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Nevada Injury Law

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Las Vegas Injury Lawyer





Vegas Law

number of cases affirmed, reversed, remanded and resolved by other disposition involving that insurer or third-party administrator, including a breakdown of that information by the type of benefits denied by the insurer or third-party administrator. 3. As used in this section, “Chief of the Hearings Division” means the Chief of the Hearings Division of the Department of Administration. (Added to NRS by 1991, 2396; A 2005, 101) NRS 616C.300 Hearing officers: Appointment; salary; disqualification from particular case. 1. The Director of the Department of Administration shall appoint one or more hearing officers to conduct hearings in contested cases for compensation under chapters 616A to 617, inclusive, of NRS. Each hearing officer shall serve at the pleasure of the Director of the Department of Administration. Each hearing officer is entitled to receive an annual salary in an amount provided by law and is in the unclassified service of the State. 2. If a hearing officer determines that he has a personal interest or a conflict of interest, directly or indirectly, in any case which is before him, he shall disqualify himself from hearing the case and the case must be assigned to another hearing officer. (Added to NRS by 1993, 669)—(Substituted in revision for NRS 616.184) NRS 616C.305 Procedure for appeal of final determination of organization for managed care which has contracted with insurer. 1. Except as otherwise provided in subsection 3, any person who is aggrieved by a final determination concerning accident benefits made by an organization for managed care which has contracted with an insurer must, within 14 days of the determination and before requesting a resolution of the dispute pursuant to NRS 616C.345 to 616C.385, inclusive, appeal that determination in accordance with the procedure for resolving complaints established by the organization for managed care. 2. The procedure for resolving complaints established by the organization for managed care must be informal and must include, but is not limited to, a review of the appeal by a qualified physician or chiropractor who did not make or otherwise participate in making the determination. 3. If a person appeals a final determination pursuant to a procedure for resolving complaints established by an organization for managed care and the dispute is not resolved within 14 days after it is submitted, he may request a resolution of the dispute pursuant to NRS 616C.345 to 616C.385, inclusive. (Added to NRS by 1993, 691; A 1993, 2452; 1995, 2149; 1999, 2216) NRS 616C.310 Procedures to be adopted by Chief of Hearings Division; representation of insurer or employer. [Effective through December 31, 2006.] 1. The Chief of the Hearings Division of the Department of Administration: (a) May by regulation provide for specific procedures for the determination of contested cases. (b) Shall develop a format to be used by hearing officers to indicate their findings in contested cases. 2. An insurer or employer may be represented in a contested case by private legal counsel or by any other agent. (Added to NRS by 1973, 1596; A 1975, 761; 1977, 1389; 1979, 1042; 1985, 50; 1991, 2417)—(Substituted in revision for NRS 616.541) NRS 616C.310 Contested cases: Procedures; format; redaction of personal identifying information; representation of insurer or employer by legal counsel or other agent. [Effective January 1, 2007.] 1. The Chief of the Hearings Division of the Department of Administration: (a) May by regulation provide for specific procedures for the determination of contested cases. (b) Shall develop a format to be used by hearing officers to indicate their findings in contested cases. (c) Shall adopt regulations to provide for the redaction of personal identifying information of a person filing a claim for compensation from a document relating to the contested case of the person, unless the identity of the person is at issue. As used in this paragraph, “personal identifying information” means any information which would identify a person, including, without limitation, an address, a birth date or a social security number. 2. An insurer or employer may be represented in a contested case by private legal counsel or by any other agent. (Added to NRS by 1973, 1596; A 1975, 761; 1977, 1389; 1979, 1042; 1985, 50; 1991, 2417; 2005, 2511; 2005, 22nd Special Session, 97, effective January 1, 2007) NRS 616C.315 Request for hearing; forms for request to be provided by insurer; prerequisites to scheduling of hearing; expeditious and informal hearing required; direct submission to appeals officer. 1. Any person who is subject to the jurisdiction of the hearing officers pursuant to chapters 616A to 616D, inclusive, or chapter 617 of NRS may request a hearing before a hearing officer of any matter within the hearing officer’s authority. The insurer shall provide, without cost, the forms necessary to request a hearing to any person who requests them. 2. A hearing must not be scheduled until the following information is provided to the hearing officer: (a) The name of: (1) The claimant; (2) The employer; and (3) The insurer or third-party administrator; (b) The number of the claim; and (c) If applicable, a copy of the letter of determination being appealed or, if such a copy is unavailable, the date of the determination and the issues stated in the determination. 3. Except as otherwise provided in NRS 616B.772, 616B.775, 616B.787 and 616C.305, a person who is aggrieved by: (a) A written determination of an insurer; or (b) The failure of an insurer to respond within 30 days to a written request mailed to the insurer by the person who is aggrieved, may appeal from the determination or failure to respond by filing a request for a hearing before a hearing officer. Such a request must include the information required pursuant to subsection 2 and must be filed within 70 days after the date on which the notice of the insurer’s determination was mailed by the insurer or the unanswered written request was mailed to the insurer, as applicable. The failure of an insurer to respond to a written request for a determination within 30 days after receipt of such a request shall be deemed by the hearing officer to be a denial of the request. 4. Failure to file a request for a hearing within the period specified in subsection 3 may be excused if the person aggrieved shows by a preponderance of the evidence that he did not receive the notice of the determination and the forms necessary to request a hearing. The claimant or employer shall notify the insurer of a change of address. 5. The hearing before the hearing officer must be conducted as expeditiously and informally as is practicable. 6. The parties to a contested claim may, if the claimant is represented by legal counsel, agree to forego a hearing before a hearing officer and submit the contested claim directly to an appeals officer. (Added to NRS by 1979, 1040; A 1981, 1490; 1983, 1294; 1985, 668; 1991, 834, 2417; 1993, 736; 1999, 3380; 2001, 2256; 2003, 2333) NRS 616C.320 Resolution of disputed decision of self-insured employer or employer who is member of association of self-insured public or private employers or insured by private carrier. If an employee of a self-insured employer, an employer who is a member of an association of self-insured public or private employers or an employer insured by a private carrier is dissatisfied with a decision of his employer, the association or the private carrier, he may seek to resolve the dispute pursuant to NRS 616C.305 and 616C.315 to 616C.385, inclusive. (Added to NRS by 1979, 1039; A 1993, 737; 1995, 2032) NRS 616C.325 Representation of employee and employer before hearings officer or appeals officer or

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