NRS
616C.315 Request for hearing; forms for request to be provided by
insurer; prerequisites to scheduling of hearing; expeditious and informal
hearing required; direct submission to appeals officer.
1. Any person who is subject to the
jurisdiction of the hearing officers pursuant to chapters
616A to 616D, inclusive, or chapter 617 of NRS may request a hearing before a hearing
officer of any matter within the hearing officer’s authority. The insurer shall
provide, without cost, the forms necessary to request a hearing to any person
who requests them.
2. A hearing must not be scheduled until
the following information is provided to the hearing officer:
(a) The name of:
(1) The claimant;
(2) The employer; and
(3) The insurer or third-party
administrator;
(b) The number of the claim; and
(c) If applicable, a copy of the letter of
determination being appealed or, if such a copy is unavailable, the date of the
determination and the issues stated in the determination.
3. Except as otherwise provided in NRS 616B.772, 616B.775, 616B.787 and 616C.427, a person who is aggrieved by:
(a) A written determination of an insurer; or
(b) The failure of an insurer to respond within
30 days to a written request mailed to the insurer by the person who is
aggrieved,
Ê may appeal
from the determination or failure to respond by filing a request for a hearing
before a hearing officer. Such a request must include the information required
pursuant to subsection 2 and, except as otherwise provided in subsections 4 and
5, must be filed within 70 days after the date on which the notice of the
insurer’s determination was mailed or, if requested by the claimant or the
person acting on behalf of the claimant, sent by facsimile or other electronic
transmission the proof of sending and receipt of which is readily verifiable by
the insurer or the unanswered written request was mailed to the insurer, as
applicable. The failure of an insurer to respond to a written request for a
determination within 30 days after receipt of such a request shall be deemed by
the hearing officer to be a denial of the request.
4. The period specified in subsection 3
within which a request for a hearing must be filed may be:
(a) Extended for an additional 90 days if the
person aggrieved shows by a preponderance of the evidence that the person was
diagnosed with a terminal illness or was informed of the death or diagnosis of
a terminal illness of his or her spouse, parent or child.
(b) Tolled if the insurer fails to mail or, if
requested by the claimant or the person acting on behalf of the claimant, send
by facsimile or other electronic transmission the proof of sending and receipt
of which is readily verifiable a determination.
5. Failure to file a request for a hearing
within the period specified in subsection 3 may be excused if the person
aggrieved shows by a preponderance of the evidence that the person did not
receive the notice of the determination and the forms necessary to request a
hearing. The claimant or employer shall notify the insurer of a change of
address.
6. The hearing before the hearing officer
must be conducted as expeditiously and informally as is practicable.
7. The parties to a contested claim may,
if the claimant is represented by legal counsel, agree to forego a hearing
before a hearing officer and submit the contested claim directly to an appeals
officer.
8. A claimant may, with regard to a
contested claim arising from the provisions of NRS 617.453, 617.455, 617.457,
617.485 or 617.487 as described in subsection 2 of NRS 616C.345, submit the contested claim
directly to an appeals officer pursuant to subsection 2 of NRS 616C.345 without the agreement of any
other party.
(Added to NRS by 1979,
1040; A 1981,
1490; 1983,
1294; 1985,
668; 1991,
834, 2417;
1993,
736; 1999,
3380; 2001,
2256; 2003,
2333; 2007,
3351; 2009,
1283; 2021,
1186; 2025,
3310)
Notes of Decisions
Seino v. Employers Ins. Co. of Nevada, 111 P.3d 1107 (Nev. 2005).
· cites it 14× “In this appeal, we examine whether Seino satisfied the jurisdictional requirements of NRS 616C.315, which requires that a hearing request be filed within seventy days of the date that the industrial insurer’s notice of determination is mailed.”
Ayala v. Caesars Palace, 71 P.3d 490 (Nev. 2003).
· cites it 2× “NRS 616C.315(2), which, according to Ayala, precludes an insurer from recalculating the benefit-level determination once seventy days have elapsed, provides, in relevant part: 2.”
Dickinson v. Am. Med. Response, 186 P.3d 878 (Nev. 2008).
“Dickinson did not necessarily waive her right to cervical PPD benefits Under NRS 616C.315(3), any person who is aggrieved by an administrator’s written determination has 70 days within which to administratively appeal that determination.”
Browning v. Young Elec. Sign Co., 936 P.2d 322 (Nev. 1997).
