Section 616B.014 - Transfer of file of claim; duties of insurer or third-party administrator who transfers or receives file1. If an insurer or third-party administrator transfers the file of a claim to another insurer or third-party administrator, the insurer or third-party administrator who transfers the file shall: (a) Provide in a usable format to the insurer or third-party administrator who receives the file the information necessary to administer the claim.(b) Provide in a usable format to the insurer or third-party administrator who receives the file the information necessary to comply with all reporting requirements and requests imposed by law.(c) Continue to pay all compensation due the claimant until the insurer or third-party administrator who receives the file provides notice in writing to the insurer or third-party administrator who transferred the file that an account to pay such compensation has been established and funded.(d) Provide to the insurer or third-party administrator who receives the file a printed report of all claims which are open on the date on which the file is transferred. The insurer or thirdparty administrator who transfers the file and the insurer or third-party administrator who receives the file shall retain a copy of the report for as long as necessary to assign responsibility for any failure to pay compensation, but in no event for a period of less than 2 years after the date on which the file is transferred. The report must be delivered to the insurer or third-party administrator who receives the file on or before the date on which the file is transferred and must include for each claim: (1) The current status of the claim;(2) For any compensation due within 90 days after the date on which the file is transferred, the dates on which the compensation is due and the anticipated period for which the compensation is due;(3) Any pending issues and determinations;(4) A brief summary of the history and projected outcome of the claim; and(5) Information sufficient to enable the insurer or third-party administrator who receives the file to make timely payment of compensation and to continue administering the claims.(e) Provide notice of the transfer by mail to: (1) The injured employee whose claim is being transferred;(2) The attorney or other authorized representative of the injured employee;(3) Any person who is a provider of health care for the injured employee;(4) Any person who is performing a rating evaluation of the injured employee;(5) Any person who is administering the claim which is being transferred; and(6) The Administrator and the Commissioner.(f) Not later than 3 days after receiving a notice or other legal documentation relating to a contested claim that is before a hearing officer, appeals officer or court of competent jurisdiction: (1) Notify, in writing, the sender of the notice or other legal documentation of the name, address and telephone number of the insurer or third-party administrator who receives the file; and(2) Forward the notice or other legal documentation to the insurer or third-party administrator who receives the file.2. An insurer or third-party administrator who receives a file that is transferred from another insurer or third-party administrator shall: (a) Within 30 days after the date of the transfer, review any open claim relating to the file and determine the action to be taken with regard to each claim.(b) In a timely manner, pay all compensation set forth in the report described in paragraph (d) of subsection 1 unless the insurer or third-party administrator issues a written determination that such compensation is not due, which written determination must set forth the right to appeal by the injured employee.(c) Take any other action set forth in the report described in paragraph (d) of subsection 1 and any other action necessary to ensure the timely and efficient administration of claims and payment of compensation and other benefits.Nev. Admin. Code § 616B.014
Added to NAC by Div. of Industrial Relations by R130-14, eff. 9/9/2016