616D,
9-11 inclusive, or chapter 617 of NRS must not be reduced by the amount of any
9-12 benefit penalty received pursuant to this subsection.
9-13 4. In addition to any fine or benefit penalty imposed pursuant to this
9-14 section, the administrator may assess against an insurer who violates any
9-15 regulation concerning the reporting of claims expenditures used to
9-16 calculate an assessment an administrative penalty of up to twice the
9-17 amount of any underpaid assessment.
9-18 5. If:
9-19 (a) The administrator determines that a person has violated any of the
9-20 provisions of NRS 616D.200, 616D.220, 616D.240, 616D.300, 616D.310
9-21 or 616D.350 to 616D.440, inclusive; and
9-22 (b) The fraud control unit for industrial insurance established pursuant
9-23 to NRS 228.420 notifies the administrator that the unit will not prosecute
9-24 the person for that violation,
9-25 the administrator shall impose an administrative fine of not more than
9-26 $10,000.
9-27 6. Two or more fines of $1,000 or more imposed in 1 year for acts
9-28 enumerated in subsection 1 must be considered by the commissioner as
9-29 evidence for the withdrawal of:
9-30 (a) A certificate to act as a self-insured employer.
9-31 (b) A certificate to act as an association of self-insured public or private
9-32 employers.
9-33 (c) A certificate of registration as a third-party administrator.
9-34 7. The commissioner may, without complying with the provisions of
9-35 NRS 616B.327 or 616B.431, withdraw the certification of a self-insured
9-36 employer, association of self-insured public or private employers , or third-
9-37 party administrator if, after a hearing, it is shown that the self-insured
9-38 employer, association of self-insured public or private employers , or third-
9-39 party administrator violated any provision of subsection 1.
9-40 Sec. 7. NRS 617.401 is hereby amended to read as follows:
9-41 617.401 1. The division shall designate one:
9-42 (a) Third-party administrator who has a valid certificate issued by the
9-43 commissioner pursuant to NRS 683A.085; or
9-44 (b) Insurer, other than a self-insured employer or association of self-
9-45 insured public or private employers,
9-46 to administer claims against the uninsured employers’ claim fund. The
9-47 designation must be made pursuant to reasonable competitive bidding
9-48 procedures established by the administrator.
10-1 2. An employee may receive compensation from the uninsured
10-2 employers’ claim fund if:
10-3 (a) He was hired in this state or he is regularly employed in this state;
10-4 (b) He contracts an occupational disease [as a result of work performed
10-5 in this state;] that arose out of and in the course of employment;
10-6 (c) He files a claim for compensation with the division; and
10-7 (d) He makes an irrevocable assignment to the division of a right to be
10-8 subrogated to the rights of the employee pursuant to NRS 616C.215.
10-9 3. If the division receives a claim pursuant to subsection 2, the division
10-10 shall immediately notify the employer of the claim.
10-11 4. For the purposes of this section, the employer has the burden of
10-12 proving that he provided mandatory coverage for occupational diseases for
10-13 the employee or that he was not required to maintain industrial insurance
10-14 for the employee.
10-15 5. Any employer who has failed to provide mandatory coverage
10-16 required by the provisions of this chapter is liable for all payments made on
10-17 his behalf, including, but not limited to, any benefits, administrative costs
10-18 or attorney’s fees paid from the uninsured employers’ claim fund or
10-19 incurred by the division.
10-20 6. The division:
10-21 (a) May recover from the employer the payments made by the division
10-22 that are described in subsection 5 and any accrued interest by bringing a
10-23 civil action in district court.
10-24 (b) In any civil action brought against the employer, is not required to
10-25 prove that negligent conduct by the employer was the cause of the
10-26 occupational disease.
10-27 (c) May enter into a contract with any person to assist in the collection
10-28 of any liability of an uninsured employer.
10-29 (d) In lieu of a civil action, may enter into an agreement or settlement
10-30 regarding the collection of any liability of an uninsured employer.
10-31 7. The division shall:
10-32 (a) Determine whether the employer was insured within 30 days after
10-33 receiving the claim from the employee.
10-34 (b) Assign the claim to the third-party administrator or insurer
10-35 designated pursuant to subsection 1 for administration and payment of
10-36 compensation.
10-37 Upon determining whether the claim is accepted or denied, the designated
10-38 third-party administrator or insurer shall notify the injured employee, the
10-39 named employer and the division of its determination.
10-40 8. Upon demonstration of the:
10-41 (a) Costs incurred by the designated third-party administrator or insurer
10-42 to administer the claim or pay compensation to the injured employee; or
10-43 (b) Amount that the designated third-party administrator or insurer will
10-44 pay for administrative expenses or compensation to the injured employee
10-45 and that such amounts are justified by the circumstances of the claim,
10-46 the division shall authorize payment from the uninsured employers’ claim
10-47 fund.
10-48 9. Any party aggrieved by a determination regarding the
10-49 administration of an assigned claim or a determination made by the
11-1 division or by the designated third-party administrator or insurer regarding
11-2 any claim made pursuant to this section may appeal that determination
11-3 within 60 days after the determination is rendered to the hearings division
11-4 of the department of administration in the manner provided by NRS
11-5 616C.305 and 616C.315 to 616C.385, inclusive.
11-6 10. All insurers shall bear a proportionate amount of a claim made
11-7 pursuant to this chapter, and are entitled to a proportionate amount of any
11-8 collection made pursuant to this section as an offset against future
11-9 liabilities.
11-10 11. An uninsured employer is liable for the interest on any amount
11-11 paid on his claims from the uninsured employers’ claim fund. The interest
11-12 must be calculated at a rate equal to the prime rate at the largest bank in
11-13 Nevada, as ascertained by the commissioner of financial institutions, on
11-14 January 1 or July 1, as the case may be, immediately preceding the date of
11-15 the claim, plus 3 percent, compounded monthly, from the date the claim is
11-16 paid from the fund until payment is received by the division from the
11-17 employer.
11-18 12. Attorney’s fees recoverable by the division pursuant to this section
11-19 must be:
11-20 (a) If a private attorney is retained by the division, paid at the usual and
11-21 customary rate for that attorney.
11-22 (b) If the attorney is an employee of the division, paid at the rate
11-23 established by regulations adopted by the division.
11-24 Any money collected must be deposited to the uninsured employers’ claim
11-25 fund.
11-26 13. In addition to any other liabilities provided for in this section, the
11-27 administrator may impose an administrative fine of not more than $10,000
11-28 against an employer if the employer fails to provide mandatory coverage
11-29 required by the provisions of this chapter.
11-30 Sec. 8. This act becomes effective on July 1, 2001.
11-31 H