payment has contracted with an organization for managed care or with providers of health care pursuant to NRS 616B.527, the amount that is allowed for the treatment or other services under that contract. 2. The provisions of subsection 1: (a) Apply only to treatment or other services provided by the provider of health care before the date on which the insurer, organization for managed care, third-party administrator or employer who provides accident benefits first denies authorization or responsibility for payments for the alleged industrial injury or occupational disease. (b) Do not apply to a provider of health care that is a hospital as defined in NRS 439B.110. The provisions of this paragraph do not exempt the provider of health care from complying with the provisions of subsections 3 and 4. 3. If: (a) The injured employee pays for the treatment or other services or a health or casualty insurer pays for the treatment or other services on behalf of the injured employee; (b) The injured employee requests a hearing before a hearing officer or appeals officer regarding the denial of coverage; and (c) The hearing officer or appeals officer ultimately determines that the treatment or other services should have been covered, or the insurer, organization for managed care, third-party administrator or employer who provides accident benefits subsequently accepts responsibility for payment, the hearing officer or appeals officer shall order the insurer, organization for managed care, third-party administrator or employer who provides accident benefits to pay to the injured employee or the health or casualty insurer the amount which the injured employee or the health or casualty insurer paid that is allowed for the treatment or other services set forth in the schedule of fees and charges established pursuant to NRS 616C.260 or, if the insurer has contracted with an organization for managed care or with providers of health care pursuant to NRS 616B.527, the amount that is allowed for the treatment or other services under that contract. 4. If the injured employee or the health or casualty insurer paid the provider of health care any amount in excess of the amount that the provider would have been entitled to be paid pursuant to this section, the injured employee or the health or casualty insurer is entitled to recover the excess amount from the provider. Within 30 days after receiving notice of such an excess amount, the provider of health care shall reimburse the injured employee or the health or casualty insurer for the excess amount. 5. As used in this section: (a) “Casualty insurer” means any insurer or other organization providing coverage or benefits under a policy or contract of casualty insurance in the manner described in subsection 2 of NRS 681A.020. (b) “Health benefit plan” means any type of policy, contract, agreement or plan providing health coverage or benefits in accordance with state or federal law. (c) “Health insurer” means any insurer or other organization providing health coverage or benefits in accordance with state or federal law. (Added to NRS by 2001, 1892; A 2005, 237, 1266) NRS 616C.140 Medical examination of claimant; effect of refusal to submit to examination; communications not privileged. 1. Any employee who is entitled to receive compensation under chapters 616A to 616D, inclusive, of NRS shall, if: (a) Requested by the insurer or employer; or (b) Ordered by an appeals officer or a hearing officer, submit himself for medical examination at a time and from time to time at a place reasonably convenient for the employee, and as may be provided by the regulations of the Division. 2. If the insurer has reasonable cause to believe that an injured employee who is receiving compensation for a permanent total disability is no longer disabled, the insurer may request the employee to submit to an annual medical examination to determine whether the disability still exists. The insurer shall pay the costs of the examination. 3. The request or order for an examination must fix a time and place therefor, with due regard for the nature of the medical examination, the convenience of the employee, his physical condition and his ability to attend at the time and place fixed. 4. The employee is entitled to have a physician or chiropractor, provided and paid for by him, present at any such examination. 5. If the employee refuses to submit to an examination ordered or requested pursuant to subsection 1 or 2 or obstructs the examination, his right to compensation is suspended until the examination has taken place, and no compensation is payable during or for the period of suspension. 6. Any physician or chiropractor who makes or is present at any such examination may be required to testify as to the result thereof. [67:168:1947; 1943 NCL § 2680.67] + [68:168:1947; 1943 NCL § 2680.68]—(NRS A 1975, 763; 1977, 314; 1979, 1054; 1981, 1169, 1197, 1489, 1830; 1985, 1546; 1993, 735, 1869; 1995, 579; 1997, 1394) DETERMINATION AND PAYMENT OF BENEFITS NRS 616C.150 Compensation prohibited unless preponderance of evidence establishes that injury arose out of and in course of employment; rebuttable presumption if notice of injury is filed after termination of employment. 1. An injured employee or his dependents are not entitled to receive compensation pursuant to the provisions of chapters 616A to 616D, inclusive, of NRS unless the employee or his dependents establish by a preponderance of the evidence that the employee’s injury arose out of and in the course of his employment. 2. For the purposes of chapters 616A to 616D, inclusive, of NRS, if the employee files a notice of an injury pursuant to NRS 616C.015 after his employment has been terminated for any reason, there is a rebuttable presumption that the injury did not arise out of and in the course of his employment. (Added to NRS by 1993, 662)—(Substituted in revision for NRS 616.5015) NRS 616C.155 Payment of compensation by insurer prohibited before required; recovery of overpayment by insurer. 1. An insurer shall not provide compensation to or for an employee or his dependents before the compensation is required to be paid pursuant to the provisions of chapters 616A to 616D, inclusive, of NRS. 2. If, within 30 days after a payment is made to an injured employee pursuant to the provisions of chapters 616A to 616D, inclusive, of NRS, the insurer determines that it has overpaid the injured employee as a result of a clerical error in its calculation of the amount of payment, or as a result of using improper or incorrect information to determine the injured employee’s eligibility for payment or to calculate the amount of payment, the insurer may deduct the amount of the overpayment from future benefits related to that claim to which the injured employee is entitled, other than accident benefits, if: (a) The insurer notifies the injured employee in writing of its determination; (b) The insurer informs the injured employee of his right to contest the deduction; and (c) The injured employee fails to contest the deduction or does so and upon final resolution of the contested deduction, it is determined that such an overpayment was made. 3. Any deductions made pursuant to subsection 2 must be made in a reasonable manner which does not cause undue hardship to the injured employee. (Added to NRS by 1993, 662)—(Substituted in revision for NRS 616.5017) NRS 616C.157 Request for prior authorization: Time to respond; effect of failure to respond in timely manner. 1. An insurer, organization for managed care or third-party administrator shall respond to a written request for prior authorization for: (a) Treatment; (b) Diagnostic testing; or (c) Consultation, within 5 working days after receiving the written request.

Vegas Law