NRS 616C.363
External review: Duties of independent review organization

  • contents and submission of decision by organization
  • costs
  • regulations.

1.

Not later than 5 business days after the date that an independent review organization receives a request for an external review, the independent review organization shall:

(a)

Review the documents and materials submitted for the external review; and

(b)

Notify the injured employee, his or her employer and the insurer whether the independent review organization needs any additional information to conduct the external review.

2.

The independent review organization shall render a decision on the matter not later than 15 business days after the date that it receives all information that is necessary to conduct the external review.

3.

In conducting the external review, the independent review organization shall consider, without limitation:

(a)

The medical records of the insured;

(b)

Any recommendations of the physician of the insured; and

(c)

Any other information approved by the Commissioner for consideration by an independent review organization.

4.

In its decision, the independent review organization shall specify the reasons for its decision. The independent review organization shall submit a copy of its decision to:

(a)

The injured employee;

(b)

The employer;

(c)

The insurer; and

(d)

The appeals officer, if any.

5.

The insurer shall pay the costs of the services provided by the independent review organization.

6.

The Commissioner may adopt regulations to govern the process of external review and to carry out the provisions of this section. Any regulations adopted pursuant to this section must provide that:

(a)

All parties must agree to the submission of a matter to an independent review organization before a request for external review may be submitted;

(b)

A party may not be ordered to submit a matter to an independent review organization; and

(c)

The findings and decisions of an independent review organization are not binding.

Source: Section 616C.363 — External review: Duties of independent review organization; contents and submission of decision by organization; costs; regulations., https://www.­leg.­state.­nv.­us/NRS/NRS-616C.­html#NRS616CSec363.

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.363’s source at nv​.us