AB 441 — Revises provisions relating to industrial insurance. (BDR 53-1002)

administrator employed by an association of self-insured public or private’s employers and a third-party administrator of an association of public or private employers from holding a financial interest in or serving as employee, officer or director of one another.

Existing law authorizes an insurer or employer who pays an annual increase in compensation for permanent total disability to a claimant or dependent who is entitled to such compensation due to certain industrial injuries or disablements to obtain reimbursement from the Administrator and sets forth the procedure for an insurer who pays an increase in certain death benefits to a widow, widower,s surviving child or surviving dependent parent to be reimbursed annually for the amount of that increase and sets forth procedures for obtaining reimbursement.

Chapter 616B of NRS is hereby amended by adding thereto a new section to read as follows:

1.

An employee of a private carrier who is licensed as a company adjuster pursuant to chapter 684A of NRS or a person who acts as a third-party administrator pursuant to chapters 616A to 616D, inclusive, or chapter 617 of NRS for a private carrier may administer claims arising under chapters 616A to 616D, inclusive, or chapter 617 of NRS from a location in or outside of this State.

All records concerning a claim administered pursuant to this subsection must be maintained at one or more offices located in this State or by computer in a microphotographic, electronic or other similar format that produces an accurate reproduction of the original.

2.

An employee of a private carrier who is not licensed as a company adjuster pursuant to chapter 684A of NRS or a person who acts as a third-party administrator pursuant to chapters 616A to 616D, inclusive, or chapter 617 of NRS for a self-insured employer or an association of self-insured public or private employers may administer claims arising under chapters 616A to 616D, inclusive, or chapter 617 of NRS only from one or more offices located in this State.

All records concerning a claim administered pursuant to this subsection must be maintained in those offices.

3.

The Commissioner may:

(a) Under exceptional circumstances, waive the requirements of subsections 1 and 2;

and (b) Adopt regulations to carry out the provisions of this section.

- *AB441_R2* – 5 – Sec.

1.5.

- *AB441_R1* – 4 – 2.

- *AB441_R2* – 6 – (2) Persons authorized to act for the insurer and, if necessary, licensed pursuant to chapter 683A of NRS, may receive information related to a claim and provide the services to an employer and his or her employees required by chapters 616A to 617, inclusive, of NRS;

and (3) An employee or his or her employer, upon request, is provided with information related to a claim filed by the employee - *AB441_R1* – 5 – or a copy or other reproduction of the information from the file for that claim, in accordance with the provisions of NRS 616B.021.

3.

An employee of a private carrier who is licensed as a company adjuster pursuant to chapter 684A of NRS or a person who acts as a third-party administrator pursuant to chapters 616A to 616D, inclusive, or chapter 617 of NRS for a private carrier who administers a claim arising under chapters 616A to 616D, inclusive, or chapter 617 of NRS from a location outside of this State pursuant to subsection 1 of section 1 of this act shall make himself or herself available to communicate in real time with the claimant or a representative of the claimant Monday through Friday, 9 a.m.

to 5 p.m.

local time in this State, excluding any day declared to be a legal holiday pursuant to NRS 236.015.

2.3.

NRS 616B.503 is hereby amended to read as follows:

616B.503 1.

A person shall not act as a third-party administrator for an insurer without a certificate issued by the Commissioner pursuant to NRS 683A.08524.

2.

A person who acts as a third-party administrator pursuant to chapters 616A to 616D, inclusive, or chapter 617 of NRS shall:

(a) [Administer from one or more offices located in this State all of the claims arising under each plan of insurance that the person administers and maintain in those offices all of the records concerning those claims;

(b)] Administer each plan of insurance directly, without subcontracting with another third-party administrator;

and [(c)] (b) Upon the termination of the person’s contract with an insurer, transfer forthwith to a certified third-party administrator chosen by the insurer all of the records in the person’s possession concerning claims arising under the plan of insurance.

- *AB441_R2* – 7 – 3.

The Commissioner may, under exceptional circumstances, waive the requirements of subsection 2.

Sec.

