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2. If the insurer, organization for managed care or third-party administrator fails to respond to such a request within 5 working days, authorization shall be deemed to be given. The insurer, organization for managed care or third-party administrator may subsequently deny authorization.
3. If the insurer, organization for managed care or third-party administrator subsequently denies a request for authorization submitted by a provider of health care for additional visits or treatments, it shall pay for the additional visits or treatments actually provided to the injured employee, up to the number of treatments for which payment is requested by the provider of health care before the denial of authorization is received by the provider.
(Added to NRS by 1999, 2214)
NRS 616C.160 Newly developed injury or disease: Inclusion in original claim for compensation; limitation. If, after a claim for compensation is filed pursuant to NRS 616C.020:
1. The injured employee seeks treatment from a physician or chiropractor for a newly developed injury or disease; and
2. The employee’s medical records for the injury reported do not include a reference to the injury or disease for which treatment is being sought, or there is no documentation indicating that there was possible exposure to an injury described in paragraph (b), (c) or (d) of subsection 2 of NRS 616A.265,
the injury or disease for which treatment is being sought must not be considered part of the employee’s original claim for compensation unless the physician or chiropractor establishes by medical evidence a causal relationship between the injury or disease for which treatment is being sought and the original accident.
(Added to NRS by 1993, 663; A 1999, 2447; 2001, 1016)
NRS 616C.165 Determination of responsibility of insurer for undisputed claim for compensation; reimbursement of insurer initially providing compensation to injured employee. If responsibility for an undisputed claim for compensation by an injured employee is contested, the insurer to which the employee first submits the claim is responsible for providing the required compensation to the employee pending final resolution of the issue regarding which insurer is responsible for the claim. If the insurer that initially provides compensation to the injured employee is not held responsible for payment of the claim, the insurer that is held responsible shall reimburse that insurer within 30 days after final resolution of the issue of responsibility for payment of the claim.
(Added to NRS by 1995, 2122)
NRS 616C.170 Resolution of disputes between insurers if benefits are claimed against more than one insurer; adoption of regulations by Administrator; appeal of decision of Administrator; payment of benefits until determination of responsibility by Administrator.
1. The Administrator shall resolve any disputes between insurers if an injured employee claims benefits against more than one insurer.
2. The Administrator shall adopt regulations concerning the resolution of disputes between insurers regarding benefits to be paid to any injured employee.
3. If the insurer or the employee is dissatisfied with the decision of the Administrator, the dissatisfied party may request a hearing before an appeals officer.
4. Until the Administrator has determined which insurer is responsible for a claim, the current insurer of the employer shall pay benefits to the claimant pursuant to chapters 616A to 617, inclusive, of NRS. Payments made by an insurer pursuant to this subsection are not an admission of liability for the claim or any portion of the claim.
(Added to NRS by 1995, 2002)
NRS 616C.175 Employment-related aggravation of preexisting condition which is not employment related; aggravation of employment-related injury by incident which is not employment related.
1. The resulting condition of an employee who:
(a) Has a preexisting condition from a cause or origin that did not arise out of or in the course of his current or past employment; and
(b) Subsequently sustains an injury by accident arising out of and in the course of his employment which aggravates, precipitates or accelerates his preexisting condition,
shall be deemed to be an injury by accident that is compensable pursuant to the provisions of chapters 616A to 616D, inclusive, of NRS, unless the insurer can prove by a preponderance of the evidence that the subsequent injury is not a substantial contributing cause of the resulting condition.
2. The resulting condition of an employee who:
(a) Sustains an injury by accident arising out of and in the course of his employment; and
(b) Subsequently aggravates, precipitates or accelerates the injury in a manner that does not arise out of and in the course of his employment,
shall be deemed to be an injury by accident that is compensable pursuant to the provisions of chapters 616A to 616D, inclusive, of NRS, unless the insurer can prove by a preponderance of the evidence that the injury described in paragraph (a) is not a substantial contributing cause of the resulting condition.
(Added to NRS by 1993, 663; A 1995, 2147; 1999, 1777)
NRS 616C.177 Medical records concerning preexisting condition: Authority of insurer to request records; injured employee required to release records under certain circumstances.
1. An insurer may inquire about and request medical records of an injured employee that concern a preexisting medical condition that is reasonably related to the industrial injury of that injured employee.
2. An injured employee must sign all medical releases necessary for the insurer of his employer to obtain information and records about a preexisting medical condition that is reasonably related to the industrial injury of the employee and that will assist the insurer to determine the nature and amount of workers’ compensation to which the employee is entitled.
(Added to NRS by 1999, 1775)
NRS 616C.180 Injury or disease caused by stress.
1. Except as otherwise provided in this section, an injury or disease sustained by an employee that is caused by stress is compensable pursuant to the provisions of chapters 616A to 616D, inclusive, or chapter 617 of NRS if it arose out of and in the course of his employment.
2. Any ailment or disorder caused by any gradual mental stimulus, and any death or disability ensuing therefrom, shall be deemed not to be an injury or disease arising out of and in the course of employment.
3. An injury or disease caused by stress shall be deemed to arise out of and in the course of employment only if the employee proves by clear and convincing medical or psychiatric evidence that:
(a) He has a mental injury caused by extreme stress in time of danger;
(b) The primary cause of the injury was an event that arose out of and during the course of his employment; and
(c) The stress was not caused by his layoff, the termination of his employment or any disciplinary action taken against him.
4. The provisions of this section do not apply to a person who is claiming compensation pursuant to NRS 617.457.
(Added to NRS by 1993, 663; A 1993, 2445)—(Substituted in revision for NRS 616.5019)
NRS 616C.185 Compensation for mastectomy and reconstructive surgery.
1. If compensation is paid to an employee under chapters 616A to 616D, inclusive, of NRS for the surgical procedure known as a mastectomy, the employee is also entitled to receive commensurate compensation for at least two prosthetic devices and for reconstructive surgery incident to the mastectomy. Except as otherwise provided in subsection 2, this compensation is subject to the same requirements and conditions that apply to the compensation for the mastectomy.
2. If reconstructive surgery is begun within 3 years after a mastectomy, the amount of the compensation provided for that surgery mu
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