Nevada Workers’ Compensation – How to File a Claim

In Nevada, workers’ compensation is generally the only way employees can receive benefits for an injury at work. When you have an accident at work, you need to file a workers’ compensation claim.

You only have to show that it is more likely than not that the injury or condition was caused by work and not some other cause for you to receive benefits.

Filing a claim for workers’ compensation benefits in Nevada is a two-step process:

1. Within seven days of the injury, you should notify the employer and submit an Incident Report
2. If you require medical treatment or miss work, you should fill out an Employee’s Claim for Compensation

The Employees Claim for Compensation is filled out by both you and an examining workers’ compensation doctor. This must be done within 90 days of the injury.

A workers’ compensation claim is filed when the doctor sends the form to the insurance company after examining you.

If the insurance company accepts the claim, it will provide one or more of the following benefits:

• medical treatment
• temporary total disability (TTD) or temporary partial disability
• permanent total disability or permanent partial disability (PPD)
• death benefits
• vocational rehabilitation
• mileage reimbursement

The insurance carrier may decide to deny the claim or not provide one of the benefits above. If you disagree with that decision, you can appeal any denial of Nevada workers’ compensation benefits.

If your claim has ended, but your condition has gotten worse, the claim can be reopened. This requires a doctor to state that:

• your condition has gotten worse, and
• a work injury is the cause

In this article, our Las Vegas Nevada workplace injury attorneys will explain:

• 1. What is a work injury?
• 2. Who is an employee?
• 3. Where to file a work injury claim
• 4. How to prove a work injury
• 5. How to file a claim
  • 5.1. Initial incident
  • 5.2. Claim of work injury
• 6. Insurance company response to claim filing
• 7. Nevada workers’ compensation benefits
  • 7.1. Medical treatment
  • 7.2. Payment for lost wages
  • 7.3. Payment for permanent loss of function
  • 7.4. Death Benefits
  • 7.5. Retraining benefits
  • 7.6. Mileage reimbursement
• 8. Insurance company decision to end the claim
• 9. Appeal of the insurance company decision
• 10. Reopening a Nevada workers’ compensation claim
• 11. Understanding the basics of filing a workers’ compensation claim in Nevada
• 12. Frequently-asked-questions

1. What is a work injury?

A work-related injury is an accident or injury that is due to or related to work. A workers’ compensation claim is how you – as an employee – get benefits such as treatment for your injury.

The injury can be from a specific incident or an accident. This is an unexpected or unforeseen event that happens suddenly and violently, with or without fault, that produces an injury – including catastrophic injuries.¹

The work-related injury can also be an occupational injury.² This includes any disease or injury that is the result of exposure or repetitive movements at work,³ likely over a period of time.

2. Who is an employee?

An employee covered by workers’ compensation is any person who works for another, whether lawfully or not, with or without a written agreement.⁴

A contractor’s subcontractors may be considered employees.⁵

However, an independent contractor is not considered an employee and is therefore not covered in an employer’s workers’ compensation policy.

Employees also do not comprise:

• Casual workers whose employment spanned no more than 20 days and earned less than $500.
• Workers in interstate commerce positions that Nevada law has no jurisdiction over.
• Employees working in Nevada temporarily and who have insurance in their home state.
• Workers in jobs covered by private death benefits and disability plans.⁶

3. Where to file a work injury claim

Employers must provide employees with the proper forms to file a workers’ comp claim. These forms are also available online with instructions from the Nevada Department of Business and Industry, Division of Industrial Relations (DIR), Workers’ Compensation Section (WCS).

Workers’ compensation is the only way in Nevada for you to receive benefits for a work injury.⁷ You generally cannot sue an employer in civil court.⁸

However, Nevada workers’ compensation laws are designed to ensure quick and efficient compensation to injured or disabled workers but at a reasonable cost to their employer.⁹

All employers are required to have workers’ compensation insurance to pay for the cost of work injuries.¹⁰ There are special provisions when an employer does not have workers’ compensation insurance.

4. How to prove a work injury

You do not have to show that the employer did anything wrong to claim a work injury. Workers’ comp is no-fault insurance. Instead, you only have to prove the injury occurred at work.