2.7.

NRS 616B.506 is hereby amended to read as follows:

616B.506 The Commissioner shall impose an administrative fine, not to exceed $1,000 for each violation, and may withdraw the certification of any third-party administrator who:

1.

Fails to comply with regulations of the Commissioner regarding reports or other requirements necessary to carry out the purposes of chapters 616A to 616D, inclusive, or chapter 617 of NRS;

or 2.

Violates any provision of NRS 616B.503 , section 1 of this act or any regulation adopted by the Commissioner or the Administrator concerning the administration of the plan of insurance.

Sec.

(1) The selection of the rating physician or chiropractic physician atin randomrotation from the list of qualified physicians and chiropractic physicians maintained by the Administrator pursuant to subsection 2 of NRS 616C.490;

- *AB441_R2* – 8 – (2) Select a treating physician or chiropractic physician and an alternative treating physician or chiropractic physician in accordance with the provisions of NRS 616C.090;

- *AB441_R1* – 6 – (4) File a complaint with the Administrator;

(a) The panel maintained by the Administrator pursuant to NRS 616C.090 must not include a physician or chiropractic physician in a discipline or specialization if the physician or chiropractic physician does not accept and treat injured employees - *AB441_R2* – 9 – for industrial injuries or occupational diseases in that discipline or specialization;

and (b) An insurer’s list of physicians and chiropractic physicians from which an injured employee may choose pursuant to NRS 616C.090 must include not less than 12 physicians or chiropractic physicians, as applicable, in each of the following disciplines and - *AB441_R1* – 7 – specializations, without limitation, from the panel of physicians and chiropractic physicians maintained by the Administrator pursuant to NRS 616C.090:

- *AB441_R2* – 10 – 4.

- *AB441_R1* – 8 – 5.

- *AB441_R2* – 11 – (c) The physician or chiropractic physician has been convicted of:

(d) The physician or chiropractic physician has been removed from the panel of physicians and chiropractic physicians maintained by the Administrator pursuant to NRS 616C.090 by the - *AB441_R1* – 9 – Administrator upon a finding that the physician or chiropractic physician [has] :

The Administrator shall establish, maintain and update not less frequently than annually on or before July 1 of each year, a panel of physicians and chiropractic physicians who have demonstrated special competence and interest in industrial health to - *AB441_R2* – 12 – treat injured employees under chapters 616A to 616D, inclusive, or chapter 617 of NRS.

- *AB441_R1* – 10 – (c) The legal name of the practice of the physician or chiropractic physician and the name under which the practice does business.

Any request for a change of physician or chiropractic physician must include the name of the - *AB441_R2* – 13 – new physician or chiropractic physician chosen by the injured employee.

Not later than 14 days after receiving the list, the - *AB441_R1* – 11 – injured employee shall select a physician or chiropractic physician from the list.

If a physician or chiropractic physician with that specialization is not available - *AB441_R2* – 14 – pursuant to the terms of the contract, the organization for managed care or the provider of health care may select a physician or chiropractic physician with that specialization.

If the injured employee is not satisfied with the physician or chiropractic physician selected by himself or herself or by the insurer, the organization for managed care or the provider of health - *AB441_R1* – 12 – care pursuant to subsection 4, the injured employee may make an alternative choice of physician or chiropractic physician pursuant to the terms of the contract.

- *AB441_R2* – 15 – (a) Under chapters 616A to 616D, inclusive, or chapter 617 of NRS for industrial injuries or occupational diseases;

or (b) For industrial injuries or occupational diseases in a discipline or specialization for which the physician or chiropractic physician is included on a panel of physicians and chiropractic - *AB441_R1* – 13 – physicians maintained by the Administrator pursuant to this section.

5.5.

NRS 616C.100 is hereby amended to read as follows:

616C.100 1.

If an injured employee disagrees with the percentage of disability determined by a physician or chiropractic physician, the injured employee may obtain a second determination of the percentage of disability.

