If you have been injured at work and your injury is a medical emergency, then you should call 911 or go to your nearest medical facility/hospital right away. The next thing to do is to organize your worker’s compensation records with the injured worker’s checklist.
If you have suffered from a workplace injury or occupational disease, you need to take the following steps immediately:
- Inform employer/supervisor of workplace injury/occupational disease (NRS 616C.010).
- Obtain C-1 form from employer/supervisor. Both parties should sign this form and keep a copy. Complete this form within seven days of the injury.
What is the C-1 Form?
The C-1 form is the Notice of Injury or Occupational Disease Incident Report which creates a formal record of the injury. This does not begin your compensation claim, but will serve as evidence that you informed the employer of the injury.
Following are some of the employment related accidental injuries and occupational diseases which can be covered by Worker’s Compensation:
- Heart disease conditions for firefighters and police officers only.
- Certain cancers for firefighters exposed to hazardous materials.
- Stress-related conditions in extremely stressful and dangerous situations.
- Preventative treatment for exposure to certain disease in certain job categories.
How can I get medical treatment for workplace injuries/occupational diseases?
You should start by discussing your treatment needs with your employer because your employer may be able to recommend you to their own authorized medical care provider. Your employer is also required to have a Brief Description of Your Rights and Benefits poster that can provide further information about the worker’s compensation insurer for your job (NAC 616A.460).
For more information, contact the Division of Industrial Relations (DIR), Workers’ Compensation Section (WCS)at the following phone numbers at any time Monday through Friday from 8 am to 5 pm:
- Las Vegas/Henderson – (702) 486-9080
- Carson City – (775) 684-7270
You can also visit the DIR WCS website: http:\\dirweb.state.nv.us/WCS/wcs.htm
Seeking Treatment from Authorized Provider
It is important to seek treatment from an authorized medical provider. Your employer will provide a list of these providers that they may obtain from a managed care organization (MCO) a preferred provider list, a third party administrator (TPA), or a health maintenance organization (HMO) (NRS 616C.090).
Requesting Change of Medical Provider
If you want to change providers, you must choose from the insurer’s panel and you must do this within 90 days of the initial injury. If you want to change providers after this point, you’ll need written permission from the insurer to do so (NRS 616C.090).
Filing Workers’ Compensation Claim
How do you file a claim for Workers’ Compensation?
To file a claim for workers’ compensation, you need to start by filling out your portion of the C-4 form (Employee’s Claim for Compensation/Report of Initial Treatment) when you visit a medical care provider for the first time after the workplace injury.
When the C-4 form is completed, you have begun your workers’ compensation claim. The physician will fill out his or her portion of the form as well, and you should get a copy for your records. A copy will also be sent to the employer and the insurer. The C-4 form needs to be completed, signed, and dated within 90 days of the injury/onset of disease (NRS 616C.020)
What happens if you file late?
In some situations, you can have a permitted excuse for not promptly notifying your employer and filing a claim. You should file as soon as you possibly can and explain the delay, especially if you file your claim after being fired by your employer.
Claim is Accepted/Denied Within 30 Days
Once the insurer receives your C-4 form, they have 30 days to send a letter accepting or denying your claim. In situations where your claim is denied, you will also receive information regarding your right to appeal to the Hearing Office and a Request for Hearing form. In some cases, the insurer may accept part of your claim, and you may want to appeal this to the Hearing Office (NRS 616C.065).
Potential Worker’s Compensation Benefits
You may receive any of the following compensation benefits through worker’s compensation:
- Medical Treatment Coverage
- Lost Wages
- Permanent Disability
- Permanent Total Disability
- Vocational Rehab
- Payment to Dependents if You Die
- Additional Benefits and Expenses (like mileage)
Compensation for Lost Wages and Expenses
If you are in a situation where your injury or illness prevents you from working for five days in a row or five days within a 20 day period, then you can receive compensation for your lost wages (NRS 616C.400). If you cannot work at all because an injury or disease that is covered by the insurer, then you may receive payments for temporary total disability.
Temporary Total Disability (TTD) Benefits
When it comes to temporary total disability benefits, your compensation will be based on your average monthly wages from the employer at the time of the accident or onset of disease. This will be calculated based on calendar days and you will receive 2/3 of your average wage, subject to statutory limits (maximum average monthly wage is limited to 150% of state-calculated monthly wage).
Requesting Recalculation of TTD
If you feel that the three months prior to your injury are not fairly reflective of your usual wages, then there are other methods to calculate your wages on request (NAC 616C.435).
The following factors can be used to calculate your average monthly wage:
- Regular wages/salary
- Commissions (prorated over calculation period)
- Incentive pay
- Sick leave pay
- Bonuses (prorated over calculation period)
- Termination pay
- Tips collected and disbursed by employer
- Reported tips (NRS 616B.227)
- Piecework payments
- Tool allowance
- Vacation/Holiday pay
- Overtime pay
- Inclusion of concurrent employment with another employer (NAC 616C.423)
Light Duty Work Position
Your employer may offer a light duty modified position so that you can return to work. This is not required, but if it is offered, you will not be eligible for temporary total disability benefits.
There are certain situations where travel expenses can be recovered as well (NRS 616C.477, NRS 616C.365) (NAC 616C.150 ).
Appealing Decision of Insurer
If you do not agree with the insurer’s decision about your worker’s compensation case in Nevada, you will have 70 days to appeal. If you send in a written request to the insurer and do not receive a response within 30 days, then you can appeal to the Hearings Office. You must appeal within 70 days from the day that you mailed your written request or you will lose your right to appeal (NRS 616C.315).