NAC616B.7764. Annual expenditures for claims of association: Calculation; statement; consideration of certain expenditures for claims; exceptions.

     1. For the purposes of subsection 1 of NAC 616B.7761, to calculate the annual expenditures for claims of an association for each of the immediately preceding 3 calendar years, the Division shall:

     (a) Consider the reports and any other information provided to the Division by the association pursuant to NAC 616B.7755;

     (b) Consider the statements obtained from the successor organization to the State Industrial Insurance System pursuant to subsection 2; and

     (c) Determine which payments made by the association are to be considered expenditures for claims pursuant to subsections 3 and 4.

     2. For each association, the Division shall obtain from the successor organization to the State Industrial Insurance System a statement showing:

     (a) The annual expenditures for claims, divided into monthly expenditures, that were made by each public or private employer in the association before such employer became a member of the association; and

     (b) The annual expenditures for claims, divided into monthly expenditures, that were made by each public or private employer in the association after such employer became a member of the association.

     3. The Division shall consider money paid by an association for any of the following to be expenditures for claims:

     (a) Charges by a hospital.

     (b) Services of a surgeon, assisting surgeon, anesthesiologist or consulting physician.

     (c) Treatment by a physician or chiropractor.

     (d) X-ray films, computerized axial tomography scans, myelograms, magnetic resonance imaging or other diagnostic tests or procedures.

     (e) Physical therapy.

     (f) Drugs, medications, eyeglasses, dental work, prosthetic devices, orthotic devices or corrective shoes, if such items are prescribed.

     (g) Travel to obtain medical care or supplies.

     (h) Any other accident benefits.

     (i) Compensation for a permanent total, temporary total, permanent partial or temporary partial disability.

     (j) Costs of vocational rehabilitation services for an injured employee.

     (k) Death benefits.

     (l) Burial expenses.

     4. The Division shall not consider any of the following to be expenditures for claims:

     (a) Money held in reserve by an association for any anticipated payment related to a claim.

     (b) Payments for compensation for a temporary total or temporary partial disability in excess of the average monthly wage.

     (c) Payments for legal expenses, including, without limitation, attorney’s fees and costs for investigations, depositions or hearings.

     (d) Payments for claims that are subsequently determined to be noncompensable.

     (e) Payments for claims related to the Uninsured Employers’ Claim Account.

     (f) Payments for administrative expenses, including, without limitation, expenses for:

          (1) Copying records;

          (2) Reviewing the report of a physician contained in any file related to a claim; or

          (3) Services related to the management of costs of medical care.

     (Added to NAC by Bd. for Admin. of Subsequent Injury Fund for Ass’ns of Self-Insured Pub. or Private Employers by R216-97, eff. 8-19-99)