If the employee wishes to obtain such a determination, the employee must select the [next] physician or chiropractic physician [in rotation] at random from the list of qualified physicians or chiropractic physicians maintained by the Administrator pursuant to subsection 2 of NRS 616C.490.

If a second determination is obtained, the injured employee shall pay for the determination.

If the physician or chiropractic physician selected to make the second determination finds a higher percentage of - *AB441_R2* – 16 – disability than the first physician or chiropractic physician, the injured employee may request a hearing officer or appeals officer to order the insurer to reimburse the employee pursuant to the provisions of NRS 616C.330 or 616C.360.

2.

The results of a second determination made pursuant to subsection 1 may be offered at any hearing or settlement conference.

Sec.

or - *AB441_R1* – 14 – (c) When a hearing or appeal is pending pursuant to NRS 616C.330 or 616C.360.

The injured employee must select the [next]next rating physician or chiropractic physician [inin rotation]rotation at random from the list of qualified physicians and chiropractic physicians maintained by the Administrator pursuant to subsection 2 of NRS 616C.490, unless the - *AB441_R2* – 17 – insurer and the injured employee otherwise agree to a rating physician or chiropractic physician.

- *AB441_R1* – 15 – 8.

- *AB441_R2* – 18 – (a) The name of the claimant or dependent of a claimant to whom the insurer paid the increase in compensation.

- *AB441_R1* – 16 – (a) Not later than 60 days after the date on which the Administrator receives the information required by subsection 1, issue a written determination approving or rejecting the insurer’s request for reimbursement.

If the income realized from the - *AB441_R2* – 19 – investment of the assets in the Account is insufficient to pay such reimbursement, the Administrator must pay the remainder of the reimbursement from the assessments levied by the Administrator pursuant to NRS 232.680.] Administrator’s determination.

- *AB441_R1* – 17 – 8.

- *AB441_R2* – 20 – (a) The name of the widow, widower, surviving child or surviving dependent parent to whom the insurer paid the increase in death benefits.

- *AB441_R1* – 18 – 3.

The Administrator shall, not later than May 31 of each year, mail to each insurer an invoice for any assessment levied by the Administrator pursuant to NRS 232.680 to be used to pay - *AB441_R2* – 21 – reimbursement pursuant to this section.

Upon receipt of the amount of the assessment that is paid after July 31, the Administrator shall - *AB441_R1* – 19 – pay to each insurer, the remaining amount of reimbursement to which the insurer is entitled.

6.8.

NRS 616C.330 is hereby amended to read as follows:

616C.330 1.

The hearing officer shall:

(a) Except as otherwise provided in subsection 2 of NRS 616C.315, within 5 days after receiving a request for a hearing, set the hearing for a date and time within 30 days after his or her receipt of the request at a place in Carson City, Nevada, or Las Vegas, Nevada, or upon agreement of one or more of the parties to pay all additional costs directly related to an alternative location, at any other place of convenience to the parties, at the discretion of the hearing officer;

(b) Give notice by mail or by personal service to all interested parties to the hearing at least 15 days before the date and time scheduled;

and (c) Conduct hearings expeditiously and informally.

2.

The notice must include a statement that the injured employee may be represented by a private attorney or seek - *AB441_R2* – 22 – assistance and advice from the Nevada Attorney for Injured Workers.

3.

If necessary to resolve a medical question concerning an injured employee’s condition or to determine the necessity of treatment for which authorization for payment has been denied, the hearing officer may order an independent medical examination, which must not involve treatment, and refer the employee to a physician or chiropractic physician of his or her choice who has demonstrated special competence to treat the particular medical condition of the employee, whether or not the physician or chiropractic physician is on the insurer’s panel of providers of health care.

If the medical question concerns the rating of a permanent disability, the hearing officer may refer the employee to a rating physician or chiropractic physician.

The rating physician or chiropractic physician must be selected [in rotation] at random from the list of qualified physicians and chiropractic physicians maintained by the Administrator pursuant to subsection 2 of NRS 616C.490, unless the insurer and injured employee otherwise agree to a rating physician or chiropractic physician.

