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Self-Insured Workers' Compensation Required Industry Reports

The following list of Self-Insured Workers’ Compensation required industry reports is provided by the Department of Business and Industry, Division of Insurance. The list is not all inclusive. It is the responsibility of each insurance company and applicable entity to know Nevada’s laws, regulations and bulletins as they pertain to an individual company license. It is also the responsibility of each insurer and applicable entity to adhere to reporting laws, regulations and bulletins that become effective after this list has been distributed. For more information, please contact Terri Chambers at (775) 687-0777.

NAC 616B.448
Industrial Insurance
Report Name: Notice of Who Employer Contracts with for Program Administration
Due Date: See Special Instructions*
Special Instructions: Report required only upon change. Pertains to Self-Insured employers who do not self-administer claims.

NAC 616B.460

NAC 616B.463
Industrial Insurance
Report Name: Claims Information Report
Due Date: September 30
Special Instructions: All Self-Insured Employers. Forms will be mailed by Division staff July 31 each year.

NAC 616B.469
Industrial Insurance
Report Name: Interim Report
Due Date: See Special Instructions*
Special Instructions: Report necessary on occurrence only.

NAC 616B.471
Industrial Insurance
Report Name: List of Annuities
Due Date: September 30
Special Instructions: Annuities purchased for the payment of claims.

NAC 616B.549
Industrial Insurance
Report Name: Statement of Association Money Controlled
Due Date: April 1
Special Instructions: Report required of Association Third-Party Administrator

NAC 616B.552
Industrial Insurance
Report Name: Statement of Association Money Controlled
Due Date: April 1
Special Instructions: Report required of Association Administrator

NAC 616B.564

NAC 616B.567
Industrial Insurance
Report Name: Claims Information Report
Due Date: September 30
Special Instructions: All Associations of Self-Insured Employers. Forms will be mailed by Division staff July 31 of each year.

NAC 616B.570
Industrial Insurance
Report Name: Injury Report
Due Date: See Special Instructions*
Special Instructions: Within 30 days of occurrence. Required of Associations of Self-Insured Employers.

NAC 616B.588
Industrial Insurance
Report Name: Claims and financial Report
Due Date: Semi-Annual
Special Instructions: Reporting required after the first two years of operations as an Association of Self-Insured Employers.

NAC 616B.588
Industrial Insurance
Report Name: Claims and financial Report
Due Date: Quarterly
Special Instructions: Reporting required during the first two years of operation as an Association of Self-Insured Employers.