SB376 - Revises provisions governing industrial insurance. (BDR 53-629)

- 83rd Session (2025) Senate Bill No. 376–Senators Daly and Steinbeck CHAPTER.......... AN ACT relating to industrial insurance; authorizing an injured employee with a claim for an occupational lung disease or occupational heart disease to seek treatment or services from a physician or chiropractic physician which is not on the panel of physicians and chiropractic physicians maintained by the Administrator of the Division of Industrial Relations of the Department of Business and Industry under certain circumstances; setting forth certain requirements for the reimbursement of the costs for such treatment or services; providing for a penalty for failure to comply with those requirements; authorizing certain notices and other documents required in certain hearings or appeals relating to industrial insurance to be provided by means of an electronic filing system; and providing other matters properly relating thereto. Legislative Counsel’s Digest: Existing law establishes the Nevada Industrial Insurance Act and the Nevada Occupational Diseases Act, which provide for the payment of compensation to employees who are injured or disabled as a result of an occupational injury or occupational disease. (Chapters 616A-616D and 617 of NRS) Existing law provides for the payment of compensation for claims for the occupational diseases of lung disease and heart disease for certain firefighters, arson investigators and police officers. (NRS 617.455, 617.457) Existing law requires the Administrator of the Division of Industrial Relations of the Department of Business and Industry to maintain a panel of physicians and chiropractic physicians to treat the injured employees of certain employers under the Nevada Industrial Insurance Act and the Nevada Occupational Diseases Act. (NRS 616C.087, 616C.090) Existing law authorizes an injured employee to choose a treating physician or chiropractic physician from the panel unless the insurer of the injured employee’s employer has entered into certain contracts with an organization for managed care or with providers of health care, in which case the injured employee is required to choose a physician or chiropractic physician in accordance with the provisions of the contract. (NRS 616C.090) Sections 1, 2 and 4 of this bill provide an exception from those requirements to authorize certain injured employees who have filed a claim for the occupational diseases of lung disease or heart disease to seek treatment or other services from a physician or chiropractic physician of his or her own choice, who meets certain other requirements, if the panel of treating physicians or chiropractic physicians maintained by the Administrator contains fewer than 12 physicians or chiropractic physicians in a discipline or specialization appropriate for the treatment of or the provision of other services related to the occupational disease of the injured employee who are accepting new patients and available to make an appointment within 30 days. Sections 2, 4.1 and 4.3 of this bill also provide that the injured employee or certain other persons who pay for the treatment or services may seek full reimbursement for the costs of the treatment or services from the employer of the – 2 – - 83rd Session (2025) injured employee or certain other persons who are obligated to provide applicable coverage or benefits to the injured employee by providing a request for reimbursement, which includes certain specified contents. Section 2 requires a person from whom reimbursement is sought to fully reimburse the requester not later than 30 days after receiving notice of the request for reimbursement. Under section 2, if the person fails to fully reimburse the requester within that time, the Administrator is required to order the person to pay to the requester an amount that is equal to two times the amount of the reimbursement which remains unpaid on the date on which the Administrator issues the order. Sections 3 and 5 of this bill revise provisions of existing law relating to the selection of a treating physician or chiropractic physician to reflect the selection of a physician or chiropractic physician pursuant to section 2. Existing law authorizes an aggrieved party in a contested case relating to industrial insurance to: (1) request a hearing before a hearing officer; and (2) appeal from a decision of a hearing officer or from a determination made by certain parties. (NRS 616C.315, 616C.330, 616C.345, 616C.355) Sections 4.5, 4.7 and 4.9 of this bill authorize certain notices and other documents required in such hearings and appeals to be provided by means of an electronic filing system that complies with the Nevada Electronic Filing and Conversion Rules adopted by the Nevada Supreme Court. EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted. THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS: Section 1. NRS 616B.527 is hereby amended to read as follows: 616B.527 1. A self-insured employer, an association of self- insured public or private employers or a private carrier may: (a) Except as otherwise provided in NRS 616B.5273, enter into a contract or contracts with one or more organizations for managed care to provide comprehensive medical and health care services to employees for injuries and diseases that are compensable pursuant to chapters 616A to 617, inclusive, of NRS. (b) Enter into a contract or contracts with providers of health care, including, without limitation, physicians who provide primary care, specialists, pharmacies, physical therapists, radiologists, nurses, diagnostic facilities, laboratories, hospitals and facilities that provide treatment to outpatients, to provide medical and health care services to employees for injuries and diseases that are compensable pursuant to chapters 616A to 617, inclusive, of NRS. (c) Require employees to obtain medical and health care services for their industrial injuries from those organizations and persons with whom the self-insured employer, association or private carrier has contracted pursuant to paragraphs (a) and (b), or as the – 3 – - 83rd Session (2025) self-insured employer, association or private carrier otherwise prescribes. (d) Except as otherwise provided in subsection 4 of NRS 616C.090 [,] and section 2 of this act, require employees to obtain the approval of the self-insured employer, association or private carrier before obtaining medical and health care services for their industrial injuries from a provider of health care who has not been previously approved by the self-insured employer, association or private carrier. 