The insurer shall pay the costs of any medical examination requested by the hearing officer.

4.

The hearing officer may consider the opinion of an examining physician, chiropractic physician, physician assistant or advanced practice registered nurse, in addition to the opinion of an authorized treating physician, chiropractic physician, physician assistant or advanced practice registered nurse, in determining the compensation payable to the injured employee.

5.

If an injured employee has requested payment for the cost of obtaining a second determination of his or her percentage of disability pursuant to NRS 616C.100, the hearing officer shall decide whether the determination of the higher percentage of disability made pursuant to NRS 616C.100 is appropriate and, if so, may order the insurer to pay to the employee an amount equal to the maximum allowable fee established by the Administrator pursuant to NRS 616C.260 for the type of service performed, or the usual fee of that physician or chiropractic physician for such service, whichever is less.

6.

The hearing officer shall order an insurer, organization for managed care or employer who provides accident benefits for injured employees pursuant to NRS 616C.265 to pay to the appropriate person the charges of a provider of health care if the conditions of NRS 616C.138 are satisfied.

The hearing officer may allow or forbid the presence of a court reporter and the use of a tape recorder in a hearing.

- *AB441_R2* – 23 – 8.

The hearing officer shall render his or her decision within 15 days after:

(a) The hearing;

or (b) The hearing officer receives a copy of the report from the medical examination the hearing officer requested.

9.

The hearing officer shall render a decision in the most efficient format developed by the Chief of the Hearings Division of the Department of Administration.

10.

The hearing officer shall give notice of the decision to each party by mail.

The hearing officer shall include with the notice of the decision the necessary forms for appealing from the decision.

11.

Except as otherwise provided in NRS 616C.380, the decision of the hearing officer is not stayed if an appeal from that decision is taken unless an application for a stay is submitted by a party.

If such an application is submitted, the decision is automatically stayed until a determination is made on the application.

A determination on the application must be made within 30 days after the filing of the application.

If, after reviewing the application, a stay is not granted by the hearing officer or an appeals officer, the decision must be complied with within 10 days after the refusal to grant a stay.

12.

References to a physician assistant and an advanced practice registered nurse in this section are for the purposes of the examination and treatment of an injured employee which are authorized to be provided by a physician assistant or advanced practice registered nurse in the exclusive context of an initial examination and treatment pursuant to NRS 616C.010.

Sec.

6.9.

NRS 616C.360 is hereby amended to read as follows:

616C.360 1.

A stenographic or electronic record must be kept of the hearing before the appeals officer and the rules of evidence applicable to contested cases under chapter 233B of NRS apply to the hearing.

2.

The appeals officer must hear any matter raised before him or her on its merits, including new evidence bearing on the matter.

3.

If there is a medical question or dispute concerning an injured employee’s condition or concerning the necessity of treatment for which authorization for payment has been denied, the appeals officer may:

(a) Order an independent medical examination and refer the employee to a physician or chiropractic physician of his or her choice who has demonstrated special competence to treat the particular medical condition of the employee, whether or not the physician or chiropractic physician is on the insurer’s panel of providers of health care.

If the medical question concerns the rating of a permanent disability, the appeals officer may refer the - *AB441_R2* – 24 – employee to a rating physician or chiropractic physician.

The rating physician or chiropractic physician must be selected [in rotation] at random from the list of qualified physicians or chiropractic physicians maintained by the Administrator pursuant to subsection 2 of NRS 616C.490, unless the insurer and the injured employee otherwise agree to a rating physician or chiropractic physician.

The insurer shall pay the costs of any examination requested by the appeals officer.

(b) If the medical question or dispute is relevant to an issue involved in the matter before the appeals officer and all parties agree to the submission of the matter to an independent review organization, submit the matter to an independent review organization in accordance with NRS 616C.363 and any regulations adopted by the Commissioner.

4.

The appeals officer may consider the opinion of an examining physician, chiropractic physician, physician assistant or advanced practice registered nurse, in addition to the opinion of an authorized treating physician, chiropractic physician, physician assistant or advanced practice registered nurse, in determining the compensation payable to the injured employee.

