How Should I File a Workers’ Compensation Claim

Nevada law prevents a worker from suing their employee if they are hurt on the job. However, this doesn’t mean that an employee has no legal recourse for obtaining appropriate medical treatment and benefits to compensate for time lost from work. When you experience an injury or occupational disease as a result of your employment in the State of Nevada, you can file a claim for workers’ compensation insurance coverage. There are necessary forms to fill out with specific information that must be filed in a certain time frame in order to prevent denial of the application for benefits.

Filing a C-4 Form

If you are injured on the job, you need to complete a Form C-4, which is an Employee’s Claim for Compensation/Report of Initial Treatment. You need to complete the upper portion of this form, including basic demographic information and questions regarding the incident that resulted in the need for medical treatment. You will then need to sign and date your portion of this document. After you complete the upper portion of the C-4, return the form to the attending physician, who will fill out the bottom portion of the document. Included information that will be provided by the doctor includes information regarding the examination and any diagnosis and treatment recommendations provided.

Where does the form get sent?

The completed C-4 form will need to be sent to the appropriate Third-Party Administrator (TPA) for the insurance provider of your employer, often designated on documents as the TPA. In Nevada, the actual workers’ compensation claim is only, considered to be filed once the completed C-4 reaches the TPA.

Who sends in the finalized form?

It is up to the physician who treats you to send in the completed form to your employer’s TPA for processing. Be sure you let the doctor know the event is work-related and that you complete the top portion of the C4 before leaving the medical facility.

What if I am unable to complete the form due to injuries?
If you are hurt too badly to complete the form yourself, let medical personnel know and they can fill out the paperwork for you. Be sure that staff knows you were injured on the job so that they know the paperwork needs to be completed.

 What Needs to Be Included in the Claim?

The upper portion of the C4 contains questions regarding the injury or occupational disease that must be completed as accurately as possible. This will prove the event is a direct result of your job in order for Nevada workers’ compensation insurance to grant benefits. The necessary information that helps prove the event was work-related includes the provided exact information regarding the following:

  • Date of injury or illness
  • Time of injury or illness
  • Place or location event occurred
  • Exact cause of the injury, or occupational disease
  • Damages sustained, including any body parts affected

It is important to be specific regarding all information and provide as much detail as possible in order to increase the success of receiving benefits.

Written Accident Report

It is important to notify your employer of the accident in writing as soon as possible after the event by using the Form C-1. You will need to provide specific information regarding the injury or occupational disease and how it occurred. If you are seriously ill or injured, it is important to get medical attention immediately. You may verbally notify your employer or supervisor before getting medical assistance. However, you must complete the Form C-1 and return it to your employer within 7 days. It is not always an accident that results in an application for benefits. Sometimes it is an illness that occurs as a result of your job. When you become aware of an occupational disease as a result of your work duties, you must still notify the employer within 7 days of the discovery of this illness with the completion of the C-1 form.

Timeliness for Making a Claim

In order to reduce the risk of a denial of workers’ compensation insurance benefits, Nevada law sets timelines for filing of the necessary paperwork.

7 days – Reported in writing to the employer

A completed C-1 form must be turned in to your employer within 7 days after the event. However, your employer may have rules regarding accidents and incidents that require immediate reporting of such events.

90 days – doctor must complete the initial treatment form

The completed C-4 form must be delivered to the employer’s TPA within 90 days of the event. However, getting immediate medical attention and filing the paperwork early may result in a more successful outcome, as well as better recall of the appropriate information to connect the physical damage or illness to work-related activities.

Risk of Filing a Claim Late or Not Complete Information

A successful application outcome depends on complete and accurate information filed in a timely manner. If the paperwork is filed late or contains incomplete information, the application for benefits is likely to be denied.

When is the Workers’ Comp Claim Considered Filed?

The workers’ compensation insurance benefit claim, is considered to be filed once the TPA receives the appropriate paperwork in the form of a completed C-4.

Timeline after Filing for Benefits

Once the TPA receives the C-4, the adjuster has 30 days in order to either accept or deny the request for benefits. If the application has been denied, you have 70 days from the date of notification in order to request a hearing. You will receive the necessary appeal rights information with your denial. Appeals will be handled through the Department of Administration Hearings Division and must be in writing and include the denial letter. A timely hearing will be set, with at least 15 days notice being given to all parties.

What if My Employer Already Knows of the Injury?

While the employer must be notified of the injury, this is not the same as filing an application for workers’ compensation insurance benefits. The completion of the C-4 through an approved medical provider is necessary. Once the TPA receives this document, this is when the claim actually begins.

Nevada Workers Compensation Attorney

Even though Nevada law prevents you from suing your employer if you are hurt on the job, you still have rights regarding proper treatment and compensation. Injuries and occupational disease that occur as a result of work-related activities can qualify for workers’ compensation benefits. The law office of Morris Anderson is here to help you with your case to be sure your rights are protected.

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