616C.235 - Closure of claim by insurer: Procedure; notice; special procedure if medical benefits less than $300.
616C.235 Closure of claim by insurer: Procedure; notice; special procedure if medical benefits less than $300.
1. Except as otherwise provided in subsections 2, 3 and 4:
(a) When the insurer determines that a claim should be closed before all benefits to which the claimant may be entitled have been paid, the insurer shall send a written notice of its intention to close the claim to the claimant by first-class mail addressed to the last known address of the claimant and, if the insurer has been notified that the claimant is represented by an attorney, to the attorney for the claimant by first-class mail addressed to the last known address of the attorney. The notice must include, on a separate page, a statement describing the effects of closing a claim pursuant to this section and a statement that if the claimant does not agree with the determination, the claimant has a right to request a resolution of the dispute pursuant to NRS 616C.305 and 616C.315 to 616C.385, inclusive, including, without limitation, a statement which prominently displays the limit on the time that the claimant has to request a resolution of the dispute as set forth in NRS 616C.315. A suitable form for requesting a resolution of the dispute must be enclosed with the notice. The closure of a claim pursuant to this subsection is not effective unless notice is given as required by this subsection.
(b) If the insurer does not receive a request for the resolution of the dispute, it may close the claim.
(c) Notwithstanding the provisions of NRS 233B.125, if a hearing is conducted to resolve the dispute, the decision of the hearing officer may be served by first-class mail.
2. If, during the first 12 months after a claim is opened, the medical benefits required to be paid for a claim are less than $300, the insurer may close the claim at any time after the insurer sends, by first-class mail addressed to the last known address of the claimant, written notice that includes a statement which prominently displays that:
(a) The claim is being closed pursuant to this subsection;
(b) The injured employee may appeal the closure of the claim pursuant to the provisions of NRS 616C.305 and 616C.315 to 616C.385, inclusive; and
(c) If the injured employee does not appeal the closure of the claim or appeals the closure of the claim but is not successful, the claim cannot be reopened.
3. In addition to the notice described in subsection 2, an insurer shall send to each claimant who receives less than $300 in medical benefits within 6 months after the claim is opened a written notice that explains the circumstances under which a claim may be closed pursuant to subsection 2. The written notice provided pursuant to this subsection does not create any right to appeal the contents of that notice. The written notice must be:
(a) Sent by first-class mail addressed to the last known address of the claimant; and
(b) A document that is separate from any other document or form that is used by the insurer.
4. The closure of a claim pursuant to subsection 2 is not effective unless notice is given as required by subsections 2 and 3.
5. In addition to the requirements of this section, an insurer shall include in the written notice described in subsection 2:
(a) If an evaluation for a permanent partial disability has been scheduled pursuant to NRS 616C.490, a statement to that effect; or
(b) If an evaluation for a permanent partial disability will not be scheduled pursuant to NRS 616C.490, a statement explaining that the reason is because the insurer has determined there is no possibility of a permanent impairment of any kind.
(Added to NRS by 1979, 707; A 1981, 1140, 1492; 1989, 333; 1991, 2421; 1993, 746; 1997, 1437; 1999, 1783, 2416; 2001, 115; 2007, 3349; 2009, 1282)