oyer fails to provide mandatory coverage required by the provisions of chapters 616A to 616D, inclusive, of NRS. (Added to NRS by 1975, 599; A 1981, 1197, 1830; 1991, 2408; 1993, 716, 1863; 1995, 579; 1997, 1436; 1999, 1726; 2001, 2739, 2767; 2003, 195, 2306) NRS 616C.225 Misrepresentation or concealment of fact to obtain benefits: Insurer entitled to reimbursement or deduction from benefits; appeal of determination; alternative remedies. 1. Except as otherwise provided in this section, if an insurer determines that an employee has knowingly misrepresented or concealed a material fact to obtain any benefit or payment under the provisions of chapters 616A to 616D, inclusive, of NRS, the insurer may deduct from any benefits or payments due to the employee, the amount obtained by the employee because of the misrepresentation or concealment of a material fact. The employee shall reimburse the insurer for all benefits or payments received because of the willful misrepresentation or concealment of a material fact. 2. An employee who is aggrieved by a determination of an insurer made pursuant to subsection 1 may appeal that determination pursuant to NRS 616C.315 to 616C.385, inclusive. If the final decision by an appeals officer is favorable to the employee, the Administrator shall order the insurer to pay $2,000 to that employee, in addition to any benefits or payments the employee is entitled to receive, if the Administrator determines that the insurer had no reasonable basis for believing that the employee knowingly misrepresented or concealed a material fact to obtain any benefit or payment. 3. If an employee elects to receive his award for a permanent partial disability in a lump sum pursuant to NRS 616C.495 and a criminal action is brought against the employee for an alleged violation of NRS 616D.300, the insurer shall, upon receiving notice of the action and until a judgment is entered in the action, pay reasonable portions of the lump-sum award in monthly installments. If the employee is not convicted of the alleged violation, the insurer shall pay the employee the balance of the award in a lump sum. The provisions of subsection 2 do not apply to require any additional payment at the conclusion of a criminal action. 4. This section does not preclude an insurer from making an investigation pursuant to, or pursuing the remedies provided by, NRS 616D.300. (Added to NRS by 1989, 1993; A 1993, 745; 1995, 1873)—(Substituted in revision for NRS 616.563) NRS 616C.230 Grounds for denial, reduction or suspension of compensation; evidence of and examination for use of alcohol or controlled substance. 1. Compensation is not payable pursuant to the provisions of chapters 616A to 616D, inclusive, or chapter 617 of NRS for an injury: (a) Caused by the employee’s willful intention to injure himself. (b) Caused by the employee’s willful intention to injure another. (c) Proximately caused by the employee’s intoxication. If the employee was intoxicated at the time of his injury, intoxication must be presumed to be a proximate cause unless rebutted by evidence to the contrary. (d) Proximately caused by the employee’s use of a controlled substance. If the employee had any amount of a controlled substance in his system at the time of his injury for which the employee did not have a current and lawful prescription issued in his name or that he was not using in accordance with the provisions of chapter 453A of NRS, the controlled substance must be presumed to be a proximate cause unless rebutted by evidence to the contrary. 2. For the purposes of paragraphs (c) and (d) of subsection 1: (a) The affidavit or declaration of an expert or other person described in NRS 50.315 is admissible to prove the existence of any alcohol or the existence, quantity or identity of a controlled substance in an employee’s system. If the affidavit or declaration is to be so used, it must be submitted in the manner prescribed in NRS 616C.355. (b) When an examination requested or ordered includes testing for the use of alcohol or a controlled substance, the laboratory that conducts the testing must be licensed pursuant to the provisions of chapter 652 of NRS. 3. No compensation is payable for the death, disability or treatment of an employee if his death is caused by, or insofar as his disability is aggravated, caused or continued by, an unreasonable refusal or neglect to submit to or to follow any competent and reasonable surgical treatment or medical aid. 4. If any employee persists in an unsanitary or injurious practice that imperils or retards his recovery, or refuses to submit to such medical or surgical treatment as is necessary to promote his recovery, his compensation may be reduced or suspended. 5. An injured employee’s compensation, other than accident benefits, must be suspended if: (a) A physician or chiropractor determines that the employee is unable to undergo treatment, testing or examination for the industrial injury solely because of a condition or injury that did not arise out of and in the course of his employment; and (b) It is within the ability of the employee to correct the nonindustrial condition or injury. The compensation must be suspended until the injured employee is able to resume treatment, testing or examination for the industrial injury. The insurer may elect to pay for the treatment of the nonindustrial condition or injury. [70:168:1947; 1943 NCL § 2680.70] + [71:168:1947; 1943 NCL § 2680.71] + [72:168:1947; 1943 NCL § 2680.72]—(NRS A 1979, 1057; 1981, 1198; 1991, 2421; 1993, 745; 1995, 2153; 1997, 1394, 1421; 1999, 224, 442, 2215; 2001, 3072) NRS 616C.235 Closure of claim by insurer: Procedure; notice; special procedure if medical benefits less than $300. 1. Except as otherwise provided in subsections 2, 3 and 4: (a) When the insurer determines that a claim should be closed before all benefits to which the claimant may be entitled have been paid, the insurer shall send a written notice of its intention to close the claim to the claimant by first-class mail addressed to the last known address of the claimant. The notice must include a statement that if the claimant does not agree with the determination, he has a right to request a resolution of the dispute pursuant to NRS 616C.305 and 616C.315 to 616C.385, inclusive. A suitable form for requesting a resolution of the dispute must be enclosed with the notice. The closure of a claim pursuant to this subsection is not effective unless notice is given as required by this subsection. (b) If the insurer does not receive a request for the resolution of the dispute, it may close the claim. (c) Notwithstanding the provisions of NRS 233B.125, if a hearing is conducted to resolve the dispute, the decision of the hearing officer may be served by first-class mail. 2. If, during the first 12 months after a claim is opened, the medical benefits required to be paid for a claim are less than $300, the insurer may close the claim at any time after he sends, by first-class mail addressed to the last known address of the claimant, written notice that: (a) The claim is being closed pursuant to this subsection; (b) The injured employee may appeal the closure of the claim pursuant to the provisions of NRS 616C. 305 and 616C.315 to 616C.385, inclusive; and (c) If the injured employee does not appeal the closure of the claim or appeals the closure of the claim but is not successful, the claim cannot be reopened. 3. In addition to the notice described in subsection 2, an insurer shall send to each claimant who receives less than $300 in medical benefits within 6 months after the claim is opened a written notice that explains the circumstances under which a claim may be closed pursuant to subsection 2. The written notice provided pursuant to this subsection does not create any right to appeal the contents of that notice. The

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