(Reprinted with amendments adopted on April 21, 2003)

 

Senate Bill No. 320–Senator Shaffer (by request)

 

March 17, 2003

____________

 

Referred to Committee on Commerce and Labor

 

SUMMARY—Makes various changes to provisions governing industrial insurance. (BDR 53‑600)

 

FISCAL NOTE:    Effect on Local Government: No.

                             Effect on the State: Yes.

 

~

 

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

 

AN ACT relating to industrial insurance; requiring the adoption of certain medical standards for evaluating permanent impairments to injured employees; revising various provisions relating to the payment of compensation to injured employees; revising certain procedures and establishing certain requirements relating to the adjudication of contested claims; 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.110 is hereby amended to read as

1-2  follows:

1-3  616C.110  1.  For the purposes of NRS 616B.557, 616B.578,

1-4  616B.587, 616C.490 and 617.459, the Division shall adopt

1-5  regulations incorporating the American Medical Association’s

1-6  Guides to the Evaluation of Permanent Impairment , 5th edition, by

1-7  reference . [and] The Division may amend those regulations from

1-8  time to time as it deems necessary[. In adopting] , except that the

1-9  amendments to those regulations:

1-10      (a) Must be consistent with the American Medical

1-11  Association’s Guides to the Evaluation of Permanent Impairment,

1-12  [the Division shall consider the edition most recently published by]

1-13  5th edition;

2-1  (b) Must not incorporate any contradictory matter from any

2-2  other edition or printing of the American Medical [Association.]

2-3  Association’s Guides to the Evaluation of Permanent Impairment;

2-4  and

2-5  (c) Must not consider any factors other than the degree of

2-6  physical impairment of the whole man in calculating the

2-7  entitlement to compensation.

2-8  2.  If the American Medical Association’s Guides to the

2-9  Evaluation of Permanent Impairment [adopted by the Division

2-10  contain] , 5th edition, contains more than one method of

2-11  determining the rating of an impairment, the Administrator shall

2-12  designate by regulation the method from that edition which must be

2-13  used to rate an impairment pursuant to NRS 616C.490.

2-14      Sec. 2.  NRS 616C.175 is hereby amended to read as follows:

2-15      616C.175  1.  The resulting condition of an employee who:

2-16      (a) Has a preexisting condition from a cause or origin that did

2-17  not arise out of or in the course of his current or past employment;

2-18  and

2-19      (b) Subsequently sustains an injury by accident arising out of

2-20  and in the course of his employment which aggravates, precipitates

2-21  or accelerates his preexisting condition,

2-22  shall not be deemed to be an injury by accident that is compensable

2-23  pursuant to the provisions of chapters 616A to 616D, inclusive, of

2-24  NRS, unless the [insurer can prove] physician or chiropractor

2-25  proves by a preponderance of the evidence that the subsequent

2-26  injury described in paragraph (b) is [not a substantial contributing]

2-27  the major cause of the resulting condition.

2-28      2.  The resulting condition of an employee who:

2-29      (a) Sustains an injury by accident arising out of and in the

2-30  course of his employment; and

2-31      (b) Subsequently aggravates, precipitates or accelerates the

2-32  injury in a manner that does not arise out of and in the course of his

2-33  employment,

2-34  shall not be deemed to be an injury by accident that is compensable

2-35  pursuant to the provisions of chapters 616A to 616D, inclusive, of

2-36  NRS, unless the [insurer can prove] physician or chiropractor

2-37  proves by a preponderance of the evidence that the injury described

2-38  in paragraph (a) is [not a substantial contributing] the major cause

2-39  of the resulting condition.

2-40      Sec. 3.  NRS 616C.245 is hereby amended to read as follows:

2-41      616C.245  1.  Every injured employee within the provisions of

2-42  chapters 616A to 616D, inclusive, of NRS is entitled to receive

2-43  promptly such accident benefits as may reasonably be required at

2-44  the time of the injury and within 6 months thereafter. Such benefits

2-45  may be further extended for additional periods as may be required.

3-1  2.  An injured employee is entitled to receive as an accident

3-2  benefit a motor vehicle that is modified to allow the employee to

3-3  operate the vehicle safely if:

3-4  (a) As a result of an injury arising out of and in the course of his

3-5  employment, he is quadriplegic, paraplegic or has had a part of his

3-6  body amputated; and

3-7  (b) He cannot be fitted with a prosthetic device which allows

3-8  him to operate a motor vehicle safely.

3-9  3.  If an injured employee is entitled to receive a motor vehicle

3-10  pursuant to subsection 2, a motor vehicle must be modified to allow

3-11  the employee to operate it safely in the following order of

3-12  preference:

3-13      (a) A motor vehicle owned by the injured employee must be so

3-14  modified if the insurer or employer providing accident benefits

3-15  determines that it is reasonably feasible to do so.

3-16      (b) A used motor vehicle must be so modified if the insurer or

3-17  employer providing accident benefits determines that it is

3-18  reasonably feasible to do so.

3-19      (c) A new motor vehicle must be so modified.

3-20      4.  The Administrator shall adopt regulations establishing a

3-21  maximum benefit to be paid under the provisions of this section.

3-22      Sec. 4.  NRS 616C.315 is hereby amended to read as follows:

3-23      616C.315  1.  Any person who is subject to the jurisdiction of

3-24  the hearing officers pursuant to chapters 616A to 616D, inclusive, or

3-25  chapter 617 of NRS may request a hearing before a hearing officer

3-26  of any matter within the hearing officer’s authority. The insurer

3-27  shall provide, without cost, the forms necessary to request a hearing

3-28  to any person who requests them.

