Section 616C.088 - File of employees' claims: Maintenance; contents; retention1. Each file of a claim concerning an industrial injury or occupational disease that is maintained by an insurer or third-party administrator must contain:(a) The employer's report of the industrial injury or occupational disease.(b) The claim for compensation and any medical report associated with that claim that is issued after the claim is filed with the insurer.(c) All:(1) Applications for a stay concerning a decision on a claim for compensation made to a hearing officer, appeals officer or a court of competent jurisdiction;(2) Written orders or decisions on a claim for compensation entered by a hearing officer, appeals officer or a court of competent jurisdiction;(3) Written determinations made by an insurer, third-party administrator or an organization for managed care concerning a claim for compensation and, if any determination is sent or served by electronic transmission, proof of a successful transmission of that determination and receipt thereof by the injured employee or any person acting on his or her behalf;(4) Written settlement agreements or stipulations made between the injured employee and his or her employer or the insurer of the employer concerning a claim for compensation; and(5) Except as otherwise provided in subparagraph (2) of paragraph (f), other documents which affect the amount, timing or denial of the payment of compensation. As used in this subparagraph, "payment of compensation" has the meaning ascribed to it in subsection 2 of NAC 616D.305.(d) A record of all compensation paid to the injured employee and all payments made to any other person in connection with the claim, for:(2) Temporary partial disability;(3) Temporary total disability;(4) Permanent partial disability;(5) Permanent total disability;(7) Vocational rehabilitation, and the amount of the expected total incurred costs and the justification.(e) A copy of any notice of termination of benefits which has been sent to the injured employee.(f) Copies of all correspondence and other documents pertaining to the claim, including, without limitation, copies of:(1) All medical bills incurred by the injured employee and received by the insurer; and(2) Any notices sent to the injured employee to inform him or her of the right to a review or appeal, but not including records of any privileged communication between the insurer and its attorney or of any investigation conducted by or on behalf of the insurer concerning a possible violation of NRS 616D.300.(g) All ratings performed by any physician or chiropractic physician.(h) A summary of conversations or oral negotiations, or both, conducted by the insurer or the third-party administrator with the injured employee, the legal counsel who represents the injured employee or any other party other than the physician or chiropractic physician of the injured employee, if action is requested or taken.(i) After the claim is closed, the log of oral communications relating to the medical disposition of a claim that must be maintained by an insurer or third-party administrator pursuant to NRS 616D.330.2. Each file of a claim must be retained for 2 years after the death of the injured employee.Nev. Admin. Code § 616C.088
Added to NAC by Div. of Industrial Insurance Regulation, eff. 10-26-83; A 2-22-88; 8-30-91; A by Div. of Industrial Relations by R167-97, 1-30-98; R098-98, 12-18-98; A by R130-14, eff. 9/9/2016; A by R134-20A, eff. 9/20/2022; Added to NAC by Div. of Industrial Relations by R134-20RA, eff. 12/19/2022; A by R032-21A, eff. 8/1/2023