FAQs

Workers’ Compensation: Frequently Asked Questions

This information is designed to give you a general understanding of the Nevada workers’ compensation system.

Starting Your Claim

What should I do immediately after a work injury?

If you suffer a serious injury, you should go directly to the nearest emergency room for treatment.

Regardless of the severity, you must take the following steps:

• Notify your employer/supervisor immediately.
• Complete Form C-1 (Notice of Injury or Occupational Disease). You, or a dependent, must provide this written notice to your employer as soon as practicable, but within 7 days after the accident. For occupational diseases, the deadline is 7 days after you have knowledge of the disability and its relationship to employment.

How do I formally file a claim for workers’ compensation?

The formal claim begins with the completion of Form C-4 (Employee’s Claim for Compensation/Report of Initial Treatment).

1. Employee’s Role: You must complete the top portion of the C-4 form and sign it when you seek initial medical treatment.
2. Medical Provider’s Role: The treating physician or chiropractor completes, signs, and is responsible for filing the C-4 with the employer and the insurer (or third-party administrator) within 3 working days after first providing treatment.

A claim is not considered filed until a completed C-4 form has been received by the claims administrator.

What is the deadline to file a workers’ compensation claim?

You must file your claim (Form C-4) within 90 days after the date of the accident or within 90 days after having knowledge of an occupational disease and its relationship to employment. If you wait too long, your claim will almost certainly be denied.

How long does the insurer have to decide if my claim is accepted?

The insurer or their claims administrator has 30 days after receiving the C-4 form to either accept the claim and begin payment or deny the claim. Denial letters must include information on your appeal rights.—–Coverage and Eligibility

Is workers’ compensation insurance mandatory for my employer in Nevada?

Yes. With only a few limited exceptions, every employer in Nevada—whether they employ one person or 1,000 people—must have workers’ compensation coverage for their employees. This generally also applies to subcontractors, independent contractors, and their employees.

What happens if my employer is uninsured?

If your employer does not have coverage, you should still seek medical treatment and complete Form C-4.

• The claim is handled under the State’s Uninsured Employer’s Claim Account (UECA), a state fund set aside to cover benefits for employees of uninsured businesses.
• You are entitled to the same range of compensation and benefits as if you worked for a fully insured employer.
• You must file Form D-17 to elect to receive benefits under the UECA.

What makes an injury “compensable” under Nevada law?

To qualify for benefits, you must prove, by a preponderance of the evidence, that the injury arose out of and occurred in the course and scope of your employment. Being on the job or “on the clock” alone is not sufficient.

• Occurred in the course of employment refers to the time and place—whether the injury occurred at work, during working hours, and while you were reasonably performing your duties.
• Arose out of employment requires a causal connection, meaning the origin of the injury is related to some risk involved within the scope of employment.

If I have a pre-existing condition, can I still file a claim?

Yes. A pre-existing injury does not automatically disqualify you from pursuing a workers’ compensation claim. If a work accident aggravates, accelerates, or precipitates a pre-existing condition, the burden of proof shifts to the insurer to show that the work accident was not a substantial contributing cause of your resulting condition.

Can I be fired for filing a claim?

Nevada is an “employment-at-will” state, meaning you can be terminated at any time without any reason. However, you may not be fired solely for filing a workers’ compensation claim.

What is a “Third-Party Claim”?

A third-party claim, or personal injury case, occurs when your work-related injury was caused by the negligence of someone who is not your employer or a co-employee.

• You may pursue this claim in addition to your workers’ compensation claim.
• If you recover money from the third-party claim, you will be required to reimburse the workers’ compensation insurer for the benefits they paid (such as medical bills and wage loss). Nevada law provides formulas to reduce the amount you must pay back, which typically results in you netting more money by pursuing both claims.

Benefits and Medical Treatment

What types of compensation and benefits are available?

If your claim is accepted, benefits may include:

• Medical Treatment: Payment for medically necessary treatment for the injury.
• Temporary Total Disability (TTD): Wage loss compensation paid bi-weekly if a treating doctor certifies you are unable to work for at least 5 consecutive days (or 5 cumulative days in a 20-day period). This is calculated as 66 2/3% of your average monthly wage.
• Temporary Partial Disability (TPD): Compensation to make up the difference if your wage upon reemployment is less than the TTD compensation.
• Permanent Partial Disability (PPD): A lump sum award at the end of the case if a rating physician determines a permanent injury remains after your condition is stable.
• Permanent Total Disability (PTD): Monthly benefits if you are permanently and totally disabled.
• Vocational Rehabilitation Services: Services like retraining if you are unable to return to your pre-injury job due to permanent physical restrictions, and your employer cannot accommodate them.
• Transportation and Per Diem Reimbursement: Eligibility for travel expenses for medical treatment if you travel more than 20 miles one way (or 40 miles in one week).

Can I choose my own doctor for treatment?

You must go to an authorized medical provider who is a member of the Panel of Treating Physicians and Chiropractors. However, within 90 days of the accident, you may select a physician or chiropractor from a list (PPO list) provided by the workers’ compensation insurer.

Do I have the right to reopen my claim in the future?

Yes. You may be able to reopen your workers’ compensation claim if your condition worsens after it is closed. You usually have lifetime reopening rights under Nevada law if you received a Permanent Partial Disability (PPD) award or missed time from work during the original claim.

Appeals and Resources

What should I do if my claim is denied or I disagree with a determination?

You have the right to appeal any determination from the insurer that adversely affects your claim.

• First Appeal (Hearings Officer): You must file a Request for Hearing with the Hearings Officer office within 70 days of the date of the insurer’s determination letter.
• Second Appeal (Appeals Officer): If you disagree with the Hearing Officer’s decision, you have 30 days to file a Request for Hearing before the Appeals Officer.
• Judicial Review: If you disagree with the Appeals Officer’s decision, you may file a Petition for Judicial Review before the District Court.

What outside resources are available to injured workers?

You can contact the following resources for assistance:

• • Nevada Attorney for Injured Workers (NAIW): NAIW is a group of public attorneys who represent injured workers free of charge in litigation at Appeals Officer hearings.
  • Division of Industrial Relations (DIR)/Workers’ Compensation Section (WCS): You can contact the WCS for assistance if you feel your claim is not being handled properly.
    • WCS Southern Nevada: (702) 486-9080
    • WCS Northern Nevada: (775) 684-7270