Claims Kit

Physician Selection   NRS 616C.090

The Administrator must establish a panel of physicians and chiropractors to treat injured employees. Every employer whose insurer has not entered into a contract with an organization for managed care or with providers of health care services must maintain a list of those physicians and chiropractors on the panel who are reasonably accessible to his employees.

Insurers may use a managed care organization (MCO), preferred provider organization (PPO), health maintenance organization (HMO) or the insurance company's internal managed care unit. An injured employee whose employer's insurer has entered into a contract with an organization for managed care or with providers of health care services must choose his treating physician or chiropractor pursuant to the terms of that contract. If the injured employee is not satisfied with the first physician or chiropractor he so chooses, he may make an alternative choice of physician or chiropractor pursuant to the terms of the contract  without the approval of the insurer if the choice is made within 90 days after his injury. 

 An injured employee whose employer's insurer has not entered into a contract with an organization for managed care or with providers of health care services pursuant to NRS 616B.527 may choose a treating physician or chiropractor from the panel of physicians and chiropractors. If the injured employee is not satisfied with the first physician or chiropractor he or she chooses, the injured employee may make an alternative choice of physician or chiropractor from the panel if the choice is made within 90 days after his or her injury. 

 An injured employee whose employer’s insurer has entered into a contract with an organization for managed care or with providers of health care pursuant to NRS 616B.527 must choose a treating physician or chiropractor pursuant to the terms of that contract. If the injured employee is not satisfied with the first physician or chiropractor he or she so chooses, the injured employee may make an alternative choice of physician or chiropractor pursuant to the terms of the contract without the approval of the insurer if the choice is made within 90 days after his or her injury. 

Reporting of Claim by Employer NRS 616C.045

Within 6 working days after the receipt of a claim for compensation from a physician or chiropractor, or a medical facility  if the duty to file the claim for compensation has been delegated to the medical facility , an employer must complete and file with his or her insurer or third-party administrator an employer's report of industrial injury or occupational disease.Form C3 Employers Report of Industrial Injury or Occupational Injury Form

An employer who files the report required by electronic transmission must upon request, mail to the insurer or third-party administrator the form that contains the original signature of the employer or the employer's designee. The form must be mailed within 7 days after receiving such a request.

The Form C3 must be accompanied by a statement of the wages of the employee if the claim for compensation received from the treating physician or chiropractor, or a medical facility has been delegated to the medical facility and indicates that the injured employee is expected to be off work for 5 days or more.

Wage statement D-8

Posting Requirements NAC 616A.460, NAC 616A.470, NAC 616A.480

Informational poster to be displayed by employers

 Each employer must display at his place of business a poster with the language and in the format specified in Form D-1

2. The title of the poster must be printed as required by statute. 

3. Each employer will:

(a) Display the poster as required and

(b) Advise his employees of the name, address and telephone number of the administrator for their claims for workers' compensation.

4. The poster must be displayed in a manner readily visible by all employees. A poster must not be displayed unless:

(a) It has been issued or approved by the Workers' Compensation Section (WCS); or

(b) If it has not been issued by the Workers' Compensation Section (WCS) or bears the Workers' Compensation Section's (WCS) indication of approval.

Poster to be displayed by employers with employees who receive tips

1. Each employer who has employees who receive tips must display a poster with the language and in the format specified in Form D-22

2. The poster must be posted in a manner visible to all employees.

Penalties for Late Reporting   NRS 616C.045  4

The Administrator will impose an administrative fine of up to $1,000 on an employer for each violation of late reporting

Reporting of Claim by Employer Ark. Code Ann. 11-9-529, Rule 099.08

Employers must report injuries involving either more than 7 days of lost time or indemnity payments on Form 1 within 10 days. Also, a Form 1 is required for all controversions including a medical-only case. Self-insured employers file Form 1 with the AWCC; other employers send it to their insurance representatives, who, in turn, reports to the state for the employer.

The employer is required by law to give notice (Form N) to workers reporting injuries informing them of their rights and responsibilities. Ark. Code Ann. 11-9-514(c)(1)