Section 616C.091 - Notice of determination to accept or deny claim1. After receipt of a claim for compensation, the insurer or third-party administrator shall give written notice of its determination to accept or deny the claim to the injured employee, the attorney or other authorized representative of the injured employee or his or her dependents and, if the injured employee's employer is not self-insured, to the injured employee's employer.2. If the insurer or third-party administrator denies the claim in whole or in part: (a) The insurer or third-party administrator shall, pursuant to NRS 616C.065, notify the Administrator of the denial.(b) The notice of denial to the injured employee, the attorney or other authorized representative of the injured employee or his or her dependents must include: (1) A written statement of the right to request a hearing on the matter before a hearing officer and a form for requesting a hearing; and(2) A specific statement of the reasons for the denial of the claim.(c) The insurer or third-party administrator shall provide a copy of each notice of denial it gives pursuant to paragraph (b) to:(1) The physician, chiropractic physician, physician assistant or advanced practice registered nurse who provided an examination and treatment of the injured employee in the context of an initial examination and treatment pursuant to NRS 616C.010; and(2) The injured employee's treating physician or chiropractic physician.(d) The notice of denial required to be given to the Administrator pursuant to paragraph (a) must include: (1) A copy of the notice of denial given to the injured employee, the attorney or other authorized representative of the injured employee or his or her dependents; and(2) A copy of Form C-4, Employee's Claim for Compensation/Report of Initial Treatment, that was completed by the injured employee or his or her dependents.3. If the insurer or third-party administrator accepts the claim, the notice of acceptance provided to the injured employee, the attorney or other authorized representative of the injured employee or his or her dependents must include: (a) Written notice of acceptance of the claim;(b) A copy of Form D-53, Alternative Choice of Physician or Chiropractor; and(c) Either: (1) If established and available, the Internet address of the website of the insurer or third-party administrator at which the injured employee, the attorney or other authorized representative of the injured employee or his or her dependents can obtain a list of providers of health care who are authorized to provide health care services to the injured employee; or(2) Notification that, pursuant to NAC 616C.030, the injured employee, the attorney or other authorized representative of the injured employee, his or her dependents or the treating physician or chiropractic physician of the injured employee may, upon written request, obtain a list of providers of health care who are authorized to provide health care services to the injured employee.4. A written notice of determination issued by an insurer or third-party administrator must include: (b) The name of the employer;(c) The name of the insurer;(d) The name of the third-party administrator, if applicable;(e) The date of the injury;(f) The date of the written notice of determination;(g) Notice that the injured employee may, pursuant to subsection 1 or 3 of NRS 616C.315, request a hearing or appeal the determination within 70 days after the determination is issued by the insurer; and(h) The addresses of the offices of the Hearings Division of the Department of Administration located in Carson City and Las Vegas.Nev. Admin. Code § 616C.091
Added to NAC by Div. of Industrial Insurance Regulation, eff. 10-26-83; A 6-29-84; 2-22-88; 8-30-91; A by Div. of Industrial Relations by R006-97, 12-9-97; R098-98, 12-18-98; R105-00, 1-18-2001, eff. 3-1-2001; A by R130-14, eff. 9/9/2016; A by R032-21A, eff. 8/1/2023