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, the person may request a resolution of the dispute pursuant to NRS 616C.345 to 616C.385, inclusive.

Source: Section 616C.305 — Procedure for appeal of final determination of organization for managed care which has contracted with insurer., https://www.­leg.­state.­nv.­us/NRS/NRS-616C.­html#NRS616CSec305.

616C.295
Duties of Chief of Hearings Division: Adoption of regulations establishing codes of conduct for hearing officers and appeals officers, standards for initial training and continuing education and qualifications for hearing officers 616C.300
Hearing officers: Appointment 616C.305
Procedure for appeal of final determination of organization for managed care which has contracted with insurer. 616C.310
Contested cases: Procedures 616C.315
Request for hearing 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. 616C.325
Representation of employee and employer before hearings officer or appeals officer or in negotiations with insurer 616C.330
Date, time and place for hearing 616C.335
Award of interest. 616C.340
Appointment, term, qualifications and salary of appeals officers and special appeals officers 616C.345
Notice of appeal 616C.350
Testimony of physician or chiropractor before appeals officer 616C.355
Use of affidavits or declarations as evidence at hearing 616C.360
Record of hearing before appeals officer 616C.363
External review: Duties of independent review organization 616C.365
Reimbursement of employee’s expenses incurred and wages lost as result of hearing requested by employer or insurer 616C.370
Judicial review. 616C.375
Stay of decision of appeals officer. 616C.380
Payment pending appeal when decision not stayed 616C.385
Costs and attorney’s fees for frivolous petitions for judicial review. 616C.390
Reopening claim: General requirements and procedure 616C.392
Reopening claim: Circumstances under which insurer is required to reopen claim for permanent partial disability.
Last Updated

Feb. 5, 2021

§ 616C.305’s source at nv​.us