NAC616C.088. File of employees’ claims: Maintenance; contents; retention.

     1. An insurer shall maintain a file of employees’ claims concerning industrial injuries and occupational disease, including, without limitation, claims which have been denied. The file must be indexed by the names and social security numbers of the injured employees.

     2. The file for each industrial injury or occupational disease must contain:

     (a) The employer’s report of the industrial injury or occupational disease.

     (b) The claim for compensation and any medical report associated with that claim that is issued after the claim is filed with the insurer.

     (c) All:

          (1) Applications for a stay concerning a decision on a claim for compensation made to a hearing officer, appeals officer or a court of competent jurisdiction;

          (2) Written orders or decisions on a claim for compensation entered by a hearing officer, appeals officer or a court of competent jurisdiction;

          (3) Written determinations made by an insurer, third-party administrator or an organization for managed care concerning a claim for compensation;

          (4) Written settlement agreements or stipulations made between the injured employee and his or her employer or the insurer of the employer concerning a claim for compensation; and

          (5) Except as otherwise provided in subparagraph (2) of paragraph (f), other documents which affect the amount, timing or denial of the payment of compensation.

Ê As used in this paragraph, “payment of compensation” has the meaning ascribed to it in subsection 2 of NAC 616D.305.

     (d) A record of all compensation paid to the injured employee and all payments made to any other person in connection with the claim, for:

          (1) Accident benefits;

          (2) Temporary partial disability;

          (3) Temporary total disability;

          (4) Permanent partial disability;

          (5) Permanent total disability;

          (6) Death benefits; and

          (7) Vocational rehabilitation,

Ê and the amount of the expected total incurred costs and the justification.

     (e) A copy of any notice of termination of benefits which has been sent to the injured employee.

     (f) Copies of all correspondence and other documents pertaining to the claim, including, without limitation, copies of:

          (1) All medical bills incurred by the injured employee and received by the insurer; and

          (2) Any notices sent to the injured employee to inform him or her of the right to a review or appeal,

Ê but not including records of any privileged communication between the insurer and its attorney or of any investigation conducted by or on behalf of the insurer concerning a possible violation of NRS 616D.300.

     (g) All ratings performed by any physician or chiropractor.

     (h) A summary of conversations or oral negotiations, or both, conducted by the insurer with the injured employee, the legal counsel who represents the injured employee or any other party other than the physician or chiropractor of the injured employee, if action is requested or taken.

     (i) After the claim is closed, the log of oral communications relating to the medical disposition of a claim that must be maintained by an insurer pursuant to NRS 616D.330.

     3. Each file of a claim must be retained for 2 years after the death of the injured employee.

     (Added to NAC by Div. of Industrial Insurance Regulation, eff. 10-26-83; A 2-22-88; 8-30-91; A by Div. of Industrial Relations by R167-97, 1-30-98; R098-98, 12-18-98)