Section 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 officer1. 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: (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, 616C.305 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, 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, 1186Amended by 2021, Ch. 245,§4, eff. 5/31/2021.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