· cites it 3× “2d 294, 295 (1993), we stated that when SIIS grants benefits to an injured worker, an employer is an “aggrieved person” under NRS 616C.315 and that this provision is the exclusive avenue of appeal from a decision to grant benefits.”
City of Las Vegas v. Lawson, 245 P.3d 1175 (Nev. 2010).
“See NRS 616C.315; NRS 616C.320. The hearing officer concluded that “a medical question exists relative to the etiology of [Lawson’s] diagnosed breast cancer” and remanded the matter to the City for a new determination, without addressing the timeliness of Lawson’s claim.”
Demaranville Vs. Cannon Cochran Mgmt. Serv.'s, Inc., 2019 NV 35 (Nev. 2019).
· cites it 2× “NRS 616C.315(7). After being informed that EICON was the appropriate insurer, Laura separately filed a claim with EICON, which also denied the claim on the basis that the evidence did not establish that Daniel died from heart disease.”
Gilman v. Clark Cty. Sch. Dist. (Nev. 2023).
· cites it 2× “COURT OF APPEALS OF NEVADA (CI) 1947B 10 by a determination to accept or to deny any claim") and NRS 616C.315(3) (providing a right of appeal from a deterrnination).”
Flamingo Hilton v. Gilbert, 148 P.3d 738 (Nev. 2006).
“NRS 616C.315(3) provides that a claimant who is aggrieved by an insurer’s determination must appeal from that determination within seventy days of the determination’s mailing date.”
— Nev. Rev. Stat. § 616C.315(2) — 2 cases
Ayala v. Caesars Palace, 71 P.3d 490 (Nev. 2003).
“NRS 616C.315(2), which, according to Ayala, precludes an insurer from recalculating the benefit-level determination once seventy days have elapsed, provides, in relevant part: 2.”
Browning v. Young Elec. Sign Co., 936 P.2d 322 (Nev. 1997).
“2d 294, 295 (1993), we stated that when SIIS grants benefits to an injured worker, an employer is an “aggrieved person” under NRS 616C.315 and that this provision is the exclusive avenue of appeal from a decision to grant benefits.”
— Nev. Rev. Stat. § 616C.315(3) — 4 cases
Seino v. Employers Ins. Co. of Nevada, 111 P.3d 1107 (Nev. 2005).
“In this appeal, we examine whether Seino satisfied the jurisdictional requirements of NRS 616C.315, which requires that a hearing request be filed within seventy days of the date that the industrial insurer’s notice of determination is mailed.”
Dickinson v. Am. Med. Response, 186 P.3d 878 (Nev. 2008).
“Dickinson did not necessarily waive her right to cervical PPD benefits Under NRS 616C.315(3), any person who is aggrieved by an administrator’s written determination has 70 days within which to administratively appeal that determination.”
Gilman v. Clark Cty. Sch. Dist. (Nev. 2023).
“COURT OF APPEALS OF NEVADA (CI) 1947B 10 by a determination to accept or to deny any claim") and NRS 616C.315(3) (providing a right of appeal from a deterrnination).”
Flamingo Hilton v. Gilbert, 148 P.3d 738 (Nev. 2006).
“NRS 616C.315(3) provides that a claimant who is aggrieved by an insurer’s determination must appeal from that determination within seventy days of the determination’s mailing date.”
— Nev. Rev. Stat. § 616C.315(3)(b) — 1 case
Seino v. Employers Ins. Co. of Nevada, 111 P.3d 1107 (Nev. 2005).
“In this appeal, we examine whether Seino satisfied the jurisdictional requirements of NRS 616C.315, which requires that a hearing request be filed within seventy days of the date that the industrial insurer’s notice of determination is mailed.”
— Nev. Rev. Stat. § 616C.315(4) — 1 case
Seino v. Employers Ins. Co. of Nevada, 111 P.3d 1107 (Nev. 2005).
“In this appeal, we examine whether Seino satisfied the jurisdictional requirements of NRS 616C.315, which requires that a hearing request be filed within seventy days of the date that the industrial insurer’s notice of determination is mailed.”
— Nev. Rev. Stat. § 616C.315(7) — 1 case
Demaranville Vs. Cannon Cochran Mgmt. Serv.'s, Inc., 2019 NV 35 (Nev. 2019).
“NRS 616C.315(7). After being informed that EICON was the appropriate insurer, Laura separately filed a claim with EICON, which also denied the claim on the basis that the evidence did not establish that Daniel died from heart disease.”
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