NRS 616C.225
Misrepresentation or concealment of fact to obtain benefits: Insurer entitled to reimbursement or deduction from benefits

  • appeal of determination
  • alternative remedies.

1.

Except as otherwise provided in this section, if an insurer determines that an employee has knowingly misrepresented or concealed a material fact to obtain any benefit or payment under the provisions of chapters 616A to 616D, inclusive, of NRS, the insurer may deduct from any benefits or payments due to the employee, the amount obtained by the employee because of the misrepresentation or concealment of a material fact. The employee shall reimburse the insurer for all benefits or payments received because of the willful misrepresentation or concealment of a material fact.

2.

An employee who is aggrieved by a determination of an insurer made pursuant to subsection 1 may appeal that determination pursuant to NRS 616C.315 to 616C.385, inclusive. If the final decision by an appeals officer is favorable to the employee, the Administrator shall order the insurer to pay $2,000 to that employee, in addition to any benefits or payments the employee is entitled to receive, if the Administrator determines that the insurer had no reasonable basis for believing that the employee knowingly misrepresented or concealed a material fact to obtain any benefit or payment.

3.

If an employee elects to receive an award for a permanent partial disability in a lump sum pursuant to NRS 616C.495 and a criminal action is brought against the employee for an alleged violation of NRS 616D.300, the insurer shall, upon receiving notice of the action and until a judgment is entered in the action, pay reasonable portions of the lump-sum award in monthly installments. If the employee is not convicted of the alleged violation, the insurer shall pay the employee the balance of the award in a lump sum. The provisions of subsection 2 do not apply to require any additional payment at the conclusion of a criminal action.

4.

This section does not preclude an insurer from making an investigation pursuant to, or pursuing the remedies provided by, NRS 616D.300.

Source: Section 616C.225 — Misrepresentation or concealment of fact to obtain benefits: Insurer entitled to reimbursement or deduction from benefits; appeal of determination; alternative remedies., https://www.­leg.­state.­nv.­us/NRS/NRS-616C.­html#NRS616CSec225.

616C.150
Compensation prohibited unless preponderance of evidence establishes that injury arose out of and in course of employment 616C.155
Payment of compensation by insurer prohibited before required 616C.157
Request for prior authorization: Time to respond 616C.160
Newly developed injury or disease: Inclusion in original claim for compensation 616C.165
Determination of responsibility of insurer for undisputed claim for compensation 616C.170
Resolution of disputes between insurers if benefits are claimed against more than one insurer 616C.175
Employment-related aggravation of preexisting condition which is not employment related 616C.177
Medical records concerning preexisting condition: Authority of insurer to request records 616C.180
Injury or disease caused by stress 616C.185
Compensation for mastectomy and reconstructive surgery. 616C.190
Compensation of employee injured out of State. 616C.195
Acceptance of compensation or benefits by employee injured out of State constitutes release of employer and waiver of remedy at common law or statutory remedy provided in another state. 616C.200
Commencement of action in another state to recover damages or compensation by employee injured out of State constitutes irrevocable waiver of compensation due under Nevada law 616C.205
Compensation not assignable 616C.210
Compensation of nonresident alien dependents 616C.215
Actions and proceedings to recover damages in tort or from proceeds of vehicle insurance: Reduction of compensation by amount of recovery 616C.220
Compensation from Uninsured Employers’ Claim Account: Administration and payment of claims 616C.223
Application for entry of summary judgment: Conditions 616C.225
Misrepresentation or concealment of fact to obtain benefits: Insurer entitled to reimbursement or deduction from benefits 616C.230
Grounds for denial, reduction or suspension of compensation 616C.232
Denial of compensation for temporary total disability because of discharge for misconduct. 616C.235
Closure of claim by insurer: Procedure
Last Updated

Feb. 5, 2021

§ 616C.225’s source at nv​.us