For an occupational injury, you have the burden of showing that the condition was caused by or was contributed to by the job and was not merely the result of the natural progression of a preexisting disease or condition.¹¹

The burden of proof is a preponderance of the evidence.¹² This means that it is more likely than not – or a 51% chance – that the injury or condition is work-related. Examples of work-related accidents include:

• A factory employee gets sick from accidentally inhaling toxic chemicals
• A construction worker employee falls off of scaffolding
• A receptionist gets injured when a light fixture falls on him
• A white-collar employee gets in a car accident while driving to meet up with a customer
• An employee slips and falls on a newly cleaned floor in the office

5. How to file a claim

Benefits for injured workers are set by Nevada statutes. There are specific procedures for filing a workers’ compensation claim in Nevada.

5.1. Initial incident

When you have an injury, you should report it to a supervisor.¹³ The supervisor should provide a form called a Notice of Injury or Occupational Disease (C-1 form). It is an incident report that records:

• the date of the accident
• the time of the accident
• what was the injury that resulted
• the parts of the body injured
• how the injury occurred
• where the injury happened
• confirmation that it occurred while working
• witnesses
• if you left work
• whether first aid was provided
• if there was anyone else involved

The form should be filled out within seven days of the injury.¹⁴

Filing the form does not mean that you require medical treatment. It only means that there was an incident at work

Example: Thomas is a blackjack dealer and injures his back at work. He tells his supervisor.

Thomas is given an Incident Report form. He fills it out and signs it.

The report only notes the incident, it does not mean Thomas necessarily needs medical treatment or that he filed a workers’ compensation claim.

Note that employers need to keep C-1 forms for three years.

5.2. The claim of work injury

You should file a workers’ compensation claim if you have

• sought medical treatment for a work injury, or
• been off work due to a work injury

You should go to an unauthorized doctor under the workers’ comp insurance. You and the physician then must both complete the Employee’s Claim for Compensation/Report of Initial Treatment (C-4 form).

You fill out the first half of the form, and the examining doctor fills out the second half.¹⁵

Injured worker’s portion

The C-4 form requires the same information as the Notice of Injury or Occupational Disease form above as well as the:

• name of the insurance company, and
• your occupation

If you do not know the name of the insurance company, you can look at the required worker’s compensation poster¹⁶ at the employer’s office. Or else you can ask the employer.

This information is also available online by searching for the Nevada employer. There is also a list for self-insured Nevada employers.

Doctor’s portion

The second half of the C-4 form is for the doctor who evaluates you. It includes:

• diagnosis
• description of injury
• if the injury is work-related
• treatment provided
• further care needed
• if you were under the influence
• if you should remain off work for more than five days
• any previous injury or disease contributing to the injury

The doctor must complete and mail the form within three days of treatment. Copies of the form are is sent to the insurance company, employer, and you.

When the form is sent in, a workers’ compensation claim is filed.

Example: Janet is a retail manager. She injures her shoulder at work. She already filled out an Incident Report.

Janet went to the doctor and requires treatment for the injury. Janet fills out the top part of the Claim for Compensation and gives it to her doctor.

The doctor fills out the bottom portion of the form and sends it in to the insurance company. Janet’s workers’ compensation claim has now been filed.

6. Insurance company response to claim filing

The insurance company has 30 days to accept or deny the claim after getting the Claim for Compensation. The insurance company will also review the Employer’s Report (C-3 form) of the injury as well as the Wage Verification (D-8 form).

The employer must submit the Employer’s Report and Wage Verification to the insurance company within six (6) working days of receiving the Employee’s Claim for Compensation (C-4 form). (The Employer’s Report includes such information as date of hire and wage history.)

The insurance company then will:

• accept the claim, notify you, and begin paying benefits; or
• deny the claim and notify you and the Nevada Department of Industrial Relations of its denial¹⁷

Example: Dean is a Nevada firefighter who suffers a burn injury at work. The insurance company receives the Claim for Compensation. It also reviews the Employer’s Report.

The insurance company accepts the injury. It will send Dean a notice in the mail and pay for any benefits he may require.

7. Nevada workers’ compensation benefits

All private employers in Nevada must maintain workers’ compensation coverage. You are entitled to certain benefits to compensate you for the work injury and to pay for the cost of treatment.

