Misrepresentation or concealment of fact to obtain benefits: Insurer entitled to reimbursement or deduction from benefits; appeal of determination; alternative remedies.
1. If an insurer determines that an employee has knowingly misrepresented or concealed a material fact to obtain any benefit or payment under the provisions of this chapter, the insurer may deduct from any benefits or payments due to the employee, the amount obtained by the employee because of the misrepresentation or concealment of a material fact. The employee shall reimburse the insurer for all benefits or payments received because of the knowing misrepresentation or concealment of a material fact.
2. An employee who is aggrieved by a determination of an insurer made pursuant to subsection 1 may appeal that determination pursuant to NRS 616C.315 to 616C.385, inclusive. If the final decision by an appeals officer is favorable to the employee, the Administrator shall order the insurer to pay $2,000 to that employee, in addition to any benefits or payments the employee is entitled to receive, if:
(a) The final decision is favorable to the employee; and
(b) The Administrator determines that the insurer had no reasonable basis for believing that the employee knowingly misrepresented or concealed a material fact to obtain any benefit or payment.
3. This section does not preclude an insurer from making an investigation pursuant to, or pursuing the remedies provided by, NRS 616D.300.
Last modified: February 25, 2006