Third Party Administrator
- TPA Application Checklist and Instructions
- TPA Application
- TPA Annual Reporting Form (Fillable)
- TPA Annual Reporting Form (PDF)
- TPA Annual Reporting Form (Excel)
- Bond Form 332
- TPA Surrendering Certification Form
- Incoming Funds Deposit Notification
- NAIC Biographical Affidavit
- Request for Contact Information
- Guaranty of Performance
THIRD PARTY ADMINISTRATOR (TPA) APPLICATION INSTRUCTIONS. EFFECTIVE JULY 1, 2009
The Nevada Division of Insurance (Division) has provided a checklist that must be incorporated into the application packet. The TPA application must be bound and tabbed as indicated or it will be returned without being reviewed.
Fees effective July 1, 2009:
The certificate of registration for a TPA license is $185. Fees are payable by check or money order to the Nevada Division of Insurance, and are nonrefundable.
Applicants must contact the Division of Insurance (Division) for a verbal name approval prior to completing any articles of incorporation, articles of organization or amendments with the Secretary of State’s (SOS) office, or prior to filing any DBA/Fictitious Firm Name filings with the appropriate Nevada County Clerk’s office.
Division Phone: (775) 687-0700
Division General E-mail
Corporations, Limited Liability Companies, Limited Liability Partnerships and Associations, etc.:
Domestic Corporations Articles of Incorporation (Articles) Purpose Clause: Business entities whose purpose is to engage of the business of insurance are required to file with the SOS must include the following statement within the purpose clause of its Articles of Incorporation, “To engage in the business of insurance in the capacity of a third party administrator all lines of authority permitted under the license issued in compliance with Nevada Revised Statutes (NRS) and Nevada Administrative Codes (NAC).” The articles or amendment must be forwarded to the Division of Insurance prior to being filed with the Secretary of State by either of the following methods:
- Mail the Articles or amendment to the Division’s address with the fee for the Secretary of State in a separate sealed envelope labeled “Secretary of State” or “SOS”.
- Faxing the Articles or amendment to the Division’s office. Upon approval of the Articles or amendment, the Division will fax the information to the fax number provided by the applicant for filing with the Secretary of State’s office. The Self-Insured Workers' Compensation fax number is (775) 687-0786
Foreign Corporations, Limited Liability Companies, Limited Liability Partnerships and Associations must contact the Nevada Secretary of State for any filings they may require.
The certificate of registration does not allow the administrator to market or administer products which are not approved in Nevada, or which are issued by a non-admitted insurer or unauthorized multiple employer trust or associate marketing plan.
NAC 616B.013 Availability, location and inspection of files of claims of injured workers; report of findings to insurer. (NRS 616A.400)
- An insurer or third-party administrator shall ensure that each file of any claim of an injured worker concerning an industrial injury which is filed in accordance with chapters 616A to 617 inclusive, of NRS or a regulation adopted pursuant thereto is available for inspection during regular business hours by:
- The injured worker;
- The attorney or other authorized representative of the injured worker;
- The Commissioner or his designee; or
- The Administrator.
- All files of the claims of injured workers concerning industrial injuries must be administered in this State and be available for inspection at an office of the insurer or third-party administrator in this State.
- After reviewing the file of a claim, the Commissioner or Administrator will report his findings to the insurer.
(Added to NAC by Div. of Industrial Relations by R105-00, 1-18-2001, eff. 3-1-2001; A by R007-06, 6-1-2006)
During the 2009 Legislative Session, Senate Bill 195 amended various provision of the Nevada Revised Statutes reflecting the Division of Industrial Relations (DIR) approval authority over for the issuance and renewal of a certificate of registration of a third party administrator.
Questions: Contact the Division’s Self-Insured Workers' Compensation Section staff member(s) by emailing email@example.com
Management Analyst I
TPAs A through H
Management Analyst II
TPAs I through Z
Nevada’s laws and regulations are available online.