The benefits are to:

1. limit the burden on you while you are being treated for the injury,
2. compensate you for any permanent damage because of the injury, and
3. ensure you have the opportunity to return to work if you are able.

There are special benefits available to some Nevada employees, such as police officers and firefighters. Employers may also place you on light duty.¹⁸

7.1. Medical treatment

You are entitled to medical treatment for your injury or illness. However, you must use an authorized medical provider. As of 2019, if you have a claim under the Nevada Industrial Insurance Act or the Nevada Occupational Diseases Act, you will be able to choose a doctor from a larger list.

Treatment includes:

• medical care
• surgery
• hospital stays
• nursing
• medicine
• physical therapists for ongoing care
• assistive devices¹⁹

See our related articles, How does utilization review work in Nevada workers’ comp cases? and Can I get out of state care in a Nevada workers’ compensation case?

7.2. Payment for lost wages

If you are off work for more than five consecutive days or five days in a 20-day period, you will receive temporary disability awards – benefits amounting to two-thirds of your monthly wage.²⁰

The employer will submit a wage verification form.²¹

7.3. Payment for permanent loss of function

If you have a permanent loss of function, you are entitled to permanent disability benefits.²² You can be permanently partially disabled (PPD) or permanently totally disabled (PTD).

Permanent disability is based on a percentage determined by a doctor. The greater the percentage, the greater the disability.

The insurance company will request and schedule an appointment with a special rating doctor or chiropractor within 30 days of receipt of a ratable report.²³

The doctor will rate the disability level based on the American Medical Association Guides to the Evaluation of Permanent Impairment.²⁴

Payments are made over time, but you can elect to receive the payments in a lump sum.

7.4. Death Benefits

Spouses and dependents of deceased Nevada workers are entitled to death benefits.²⁵ Death benefits include:

• funeral/burial expenses not to exceed $10,000
• payment of two-thirds of the average monthly wage earned by the deceased worker to the surviving spouse and children²⁶

If there are no children, the spouse receives the payment for the rest of the spouse’s life. If there are children, the spouse gets 50% of the total amount for the rest of the spouse’s life. The children split the remaining 50% until each reaches 18 years old.²⁷

The death claim must be filed within one year of the worker’s date of death.²⁸

7.5. Retraining benefits

Every effort is made to return you to your prior job after an injury has stabilized. However, you are entitled to vocational rehabilitation and training benefits if you cannot return to work.²⁹

You will work with a vocational rehabilitation counselor to find a new trade or profession.

You can also settle the rehabilitation with a lump sum payment after signing that you understand the consequences.

Note that undocumented workers are not entitled to vocational rehabilitation benefits because federal law prohibits hiring illegal aliens. But undocumented workers are entitled to other workers’ comp benefits.³⁰

7.6. Mileage reimbursement

You should fill out an Application for Reimbursement of Claim Related Travel Expenses to claim mileage reimbursement.³¹

You can also request reimbursement for attendance at hearings. This includes food, lodging, and lost wages.³²

8. Insurance company decision to end the claim

The insurance company will decide based on medical evidence how long your claim will remain open and any permanent disability benefits that will be paid. It will also decide if vocational rehabilitation is necessary.

The insurance company will send a notice when the claim is closed.³³

9. Appeal of the insurance company decision

If you disagree with the decision or actions of the insurance company, you can appeal to the Department of Administration, Hearings Division. To appeal, you must file a Request for Hearing – Contested Claim within 70 days of the decision.³⁴

You also have the opportunity to settle your Nevada workers’ compensation claim.

10. Reopening a Nevada workers’ compensation claim

If a work injury gets worse after a claim has been closed, the workers’ compensation claim can be reopened.³⁵

Reopening a claim requires a letter from a doctor that states that:

• your condition has changed, and
• the change is the result of the original injury.³⁶

You send the letter to the insurance company and ask them to reopen the claim.

Example: Jerry is a Nevada police officer injured in the line of duty. His claim for his back injury has been closed for three years. But Jerry’s back condition is worse. He believes it is from his work injury.

Jerry goes to the doctor and gets his doctor to write a letter that agrees with Jerry’s opinion.