3-29      2.  A request for a hearing must not be granted unless the

3-30  request for a hearing includes:

3-31      (a) The name and last known mailing address of:

3-32          (1) The claimant;

3-33          (2) The employer; and

3-34          (3) The insurer;

3-35      (b) The number of the claim; and

3-36      (c) If applicable, a copy of the letter of determination being

3-37  appealed, or if such a copy is unavailable, the date of the

3-38  determination and the issues stated in the determination.

3-39      3.  Except as otherwise provided in NRS 616B.772, 616B.775,

3-40  616B.787 and 616C.305, a person who is aggrieved by:

3-41      (a) A written determination of an insurer; or

3-42      (b) The failure of an insurer to respond within 30 days to a

3-43  written request mailed to the insurer by the person who is

3-44  aggrieved,

4-1  may appeal from the determination or failure to respond by filing a

4-2  request for a hearing before a hearing officer. Such a request must

4-3  include the information required pursuant to subsection 2 and

4-4  must be filed within 70 days after the date on which the notice of

4-5  the insurer’s determination was mailed by the insurer or the

4-6  unanswered written request was mailed to the insurer, as applicable.

4-7  The failure of an insurer to respond to a written request for a

4-8  determination within 30 days after receipt of such a request shall be

4-9  deemed by the hearing officer to be a denial of the request.

4-10      [3.] 4.  Failure to file a request for a hearing within the period

4-11  specified in subsection [2] 3 may be excused if the person aggrieved

4-12  shows by a preponderance of the evidence that he did not receive

4-13  the notice of the determination and the forms necessary to request a

4-14  hearing. The claimant or employer shall notify the insurer of a

4-15  change of address.

4-16      [4.] 5.  The hearing before the hearing officer must be

4-17  conducted as expeditiously and informally as is practicable.

4-18      [5.] 6.  The parties to a contested claim may, if the claimant is

4-19  represented by legal counsel, agree to forego a hearing before a

4-20  hearing officer and submit the contested claim directly to an appeals

4-21  officer.

4-22      Sec. 5.  NRS 616C.345 is hereby amended to read as follows:

4-23      616C.345  1.  Any party aggrieved by a decision of the

4-24  hearing officer relating to a claim for compensation may appeal

4-25  from the decision by filing a notice of appeal with an appeals officer

4-26  within 30 days after the date of the decision.

4-27      2.  A request for a hearing must be dismissed unless the

4-28  request for a hearing includes:

4-29      (a) The name and last known mailing address of:

4-30          (1) The claimant;

4-31          (2) The employer; and

4-32          (3) The insurer;

4-33      (b) The number of the claim; and

4-34      (c) A copy of the decision of the hearing officer being

4-35  appealed, or if such a copy is unavailable, the date of the

4-36  determination and the issues stated in the determination.

4-37      3.  If a dispute is required to be submitted to a procedure for

4-38  resolving complaints pursuant to NRS 616C.305 and:

4-39      (a) A final determination was rendered pursuant to that

4-40  procedure; or

4-41      (b) The dispute was not resolved pursuant to that procedure

4-42  within 14 days after it was submitted,

4-43  any party to the dispute may file a notice of appeal within 70 days

4-44  after the date on which the final determination was mailed to the

4-45  employee, or his dependent, or the unanswered request for

5-1  resolution was submitted. Failure to render a written determination

5-2  within 30 days after receipt of such a request shall be deemed by the

5-3  appeals officer to be a denial of the request.

5-4  [3.] 4. Except as otherwise provided in NRS 616C.380, the

5-5  filing of a notice of appeal does not automatically stay the

5-6  enforcement of the decision of a hearing officer or a determination

5-7  rendered pursuant to NRS 616C.305. The appeals officer may order

5-8  a stay, when appropriate, upon the application of a party. If such an

5-9  application is submitted, the decision is automatically stayed until a

5-10  determination is made concerning the application. A determination

5-11  on the application must be made within 30 days after the filing of

5-12  the application. If a stay is not granted by the officer after reviewing

5-13  the application, the decision must be complied with within 10 days

5-14  after the date of the refusal to grant a stay.

5-15      [4.] 5. Except as otherwise provided in this subsection, the

5-16  appeals officer shall, within 10 days after receiving a notice of

5-17  appeal pursuant to this section or a contested claim pursuant to

5-18  subsection [5] 6 of NRS 616C.315, schedule a hearing on the merits

5-19  of the appeal or contested claim for a date and time within 90 days

5-20  after his receipt of the notice and give notice by mail or by personal

5-21  service to all parties to the matter and their attorneys or agents at

5-22  least 30 days before the date and time scheduled. A request to

5-23  schedule the hearing for a date and time which is:

5-24      (a) Within 60 days after the receipt of the notice of appeal or

5-25  contested claim; or

5-26      (b) More than 90 days after the receipt of the notice or

5-27  claim,

5-28  may be submitted to the appeals officer only if all parties to the

5-29  appeal or contested claim agree to the request.

5-30      [5.] 6. An appeal or contested claim may be continued upon

5-31  written stipulation of all parties, or upon good cause shown.

5-32      [6.] 7. Failure to file a notice of appeal within the period

5-33  specified in subsection 1 or [2] 3 may be excused if the party

5-34  aggrieved shows by a preponderance of the evidence that he did not

5-35  receive the notice of the determination and the forms necessary to

5-36  appeal the determination. The claimant, employer or insurer shall

5-37  notify the hearing officer of a change of address.

5-38      Sec. 6.  1.  This section and sections 4 and 5 of this act

5-39  become effective upon passage and approval.

5-40      2.  Section 3 of this act becomes effective upon passage and

5-41  approval for the purpose of adopting regulations and on October 1,

5-42  2003, for all other purposes.

 

 

6-1  3.  Sections 1 and 2 of this act become effective on January 1,

6-2  2004.

 

6-3  H