Nev. Admin. Code § 616C.080 - Duties of physician, chiropractor or medical facility required to file claim

1. A health care provider who is required to file a claim for compensation pursuant to NRS 616C.040, or a physician assistant or advanced practice registered nurse at a medical facility who has been delegated the duty to file a claim for compensation pursuant to subsection 2 of NRS 616C.040, shall:

(a) Require the injured employee to complete the upper portion of the form designated in NAC 616A.480 as Form C-4, Employee's Claim for Compensation/Report of Initial Treatment, including, without limitation, the name, address and telephone number of the employer of the injured employee and the name of the insurer or third-party administrator of the employer;

(b) Contact the employer or the insurer or third-party administrator of the employer to confirm the name and address of the insurer or third-party administrator;

(c) Send a copy of the completed Form C-4 to the employer and to the insurer or third-party administrator of the employer; and

(d) Maintain, together with the completed Form C-4, documentation of the steps taken by the health care provider to verify that the insurer or third-party administrator is the insurer or third-party administrator of the employer.

2. If the health care provider is unable to confirm whether an insurer or third-party administrator is the insurer or third-party administrator of the employer within 3 working days after first providing treatment to an injured employee for a particular injury, the health care provider shall:

(a) Contact the nearest office of the Division by telephone at (702) 486-9000 for Las Vegas, Nevada, or at (775) 684-7260 for Carson City, Nevada; and

(b) If requested by the Division, provide a copy of the completed Form C-4 and documentation of the steps taken to verify that the insurer or third-party administrator is the insurer or third-party administrator of the employer.

3. As used in this section, "health care provider" means a physician, chiropractic physician, physician assistant or advanced practice registered nurse.

Notes

Nev. Admin. Code § 616C.080

Added to NAC by Div. of Industrial Relations by R150-04, eff. 11-17-2005; A by R032-21A, eff. 8/1/2023

NRS 616A.400, 616C.040