5.

If an injured employee has requested payment for the cost of obtaining a second determination of his or her percentage of disability pursuant to NRS 616C.100, the appeals officer shall decide whether the determination of the higher percentage of disability made pursuant to NRS 616C.100 is appropriate and, if so, may order the insurer to pay to the employee an amount equal to the maximum allowable fee established by the Administrator pursuant to NRS 616C.260 for the type of service performed, or the usual fee of that physician or chiropractic physician for such service, whichever is less.

6.

The appeals officer shall order an insurer, organization for managed care or employer who provides accident benefits for injured employees pursuant to NRS 616C.265 to pay to the appropriate person the charges of a provider of health care if the conditions of NRS 616C.138 are satisfied.

7.

Any party to the appeal or contested case or the appeals officer may order a transcript of the record of the hearing at any time before the seventh day after the hearing.

The transcript must be filed within 30 days after the date of the order unless the appeals officer otherwise orders.

8.

Except as otherwise provided in subsection 9, the appeals officer shall render a decision:

(a) If a transcript is ordered within 7 days after the hearing, within 30 days after the transcript is filed;

or - *AB441_R2* – 25 – (b) If a transcript has not been ordered, within 30 days after the date of the hearing.

9.

The appeals officer shall render a decision on a contested claim submitted pursuant to subsection 2 of NRS 616C.345 within 15 days after:

(a) The date of the hearing;

or (b) If the appeals officer orders an independent medical examination, the date the appeals officer receives the report of the examination,  unless both parties to the contested claim agree to a later date.

10.

The appeals officer may affirm, modify or reverse any decision made by a hearing officer and issue any necessary and proper order to give effect to his or her decision.

11.

References to a physician assistant and an advanced practice registered nurse in this section are for the purposes of the examination and treatment of an injured employee which are authorized to be provided by a physician assistant or advanced practice registered nurse in the exclusive context of an initial examination and treatment pursuant to NRS 616C.010.

Sec.

7.

(2) Rating physicians and chiropractic physicians must be selected [in rotation] at random from the list of qualified physicians - *AB441_R2* – 26 – and chiropractic physicians designated by the Administrator [, according to their area of specialization and the order in which their names appear on the list] unless the [next] physician or chiropractic physician who is selected is currently an employee of the insurer making the selection, in which case [the insurer must select the] another random selection must be made until a physician or chiropractic physician [who is next on the list and] who is not currently an employee of the insurer [.] is selected.

Notwithstanding any other provision of law, an injured employee or the legal representative of an injured employee may, at - *AB441_R1* – 20 – any time, without limitation, request that the Administrator select a rating physician or chiropractic physician from the list of qualified physicians and chiropractic physicians designated by the Administrator.

The Administrator, upon receipt of the request, shall immediately select for the injured employee the rating physician or chiropractic physician [whowho is next in rotation on]on atthe randomlist, fromaccording to the listarea .of specialization.

[, according to the area of specialization.] 4.

Except in the case of claims accepted pursuant to NRS 616C.180, no factors - *AB441_R2* – 27 – other than the degree of physical impairment of the whole person may be considered in calculating the entitlement to compensation for a permanent partial disability.

- *AB441_R1* – 21 – (a) Of 0.5 percent of the claimant’s average monthly wage for injuries sustained before July 1, 1981;

- *AB441_R2* – 28 – 13.

- *AB441_R1* – 22 – (1) The number of times the rating physician or chiropractic physician was selected to conduct an evaluation to determine the extent of an employee’s disability;

- *AB441_R2* – 29 – (1) Does not exceed 25 percent may elect to receive his or her compensation in a lump sum.

- *AB441_R1* – 23 – (e) Any claimant injured on or after January 1, 2016, and before July 1, 2017, who incurs a disability that:

Except as - *AB441_R2* – 30 – otherwise provided in paragraph (d), the claimant’s acceptance of that payment constitutes a final settlement of all factual and legal issues in the case.

and (d) The right of the claimant to conclude or resolve any contested matter which is pending at the time that the claimant - *AB441_R1* – 24 – executes his or her election to receive his or her payment for a permanent partial disability in a lump sum.

