2019 Nevada Revised Statutes
Chapter 616C - Industrial Insurance: Benefits for Injuries or Death
NRS 616C.065 - Duty of insurer to accept or deny claim; new determination; penalty; failure of insurer to indicate acceptance or denial of claim; written determination.
1. Except as otherwise provided in NRS 616C.136, within 30 days after the insurer has been notified of an industrial accident, every insurer shall:
(a) Accept a claim for compensation, notify the claimant or the person acting on behalf of the claimant that the claim has been accepted and commence payment of the claim; or
(b) Deny the claim and notify the claimant or the person acting on behalf of the claimant and the Administrator that the claim has been denied.
2. If an insurer is ordered by the Administrator, a hearing officer, an appeals officer, a district court, the Court of Appeals or the Supreme Court of Nevada to make a new determination, including, without limitation, a new determination regarding the acceptance or denial of a claim for compensation, the insurer shall make the new determination within 30 days after the date on which the insurer has been ordered to do so.
3. Payments made by an insurer pursuant to this section are not an admission of liability for the claim or any portion of the claim.
4. Except as otherwise provided in this subsection, if an insurer unreasonably delays or refuses to pay the claim within 30 days after the insurer has been notified of an industrial accident, the insurer shall pay upon order of the Administrator an additional amount equal to three times the amount specified in the order as refused or unreasonably delayed. This payment is for the benefit of the claimant and must be paid to the claimant with the compensation assessed pursuant to chapters 616A to 617, inclusive, of NRS. The provisions of this section do not apply to the payment of a bill for accident benefits that is governed by the provisions of NRS 616C.136.
5. The insurer shall notify the claimant or the person acting on behalf of the claimant that a claim has been accepted or denied pursuant to subsection 1 or 2 by:
(a) Mailing its written determination to the claimant or the person acting on behalf of the claimant; and
(b) If the claim has been denied, in whole or in part, obtaining a certificate of mailing.
6. The failure of the insurer to obtain a certificate of mailing as required by paragraph (b) of subsection 5 shall be deemed to be a failure of the insurer to mail the written determination of the denial of a claim as required by this section.
7. The failure of the insurer to indicate the acceptance or denial of a claim for a part of the body or condition does not constitute a denial or acceptance thereof.
8. Upon request, the insurer shall provide a copy of the certificate of mailing, if any, to the claimant or the person acting on behalf of the claimant.
9. For the purposes of this section, the insurer shall mail the written determination to:
(a) The mailing address of the claimant or the person acting on behalf of the claimant that is provided on the form prescribed by the Administrator for filing the claim; or
(b) Another mailing address if the claimant or the person acting on behalf of the claimant provides to the insurer written notice of another mailing address.
10. As used in this section, “certificate of mailing” means a receipt that provides evidence of the date on which the insurer presented its written determination to the United States Postal Service for mailing.
(Added to NRS by 1995, 2001; A 2001, 2738; 2007, 3345; 2009, 1278, 3031; 2013, 1794)
