What To Do Next
Injured Workers Checklist:
The NAIW Injured Worker's checklist is designed to help you keep your workers' compensation records organized. It is in Adobe PDF format to make it easier to print. To get it click here -> Injured Workers' Checklist
Please Select the Subject You Are Interested in and Click on its Title.
FILING A WORKERS’ COMPENSATION CLAIM
LOST WAGES AND EXPENSES
APPEALING THE INSURER'S DETERMINIATION
- Immediately inform your employer or supervisor of your injury or the onset of an occupational disease. (NRS 616C.010)
- Get a C-1 form from your employer.You and your employer sign it. Make sure to get a copy for yourself. Your employer is required to have a supply of blank C-1 forms for workers to fill out. You can also get one by clicking here -> C-1 form
- You have seven (7) days from the date of the injury to get the C-1 form completed.
What the C-1 Form Does:
The C-1 form is titled the “Notice of Injury or Occupational Disease – Incident Report”. It creates a record of your injury, and it is proof that you informed your employer about the injury. The C-1 form is simply a report. It does not start a workers’ compensation claim.
Injuries and Diseases Covered by Worker’s Compensation:
Covered work related injuries are accidental injuries and occupational diseases that are related to your employment.
- Heart disease conditions are not covered unless you are a fireman or policeman.
- Certain cancers are covered conditions for firefighters exposed to hazardous substances.
- Stress-caused conditions are covered only if caused by extreme stress in time of danger.
- Certain job categories entitle you to preventive treatment for exposure to certain diseases.
How To Get Medical Treatment for a Work Injury or Occupational Disease:
Your employer may have a contract with an authorized medical provider to treat work injuries. Ask your employer or supervisor who that provider is and go there for treatment as directed. If you need information about who the workers' compensation insurer is for your employer, you should be able to get the information from the “ Brief Description of Your Rights and Benefits” poster. This is a poster that provides your employer’s workers’ compensation information. Your employer is required to have it posted at work in a common area such as the break room. (NAC 616A.460)
You may also contact the Division of Industrial Relations (DIR), Workers’ Compensation Section (WCS), Monday through Friday, 8:00 am - 5:00 pm
In Las Vegas/Henderson at (702) 486-9080 or
in Carson City at (775) 684-7270 or
go to the DIR Workers' Compensation Section web site at : http:\\dirweb.state.nv.us/WCS/wcs.htm
Get Medical Treatment from an Authorized Provider:
Workers’ compensation insurance covers medical treatment, but you must go to an authorized medical provider. Your employer may belong to a managed care organization (MCO), a health maintenance organization (HMO), have a Preferred Provider List, or work through a third party administrator (TPA). Regardless, the employer must provide you with a selection of authorized medical providers where you can get treatment for your work injury.
You Can Request a Change of Medical Provider:
You may change providers by choosing one from the insurer’s panel if you do so within the first 90 days after the injury. After that, you must get written permission from the insurer to change physicians.
How to File a Claim for Workers’ Compensation:
You will need to fill out your part of the C-4 form the first time you visit a medical provider for treatment of your work injury. Your workers’ compensation claim does not start until the C-4 form is completed. The C-4 form is titled “Employee’s Claim for Compensation/Report of Initial Treatment”. The physician fills out their part of the form, and sends a copy to your employer and the insurer. Be sure to get a copy for your records.
You must fill out the C-4 form, and have the medical provider sign and date it within 90 days from the date of your injury or the date you first noticed the onset of an occupational disease. (NRS 616C.020)
If you did not promptly notify your employer or you did not promptly file a claim, you may have a permitted excuse, so file the claim as soon as possible even if the time limits have passed. If you filed a claim after you were terminated by your employer you must explain the delay.
The Insurer has 30 Days to Either Accept or Deny Your Workers’ Compensation Claim:
Within 30 days after the insurer gets your C-4 form they must send you a letter which states whether they accept or deny your claim. If the insurer denies your claim the letter must also include a description of your right to appeal to the Hearing Office and a Request for Hearing form. Read the letter carefully. If the insurer only accepted part of your claim you can still appeal the matter to the Hearing Officer.
Workers’ Compensation Benefits May Include The Following:
• Coverage of Medical Treatment;
• Compensation for Lost Wages (TTD);
• Permanent Partial Disability (PPD);
• Permanent Total Disability (PTD);
• Vocational Rehabilitation;
• Payment to your dependent’s in the event of your death; and
• Other claims-related benefits or expenses (i.e., mileage)
To read a detailed explanation of these benefits ->Click Here
Compensation for Lost Wages Due to Work Injury or Disease:
If you are unable to work for five (5) consecutive days or five (5) cumulative days within a 20 day period you may be entitled to compensation for lost wages. (NRS 616C.400) If the medical provider’s report indicates that you can not work because of a covered work injury or disease then you may receive Temporary Total Disability (TTD) payments.
Calculation of Temporary Total Disability (TTD) Benefits:
The amount of disability compensation payable to an injured employee is based on his average monthly wage at the time of the accident. The compensation due is calculated on a calendar day basis, and paid at the rate of 66 2/3% of the average monthly wage, subject to the statutory limitation that creates a maximum average monthly wage benefit that is 150% of the state-calculated average monthly wage. To view a more in-depth description of the wage calculation process click here -> Form D-7
You Can Ask For a Recalculation of TTD:
If the 12 weeks before your injury are not a fair representation of your wages other methods for calculating your wages may be used. (NAC 616C.435 )
The calculation of your average monthly wage includes the following: wages or salary; commissions which are prorated over the period used to calculate the AMW; incentive pay; payment for sick leave; bonuses which are prorated over the period used to calculate the average monthly wage; termination pay; tips which are collected and disbursed by the employer and are not paid at the discretion of the customer; tips you report pursuant to NRS 616B.227; payment for piecework, tool allowance, vacation, holidays, overtime, and travel time; and value of room and/or board. Concurrent employment with another employer may be included. (NAC 616C.423)Light Duty Work:
If your employer offers you a modified position (i.e. a "light duty" position) you are not eligible for Temporary Total Disability benefits. Your employer is not required to offer light duty work.
When an insurer or self-insured employer makes a decision that the injured worker does not agree with, the injured worker has 70 days to appeal the decision. If the injured worker has written a request to the insurer, and the insurer fails to respond to the written request within 30 days, the injured worker may appeal to a Hearings Officer. The injured worker must appeal the failure of the insurer to respond within 70 days from the day the worker mailed the written request to the insurer or the right to do so will be lost. (NRS 616C.315). You can get the form to request a hearing by clicking here -> Hearing Request Form.
To read more about appealing the determinations of insurers, MCOs, TPAs, and other workers' compensation decision makers -> Click Here