616D.130 - Investigation of alleged violation; determination of Administrator. - Nevada Statutes

616D.130  Investigation of alleged violation; determination of Administrator.

      1.  Upon receipt of a complaint for a violation of subsection 1 of NRS 616D.120, or if the Administrator has reason to believe that such a violation has occurred, the Administrator shall cause to be conducted an investigation of the alleged violation. Except as otherwise provided in subsection 2, the Administrator shall, within 30 days after initiating the investigation:

      (a) Render a determination. The determination must include the Administrator’s findings of fact and, if the Administrator determines that a violation has occurred, one or more of the following:

             (1) The amount of any fine required to be paid pursuant to NRS 616D.120.

             (2) The amount of any benefit penalty required to be paid to a claimant pursuant to NRS 616D.120.

             (3) A plan of corrective action to be taken by the insurer, organization for managed care, health care provider, third-party administrator or employer, including the manner and time within which the violation must be corrected.

             (4) A requirement that notice of the violation be given to the appropriate agency that regulates the activities of the violator.

      (b) Notify the Commissioner if the Administrator determines that a violation was committed by a self-insured employer, association of self-insured public or private employers or third-party administrator.

      2.  Upon receipt of a complaint for any violation of paragraph (a), (b), (c) or (d) of subsection 1 of NRS 616D.120, or if the Administrator has reason to believe that such a violation has occurred, the Administrator shall complete the investigation required by subsection 1 within 60 days and, within 30 days after the completion of the investigation, render a determination and notify the Commissioner if the Administrator determines that a violation was committed by a self-insured employer, association of self-insured public or private employers or third-party administrator.

      3.  If, based upon the Administrator’s findings of fact, the Administrator determines that a violation has not occurred, the Administrator shall issue a determination to that effect.

      (Added to NRS by 1995, 1637; A 2003, 1680)