Jerry sends the letter to the insurance company and requests that his claim be reopened.

11. Understanding the basics of filing a workers’ compensation claim in Nevada

You should not necessarily believe or trust the information provided by your employer or the insurance company. You can obtain detailed information and forms at the Nevada workers’ compensation website.

Employers may try to fight workers’ comp claims by claiming that you intentionally hurt yourself, made up the injury, or were under the influence of alcohol or drugs. You should consider retaining an attorney to navigate the Nevada workers’ compensation system and obtain the benefits you deserve.

12. Frequently-asked-questions

1. Is there workers’ compensation in Nevada?

Yes. Employers who sustain a work-related injury in Nevada can file a workers’ comp claim. In many cases, collecting workers’ comp benefits is an exclusive remedy. This means that you cannot sue the employer directly for the injury.

2. Is workers’ compensation insurance required in Nevada?

Yes. Any company with one or more employees is required to carry workers’ compensation insurance. If an employer does not have insurance, you can file a claim for compensation with the Division of Industrial Relations or deal directly with the employer regarding compensation. And the employer could face up to $15,000 in fines.

3. How does workers’ compensation work in Nevada?

If you sustain a work-related injury, first notify the employer within 7 days of the injury. Then see a physician authorized by the workers’ comp insurance plan.

The provider then submits the C4 form to officially file the worker’s comp claim. Meanwhile, the employer will file an employers report about the incident.

Within 30 days of receiving the C4 form, the insurance company will accept or deny the claim. If the claim is denied, you can appeal. If the claim is approved, you will start receiving benefits depending on the extent of the injuries.

4. What is a C4 form?

The C4 form is a form that both you and the physician must fill out in order to make a workers’ compensation claim. This form must be filled out within 90 days of the injury. The physician must submit the form within three days of treating you.

5. What percentage does workers’ comp pay in Nevada?

Workers’ comp disability payments are capped at $4,873.20 per month.

Both temporary total disability (TTD) and permanent total disability benefits amount to two-thirds of your average monthly wages. And a temporary partial disability benefit is the difference between what the TTD amount would have been minus your new salary.

In order to calculate permanent partial disability (PPD), your physician will first assign you an impairment percentage. (For instance, a person who is half impaired is assigned a 50% disability rating.) Permanent partial disability is determined by multiplying your pre-injury monthly salary by the disability rating number, and then multiplying that product by .006. Many workers opt to receive PPD benefits as a lump sum.

6. How long does workers’ comp last in Nevada?

Temporary total disability (TTD) payments last until you achieve maximum medical improvement (MMI) and are recovered enough to work. If you are still injured but can perform modified duties, you may then be eligible for temporary partial disability. If your work injuries are permanent, you could receive permanent benefits.

Meanwhile, temporary partial disability benefits are available for as long as the disability lasts to a maximum of two years.

Permanent partial disability benefits last for as long as you are completely disabled until you reach age 70 (unless you opt to get a lump sum instead). If you are older than 65 when you get injured, payments last for about five years. If you are on permanent total disability, you typically receive payments for the rest of your life.

7. Does a sole proprietor need workers’ comp in Nevada?

No. Sole proprietors who have no employees are not required to carry workers’ comp insurance in Nevada.

Injured at work in Nevada? Call us for help…

If you or someone you care about was injured at work in the state of Nevada, our Las Vegas workers’ compensation attorneys may be able to get you compensation for your claim.

See our related articles on workers’ compensation fraud and workers’ comp A-Z. To learn more about workers’ comp insurance rates, visit the National Council on Compensation Insurance (NCCI) and the Nevada Division of Insurance, Property & Casualty.

Also see our related articles, What is a “Medicare Set-Aside” in a Nevada Workers’ Compensation Case?, Is carpal tunnel covered by workers’ compensation in Nevada?, Nevada Work Injury Laws – 4 That You Should Know, How do I acquire a Nevada workers’ compensation account?, and Can a Company Retaliate Against a Worker for Filing a Workers Compensation Claim in Nevada?

For cases in California, please visit our page on how to bring a workers’ compensation claim in California.

For a free consultation to discuss your case simply fill out the form below or call us.

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