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Workers’ Compensation Claim Process

What’s Going On with Your Work Injury Claim?

When you suffer a work-related injury or you develop an occupational illness, it’s important to understand how the workers’ compensation claim process works so you don’t accidentally jeopardize your right to receive money and medical treatment while you recover. Give our office a call right away to schedule a free consultation. We can go over any questions you might have, explain how certain rules may apply to your situation, and help you understand how the claim process works.

Were You Injured at Work? First Things First.

If you’ve suffered a serious or life-threatening injury, the first thing you should do is get medical help right away. Call 9-1-1 or go to the nearest hospital emergency room before you do anything else. Don’t worry, we can help you pick up the pieces and move forward with filing your claim for injuries once your condition has stabilized.

Notifying Your Employer

If your injury is not a medical emergency, you’ll need to report your accident to your employer right away. Although you have seven days from the time you were injured to let your employer know you’ve been hurt on the job, the sooner you file a report, the better. Putting off a report can cause medical care to be delayed, allow evidence to disappear, and give time for any witnesses to forget what really happened. If you wait longer than seven days to report your injury, your claim will likely be denied.

When you report your injury to your employer, you’ll need to fill out a form C-1; Notice of Injury or Occupational Disease. In Nevada, your employer is required to keep this form on file for a minimum of three years. This form is important because it can help establish a timeline to show when the symptoms of your injury or illness first appeared. You will also need to complete your portion of form C-4; Employee’s Claim for Compensation/Report of Initial Treatment and take this form with you when you see the doctor.

Obtaining Medical Care

When your injuries do not require emergency care, you must seek treatment from an authorized medical professional. For non-emergency conditions, your employer can provide you with information about which healthcare providers to see.  If your injuries are a medical emergency, you can see any doctor, hospital, or other healthcare provider you choose. Even when your injuries do not appear to be severe at first, you should get checked by a doctor. If the symptoms get worse over time and you did not get checked out when the incident happened, you can lose your right to recover money for lost wages and medical bills under the workers’ compensation system.

Additionally, be sure to follow the instructions of the medical care team. Attend all follow-up appointments, take prescribed medications, and follow through with medical treatments. If you do not follow the advice of the medical team, your claim could be denied.

When you first obtain medical care, be sure to notify the healthcare team that your condition is work-related. The physician will need to fill out his or her portion of the C-4 form and return it to your employer and the insurer within three working days after you’ve been treated. Your workers’ comp claim does not officially begin until this form is filed.

When you are hurt at work, you must file a claim to recover money for missed work and medical bills within 90 days after the incident. Survivors of those who were killed on the job have up to one year after their loved one’s death to file a claim for compensation.

What Happens Next

Within six working days of receiving the C-4 form from the attending physician, your employer must file for C-3; Employer’s Report of Industrial Injury or Occupational Disease with the workers’ compensation insurance provider. At this point, the insurer will evaluate your claim for workers’ compensation benefits.

Claim Determination

Your employer’s insurer has 30 days after receiving form C-4 to act on your claim. By this deadline, the insurer must:

  • Accept the claim and notify you of its acceptance
  • Start paying on the claim
  • Deny the claim and notify you and the DIR of the denial

If Your Work Injury Claim Is Denied

If the workers’ compensation insurance company denies your claim or only accepts a portion of it, give us a call as soon as possible to discuss your legal options. You only have 70 days from the day you received the denial letter to file an appeal. Additionally, you must follow the guidelines set forth by the workers’ comp laws in Nevada when filing an appeal. Failure to do so can cause you to lose your right to recover benefits. We can help make sure you don’t miss any deadlines and the proper forms are filed on your behalf.

When you file an appeal with the Hearings Division of the Nevada Department of Administration, you’ll need to get prepared. We’ll help you collect evidence, get copies of your updated medical records, obtain physician statements, and demonstrate how your injuries prevent you from working if applicable.

Determining When Your Injury Happened

Determining whether your injury happened during the course of your employment is significant when you file a workers’ comp claim and when you appeal an adverse decision. One of the most common reasons for the denial of work injury benefits is a dispute over when claimants became injured and whether the injuries are considered work-related.

An injury is usually considered work-related from a workers’ compensation standpoint when an incident or exposure occurred during activities that were performed for work. Work-related injuries can happen at your place of work, at a company-sponsored event, or while you are traveling for the benefit of your employer. While this may sound pretty straightforward, some common situations can make determining whether an injury is work-related rather complicated.

  • Unpaid lunch breaks
  • Company events
  • Travel
  • Consumption of alcohol or drugs, horseplay, and other misconduct

The connection between your work and cumulative injuries, occupational illnesses, and the aggravation of preexisting conditions can be even more difficult. If your job is to blame, we can help you demonstrate how conditions or incidents at work played a role in the development of your condition

If you question whether your injuries happened during the course and scope of your employment, call our office Even if your injuries are not covered under workers’ compensation insurance, you may be able to recover damages by filing a third-party personal injury lawsuit.

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