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.463 Industrial Insurance
Report Name : Claims Information Report
Due Date: September 30
Special Instructions: All Self-insured Employers
NAC 616B.469 Industrial Insurance
Report Name : Interim Report
Due Date: See Special Instructions*
Special Instructions: Report necessary only upon occurrence
NAC 616B.471 Industrial Insurance
Report Name : List of Annuities
Due Date: September 30
Special Instructions: Annuities purchased for payment of claims
NAC 616B.549 Industrial Insurance
Report Name : Statement of Association Money Controlled
Due Date: April 1
Special Instructions: Third Party Administrator
NAC 616B.552 Industrial Insurance
Report Name : Statement of Association Money
Due Date: April 1
Special Instructions: Report by Association Administrator
NAC 616B.567 Industrial Insurance
Report Name : Claims Information Report
Due Date: September 30
Special Instructions: All Associations must report
NAC 616B.570 Industrial Insurance
Report Name : Injury Report
Due Date: See Special Instructions*
Special Instructions: Within 30 days of occurrence. Report to be furnished by Association Administrator.
NAC 616B.572 Industrial Insurance
Report Name : List of Annuities
Due Date: September 30
Special Instructions: Annuities purchased for payment of claims
NAC 616B.588 Industrial Insurance
Report Name : Financial Report
Due Date: Semi-annual
Special Instructions: Report after first two years of operation
NAC 616B.588 Industrial Insurance
Report Name : Financial Report
Due Date: Quarterly
Special Instructions: For first two years of operation


Carson City Office 1818 East College Parkway, Suite 103 Carson City, Nevada 89706 Ph: (775) 687-0700 Fax: (775) 687-0787
Las Vegas Office 2501 East Sahara Ave., Suite 302 Las Vegas, Nevada 89104 Ph: (702) 486-4009 Fax:(702) 486-4007
©2010 Nevada Division of Insurance