The present value must be calculated using monthly - *AB441_R2* – 31 – payments in the amounts prescribed in subsection 8 of NRS 616C.490 and actuarial annuity tables adopted by the Division.

- *AB441_R1* – 25 – 8.

- *AB441_R2* – 32 – 3.

A benefit penalty imposed pursuant to NRS 616D.120 must payment is not made within the period required by NRS 616D.120,a the benefit penalty may be recoveredpaid into a civil action brought by the Administrator [on behalf of] or the claimant inon awhose courtbehalf ofit competent jurisdiction in the county in which the claimant resides, in which the violation occurred or in which the person who is requiredimposed. to pay the benefit penalty has his or her principal place of business.

If such a payment is not made within the period required by NRS 616D.120, the benefit penalty may be recovered in a civil action brought by the Administrator [on behalf of] or the claimant in a court of competent - *AB441_R1* – 26 – jurisdiction in the county in which the claimant resides, in which the violation occurred or in which the person who is required to pay the benefit penalty has his or her principal place of business.

(DeletedChapter 684A of NRS is hereby amended by amendment.)adding Sec.thereto a new section to read as follows:

1.

All claims arising under chapters 616A to 616D, inclusive, or chapter 617 of NRS shall be administered by:

(a) A salaried employee of an insurer located in this State;

(b) An adjuster located in or outside this State, who holds a license pursuant to this chapter;

or (c) A person authorized to adjust claims under the authority of a third-party administrator who holds a certificate of registration issued by the Commissioner pursuant to NRS 683A.08524 acting on behalf of an insurer located in or outside this State.

2.

All files relating to a claim filed pursuant to chapters 616A to 616D, inclusive, or chapter 617 of NRS must be made available for inspection:

(a) At the office of an insurer or a third-party administrator located in this State;

or (b) By electronic means.

3.

A person who is not located in this State and who administers a claim pursuant to subsection 1 that is filed by a claimant located in this State shall make himself or herself available to communicate in real time with the claimant or a representative of the claimant Monday through Friday, 9 a.m.

to 5 p.m.

local time in this State, excluding any day declared to be a legal holiday pursuant to NRS 236.015.

4.

The provisions of this section do not apply to:

(a) A self-insured employer, as defined by NRS 616A.305;

(b) An association of self-insured private employers, as defined by NRS 616A.050;

or (c) An association of self-insured public employers, as defined by NRS 616A.055.

Sec.

(DeletedNRS by616B.371 amendment.)is Sec.hereby repealed.

Sec.

Sections 1 to 10.5, inclusive, of this act become effectiveeffective: upon passage and approval for the purpose of adopting any regulations and performing any other preparatory administrative tasks that are necessary to carry out the provisions of this act, and on January 1, 2024, for all other purposes.

H(a) -Upon *AB441_R2*passage and approval for the purpose of adopting any regulations and performing any other preparatory administrative tasks that are necessary to carry out the provisions of this act;

and (b) On January 1, 2024, for all other purposes.

- *AB441_R1* – 27 – TEXT OF REPEALED SECTION financial interest in third-party administrator;

third-party from administrator prohibited from financial interest in association’s administrator;

contractual requirement.

1.

An association’s administrator employed by an association of self-insured public or private employers, or an employee, officer or director of an association’s administrator, may not be an employee, officer or director of a third-party administrator employed by the association or have a direct or indirect financial interest in the third-party administrator of the association.

2.

The third-party administrator of an association of self- insured public or private employers, or an employee, officer or director of the third-party administrator, may not be an employee, association or have a direct or indirect financial interest in thathe association’s administrator.

3.

Any contract entered into by an association of self-insured public or private employers and a third-party administrator must include a provision which states that, unless the Commissioner otherwise provides, the third-party administrator shall administer any claim or other obligation of the association to its conclusion during the period of the contract.

H - *AB441_R1*