The Nevada Employees Claim For Compensation Report of Initial Treatment is a detailed form designed to provide information about a workers' injury, illness, or condition, and the initial treatment for the same. It is required by the Nevada Division of Industrial Relations and must be completed within five days of the initial treatment. The report is used to determine whether the employee is eligible for workers' compensation benefits. The form includes information such as the employee's name, Social Security number, job title, date of injury, and a detailed description of the injury and the initial treatment. Depending on the type of injury, there may be additional forms or documents that must be completed, such as a physician's report. Different types of Nevada Employees Claim For Compensation Report of Initial Treatment include: Report of Injury with or without emergency medical care, Report of Occupational Disease, Report of Recurrence, and Report of Residual Impairment.
Nevada Employees Claim For Compensation Report of Initial Treatment
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How to fill out Nevada Employees Claim For Compensation Report Of Initial Treatment?
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6 Injured Employee's Request for Compensation (7/99) 7 Explanation of Wage Calculation (7/99) 8 Employer's Wage Verification Form (10/10)
DWC-1 Workers Compensation Claim Form. This is the form you will complete and send to EMPLOYERS to initiate the claim process for your employee.
In Nevada, a workers' compensation claim begins when a C-4 form is sent to the insurance company that your employer uses for workers' compensation coverage. 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.
Worker's compensation form completed when the patient first seeks treatment for a work-related illness or injury. It does not contain a signature line. It is filed with State Worker's Compensatin Board/Commission.
Every physician who treats an injured employee must file a complete Form 5021 Doctor's First Report of Occupational Illness or Injury (DFR) with the employer's claims administrator within five days of the initial examination.
Employer must complete and file with the insurer within 6 working days of receipt of the C-4 (if the C-4 indicates the injured employee will be off work for 5 consecutive days or more or 5 days in a 20 day period) or when requested by the insurer. Insurer/TPA should supply forms.
The employer is required to file an Employer's First Report of Injury or Illness DWC FORM-001 Rev. 10/05 with the injured worker's insurance carrier, and the injured claimant or the claimant's representative within 8 days after the employee's absence from work or receipt of notice of occupational disease.
Under worker's comp regulations, the first report of injury document must be filled by either the employer or the physician within a certain time period defined by state law.