2. An organization for managed care with whom a self-insured employer, association of self-insured public or private employers or a private carrier has contracted pursuant to this section shall comply with the provisions of NRS 616B.528, 616B.5285 and 616B.529. Sec. 2. Chapter 616C of NRS is hereby amended by adding thereto a new section to read as follows: 1. If an injured employee has filed a claim pursuant to NRS 617.455 or 617.457 and, at the time the claim is filed, the panel of physicians or chiropractic physicians maintained by the Administrator pursuant to NRS 616C.090 contains fewer than 12 physicians or chiropractic physicians in a discipline or specialization appropriate for the treatment of or the provision of other services relating to the occupational disease of the injured employee who are accepting new patients and are available to meet with the injured employee within 30 days after the date on which the injured employee first contacts the physician or chiropractic physician to request an appointment, the injured employee may seek treatment or other services related to the occupational disease of the injured employee from a physician or chiropractic physician of his or her choice selected in accordance with subsection 2. 2. An injured employee may select a physician or chiropractic physician of his or her choice pursuant to subsection 1 from a list of all physicians or chiropractic physicians in the relevant discipline or specialization who have entered into a contract with an organization for managed care, under a health benefit plan or otherwise with a health insurer or casualty insurer of the employer of the injured employee, whether or not the physician or chiropractic physician has specifically contracted to provide treatment or other services to employees for injuries and diseases that are compensable pursuant to chapters 616A to 617, inclusive, of NRS, or been previously approved pursuant to NRS 616B.527. 3. If an injured employee seeks treatment or services pursuant to subsection 1, the treatment or services may be paid for – 4 – - 83rd Session (2025) by the injured employee or a health insurer or casualty insurer on behalf of the injured employee. 4. Full reimbursement of the amount paid by: (a) The injured employee who paid for his or her own treatment or services; or (b) A health insurer or casualty insurer who paid for treatment or services on behalf of the injured employee,  pursuant to subsection 3 may be sought by the injured employee, health insurer or casualty insurer, as applicable, from the employer of the injured employee or an insurer, organization for managed care or third-party administrator, as applicable, who is obligated to provide applicable coverage or benefits to the injured employee. 5. To seek reimbursement as described in subsection 4, the injured employee, health insurer or casualty insurer must submit a request for reimbursement to the employer of the injured employee or the employer’s insurer, organization for managed care or third- party administrator, as applicable. The request for reimbursement must include, without limitation: (a) The identity of the injured employee for whom the costs of treatment and services was paid. (b) A description of the treatment and services provided to the injured employee. (c) The identity of the person who paid for the treatment and services for the injured employee. (d) The costs of treatment and services for which reimbursement is being requested. 6. Not later than 30 days after receipt of a request for reimbursement submitted pursuant to subsection 5, the employer of the injured employee or the employer’s insurer, organization for managed care or third-party administrator, as applicable, from whom reimbursement is sought shall fully reimburse the injured employee, health insurer or casualty insurer, as applicable, who paid for treatment and services on behalf of the injured employee for the amount paid for the treatment or services as set forth in the request for reimbursement. 7. If the Administrator determines that an insurer, organization for managed care or third-party administrator has failed to fully reimburse an injured employee, health insurer or casualty insurer, as applicable, within the time required by subsection 6, the Administrator shall order the insurer, organization for managed care or third-party administrator to pay to the injured employee, health insurer or casualty insurer, as – 5 – - 83rd Session (2025) applicable, an amount equal to two times the amount of reimbursement that remains unpaid on the date on which the Administrator issues the order. 8. Any amount ordered by the Administrator to be paid pursuant to subsection 7 is in addition to any amounts for: (a) Benefits to which the injured employee is entitled under the claim for the occupational disease set forth in NRS 617.455 or 617.457, as applicable; and (b) Any fines and penalties imposed by the Administrator pursuant to NRS 616D.120. 9. As used in this section: (a) “Casualty insurer” means an 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 an insurer or other organization providing health coverage or benefits in accordance with state or federal law. Sec. 3. NRS 616C.050 is hereby amended to read as follows: 616C.050 1. An insurer shall provide to each claimant: (a) Upon written request, one copy of any medical information concerning the claimant’s injury or illness. (b) A statement which contains information concerning the claimant’s right to: (1) Receive the information and forms necessary to file a claim; (2) Select a treating physician or chiropractic physician and an alternative treating physician or chiropractic physician in accordance with the provisions of NRS 616C.090 [;] and section 2 of this act; (3) Request the appointment of the Nevada Attorney for Injured Workers to represent the claimant before the appeals officer; (4) File a complaint with the Administrator; (5) When applicable, receive compensation for: (I) Permanent total disability; (II) Temporary total disability; (III) Permanent partial disability; (IV) Temporary partial disability; (V) All medical costs related to the claimant’s injury or disease; or – 6 – - 83rd Session (2025) (VI) The hours the claimant is absent from the place of employment to receive medical treatment pursuant to NRS 616C.477; (6) Receive services for rehabilitation if the claimant’s injury prevents him or her from returning to gainful employment; (7) Review by a hearing officer of any determination or rejection of a claim by the insurer within the time specified by statute; and (8) Judicial review of any final decision within the time specified by statute. 2. The insurer’s statement must include a copy of the form designed by the Administrator pursuant to subsection 12 of NRS 616C.090 that notifies injured employees of their right to select an alternative treating physician or chiropractic physician. The Administrator shall adopt regulations for the manner of compliance by an insurer with the other provisions of subsection 1. Sec. 4. NRS 616C.090 is hereby amended to read as follows: 616C.090 1. The Administrator shall establish, maintain and update not less frequently than annually on or before July 1 of each year, a panel of physicians and chiropractic physicians who have demonstrated special competence and interest in industrial health to treat injured employees under chapters 616A to 616D, inclusive, or chapter 617 of NRS. The Adminis [Text truncated for display. Full text available on LegiScan.]