Claims Kit

Physician Selection  NRS 616C.087  NRS 616C.090

The choice of a treating physician or chiropractic physician is a substantive right and substantive benefit of an injured employee who has a claim under the Nevada Industrial Insurance Act or the Nevada Occupational Diseases Act.

The injured employees of this State have a substantive right to an adequate choice of physicians and chiropractic physicians to treat their industrial injuries and occupational diseases.

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. 

The physician panel is deemed the Insurer Treating Provider List. These must be filed with the state at medpanels@dir.nv.gov. The subject line must include the insurer's name and that the provider list is attached. Lists are to include the submission date as well as the name and license number of the certified adjuster (or the highest-ranking salaried employee responsible for processing workers' compensation claims). The Insurer's List will be published on the state site at https://dir.nv.gov/WCS/Medical_Providers/. Lists must be submitted between September 1 and October 1 of each year. TPAs may file a single list on behalf of more than one insurer. No standard form is required at present but such a formal outline is in development.

All providers listed must be confirmed to accept and treat injured workers. They may remove providers voluntarily (by provider or insurer/TPA request) or involuntarily (by good cause if the provider died or is disabled, has their license revoked or suspended, or is convicted of a felony). The Administrator of the DIR may also remove a provider from the list upon finding that they failed to comply with the posted standards of treatment or no longer treats injured workers). Insurers are to audit their list of providers beginning September 1, 2026 and every 3 years thereafter. A provider removed from the list should be replaced by the insurer within 90 days of the removal. 

Lists were previously required to include at least 12 of the following providers (neurologists, psychiatrists, general practice/family medicine) but this is no longer required. Instead, a list of mental health care providers is required by NRS 616C.180. If operating in a county of more than 100,000 people, a list of 12 mental health care providers should be provided. Mental health care providers are psychiatrists, licensed psychologists, licensed clinical professional counselors, or licensed marriage and family therapists. Insurers may add providers to their list at any time throughout the year. 

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. 

SB 317 - Approved by Governor 6/10/25 and effective same date.

This bill impacts various statutes, including NRS 616C. Of note, the Administrator of DIR may adopt regulations authorizing physician or chiropractic physician to delegate certain routine follow-up care of an injured worker to a physician assistant who is an employee of and under the supervision of the physician or chiropractic physician. These regulations are under development but not yet in place. This section will be updated when these regulations have been put in place permitting such delegation of care from the treating physician to a subordinate physician assistant.

AB 376 - Approved by Governor on 6/10/25 and effective 10/1/25.

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 of their choosing 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 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. 

Effective June 28, 2024.

Important updates were implemented by the Division of Industrial Relations (DIR) Audit Unit. Moving forward, the DIR Audit Unit will implement and enforce the issuance of the subsequent fine structure under NRS 616D.120(2)(b) using a graduated fine schedule. The Medical Unit will also implement and enforce the issuance of this fine structure under NRS 616D.120(2)(b) using a graduated fine schedule for insurers failing to submit their treating provider list(s) to DIR by October 1st of each year per NRS 616C.087(6).

DIR has updated its procedure regarding requests to insurers and TPAs for claim files and other records due to ongoing non-compliance concerns pertaining to the timely delivery of requested records. Requests for records will be sent via email and/or mail with a due date ranging from 2 to 30 days clearly defined.  In the event the due date expires and requested records are not provided, a Monetary Assessment (Administrative Fine) will be issued following the subsequent violation schedule. If records are requested after the initial records request was made, the due date will range from 2 to 5 days clearly defined. Only three requests will be made. For complaints from injured workers, a Benefit Penalty will be issued if compliance is not timely obtained after the third request. For records requests associated with audits of insurers, an Administrative Fine will be imposed for failure to timely comply using the graduated fee schedule. These matters may also be referred to the Division of Insurance for de-certification of the insurer or TPA.

Penalties for Late Reporting  NRS 616C.045(4)  NRS 616D.120(2)

SB 317 - Passed by Governor 6/10/25

The above statute previously established administrative fines of up to $1,000 for each employer for each violation of late reporting. This bill, however, adjusts this. The bill created a new graduated fine schedule as follows:

• First violation: Fine no more than $375.
• Second violation of same section: Fine no more than $750.
• Third violation of same section: Fine no more than $1,500.
• Fourth or subsequent violation of same section: Fine no more than $3,000.

Administrative fines for subsequent violations may only be issued if the new violation is of the same section as the prior violation(s) and the prior violation occurred within 3 years of the new fine. If more than 3 years have passed, or the violation concerns a different section, it must be treated as a first-time violation.

The Administrator may issue a Notice of Correction (NOC) in lieu of a fine if they determine there was an initial minor, clerical, or ministerial violation. There are no monetary penalties associated with an NOC. Minor violations are those considered a minor, clerical, or ministerial violation so long as the violation does not create a financial impact to the injured worker. The occurrence of more than one such violation that is substantially similar across multiple claims all such violations must be combined into a single finding in an NOC. Second or subsequent violations of the same section for which an NOC was issued may result in the issuance of a formal fine as above.

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

The Workers’ Compensation Section (WCS) issues and approves the template D-1 poster. Each employer must display this poster in a place that is “readily visible” to allow every employee an opportunity to review.

NAC 616A.480 sets forth the applicable posting requirements for this poster. Subpoint D-1 confirms the informational D-1 poster must include such as insurer, third-party administrator, self-insurer, and managed care or other health care provider information. The poster must be prominently displayed at the employer’s place of business. Text (at least 20-point bold type for title, at least 12-point bold type for claim questions or concerns, at least 10-point type for all other poster content) and physical printed notice (at least 11” x 17”) sizing requirements are set forth. The poster must be displayed in a “readily visible” manner that ensures all employees an opportunity to review.

Poster to be displayed by employers with employees who receive tips

Employers with employees who receive tips must display an alternate poster, the Form D-22. This must again be posted in a manner that remains visible and accessible to all employees.