Erroneous denial of authorization or responsibility for payment for services provided to injured employee: Order for payment of provider of health care; reimbursement of injured employee. If:
1. An insurer, an organization for managed care, a third-party administrator or an employer who provides accident benefits for injured employees pursuant to NRS 616C.265 denies authorization or responsibility for payment for treatment or other services provided by a provider of health care that the injured employee alleges are related to an industrial injury or occupational disease;
2. The injured employee pays in protest for the treatment or other services; and
3. A hearing officer or appeals officer ultimately determines that the treatment or other services should have been covered, or the insurer, organization for managed care, third-party administrator or employer who provides accident benefits subsequently accepts responsibility for payment,
Ê the hearing officer or appeals officer shall order the insurer, organization for managed care, third-party administrator or employer who provides accident benefits to pay to the provider of health care the amount which is allowed for the treatment or other services set forth in the schedule of fees and charges established pursuant to NRS 616C.260 or, if the insurer has contracted with an organization for managed care or with providers of health care pursuant to NRS 616B.527, the amount that is allowed for the treatment or other services under that contract. Within 30 days after receiving the payment, the provider of health care shall reimburse the injured employee for the amount paid in protest by him.
Last modified: February 25, 2006