t to NRS 616C.025; or 2. The injured employee or another dependent filed a claim for compensation for that industrial injury, the claim was denied and, upon final resolution of the claim, it was denied. (Added to NRS by 1993, 663)—(Substituted in revision for NRS 616.50115) NRS 616C.035 Application for death benefit. Where death results from injury, the parties entitled to compensation under chapters 616A to 616D, inclusive, of NRS, or someone in their behalf, must make application for compensation to the insurer. The application must be accompanied by: 1. Proof of death; 2. Proof of relationship showing the parties to be entitled to compensation under chapters 616A to 616D, inclusive, of NRS; 3. Certificates of the attending physician, if any; and 4. Such other proof as required by the regulations of the Division. [54:168:1947; 1943 NCL § 2680.54]—(NRS A 1979, 1053; 1981, 1488; 1993, 1869)—(Substituted in revision for NRS 616.505) NRS 616C.040 Claim for compensation: Duty of treating physician or chiropractor to file or delegate duty to medical facility; electronic filing; form and contents; maintenance of forms; penalty. 1. Except as otherwise provided in this section, a treating physician or chiropractor shall, within 3 working days after first providing treatment to an injured employee for a particular injury, complete and file a claim for compensation with the employer of the injured employee and the employer’s insurer. If the employer is a self-insured employer, the treating physician or chiropractor shall file the claim for compensation with the employer’s third-party administrator. If the physician or chiropractor files the claim for compensation by electronic transmission, the physician or chiropractor shall, upon request, mail to the insurer or third-party administrator the form that contains the original signatures of the injured employee and the physician or chiropractor. The form must be mailed within 7 days after receiving such a request. 2. A physician or chiropractor who has a duty to file a claim for compensation pursuant to subsection 1 may delegate the duty to a medical facility. If the physician or chiropractor delegates the duty to a medical facility: (a) The medical facility must comply with the filing requirements set forth in this section; and (b) The delegation must be in writing and signed by: (1) The physician or chiropractor; and (2) An authorized representative of the medical facility. 3. A claim for compensation required by subsection 1 must be filed on a form prescribed by the Administrator. 4. If a claim for compensation is accompanied by a certificate of disability, the certificate must include a description of any limitation or restrictions on the injured employee’s ability to work. 5. Each physician, chiropractor and medical facility that treats injured employees, each insurer, third-party administrator and employer, and the Division shall maintain at their offices a sufficient supply of the forms prescribed by the Administrator for filing a claim for compensation. 6. The Administrator may impose an administrative fine of not more than $1,000 for each violation of subsection 1 on: (a) A physician or chiropractor; or (b) A medical facility if the duty to file the claim for compensation has been delegated to the medical facility pursuant to this section. (Added to NRS by 1993, 661; A 1995, 649; 1997, 1434; 2003, 2305) NRS 616C.045 Report of industrial injury or occupational disease: Duty of employer to file; electronic filing; form and contents; penalty. 1. Except as otherwise provided in NRS 616B.727, within 6 working days after the receipt of a claim for compensation from a physician or chiropractor, or a medical facility if the duty to file the claim for compensation has been delegated to the medical facility pursuant to NRS 616C.040, an employer shall complete and file with his insurer or third-party administrator an employer’s report of industrial injury or occupational disease. 2. The report must: (a) Be filed on a form prescribed by the Administrator; (b) Be signed by the employer or his designee; (c) Contain specific answers to all questions required by the regulations of the Administrator; and (d) Be accompanied by a statement of the wages of the employee if the claim for compensation received from the treating physician or chiropractor, or a medical facility if the duty to file the claim for compensation has been delegated to the medical facility pursuant to NRS 616C.040, indicates that the injured employee is expected to be off work for 5 days or more. 3. An employer who files the report required by subsection 1 by electronic transmission shall, upon request, mail to the insurer or third-party administrator the form that contains the original signature of the employer or his designee. The form must be mailed within 7 days after receiving such a request. 4. The Administrator shall impose an administrative fine of not more than $1,000 on an employer for each violation of this section. (Added to NRS by 1993, 661; A 1995, 649; 1997, 1435; 1999, 3146; 2003, 2305) NRS 616C.050 Information required to be provided by insurer to claimant. 1. An insurer shall provide to each claimant: (a) Upon written request, one copy of any medical information concerning his injury or illness. (b) A statement which contains information concerning the claimant’s right to: (1) Receive the information and forms necessary to file a claim; (2) Select a treating physician or chiropractor and an alternative treating physician or chiropractor in accordance with the provisions of NRS 616C.090; (3) Request the appointment of the Nevada Attorney for Injured Workers to represent him before the appeals officer; (4) File a complaint with the Administrator; (5) When applicable, receive compensation for: (I) Permanent total disability; (II) Temporary total disability; (III) Permanent partial disability; (IV) Temporary partial disability; (V) All medical costs related to his injury or disease; or (VI) The hours he is absent from the place of employment to receive medical treatment pursuant to NRS 616C.477; (6) Receive services for rehabilitation if his injury prevents him from returning to gainful employment; (7) Review by a hearing officer of any determination or rejection of a claim by the insurer within the time specified by statute; and (8) Judicial review of any final decision within the time specified by statute. 2. The insurer’s statement must include a copy of the form designed by the Administrator pursuant to subsection 7 of NRS 616C.090 that notifies injured employees of their right to select an alternative treating physician or chiropractor. The Administrator shall adopt regulations for the manner of compliance by an insurer with the other provisions of subsection 1. (Added to NRS by 1995, 2003; A 2001, 1892; 2005, 100) NRS 616C.052 Exposure of police officer or firefighter to contagious disease: Reporting and testing requirements; eligibility for compensation. 1. Except as otherwise provided in NRS 617.485 and 617.487, if a police officer or a salaried or volunteer firefighter is exposed to a contagious disease: (a) Upon battery by an offender; or (b) While performing the duties of a police officer or firefighter, the employer of the police officer or firefighter shall create and maintain a report concerning the exposure that includes, without limitation, the name of each police officer or firefighter, as applicable, who was exposed to the contagious disea

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