Nevada Workers’ Compensation Claims: Eligibility, Filing, and Appeals
Learn about your rights under the workers' compensation system in Nevada.
Nevada law requires all private employers with one or more employees to have workers’ compensation insurance. Worker’s comp pays for medical bills, lost wages, and any permanent disability suffered by workers who are injured on the job. However, there are certain guidelines that employees must follow in order to protect their interests. This article will help you understand if you’re eligible for workers’ comp, what benefits you can expect to receive, and how to file a workers’ comp claim.
Who is Eligible for Workers’ Comp Benefits?
Like most other states, Nevada workers’ comp covers injuries that happen in the course of employment. This means that if you’re injured while performing work-duties or running work errands, you will typically be covered by workers’ comp. On the other hand, injuries that are sustained while an employee is off-duty are not usually compensated through workers’ comp. For example, if you were injured during your lunch break or during your commute to and from work, you will typically not be covered by workers’ comp.
Traumatic injuries that result from a one-time accident at work, such as a broken bone from a slip and fall, are covered by workers’ comp. Occupational diseases are also covered, which are injuries or illnesses that occur over a period of time. This includes injuries caused by repetitive movements at work, as well as illnesses developed from exposure to toxic substances at the workplace.
What Should I Do if I’m Injured at Work?
If you are injured at work, you should notify your employer and get medical treatment right away. You must give notice to your employer in writing within seven days of your accident or injury. If you have an occupational disease, the clock begins when you discover that your disease was caused by work. Your employer can provide you with the necessary form to report your injury (Form C-1). If you delay in giving notice to your employer, or fail to give notice at all, your workers’ comp claim may be denied.
In an emergency, you can choose which doctor or hospital to seek treatment from. If your injuries don’t require emergency care, you’ll have to follow the workers’ comp guidelines for selecting a treating doctor. In Nevada, workers don’t have as much freedom to choose their health care providers as in some other states. If your employer has contracted with an Organization of Managed Care (MCO) or a Preferred Provider Organization (PPO), you will probably need to select a doctor from an approved list provided by your employer. And, even if your employer doesn’t have one of these networks, you may only select a doctor from a state-issued list of authorized medical providers, called the Panel of Treating Physicians and Chiropractors.
At your initial appointment, you should let the doctor know that your injuries are work-related. The doctor should fill out a required form called “Employee’s Claim for Compensation/Report of Initial Treatment” (Form C-4) and send it to your employer within three days of your appointment. The insurance company has 30 days after receiving Form C-4 to accept or deny your claim.
Your workers’ comp claim officially begins with the filing of Form C-4, which must be filed within 90 days of your injury. If your medical provider doesn’t fill out Form C-4 at your initial visit, make sure to follow up. If you miss this deadline, your workers’ comp claim may be denied.
What Benefits Can I Receive?
In addition to having your medical bills paid for all reasonably and necessary treatment, you are eligible to receive temporary disability payments and a permanent disability award.
If you are temporarily disabled and unable to work, you will be eligible to receive temporary total disability benefits. Temporary total disability payments are two-thirds of your average monthly wages, up to a maximum of $3,570.82 per month (for 2015). You can continue to receive total temporary disability until your doctor finds that you’ve reached maximum medical improvement (MMI), meaning that your condition has plateaued and is not expected to improve in the next year.
If you’re able to return to part-time or modified work while you’re recovering, you may eligible for temporary partial disability benefits. Temporary partial disability benefits are available for workers to make sure that they receive at least what they would receive under temporary total disability. These benefits are available for a maximum of two years.
For example, suppose you earned $3,300 per month before your accident, but receive $1,100 after going to part-time work. You would be entitled to $2,200 if you were totally disabled (two-thirds of $3,300), so you will receive $1,100 in partial disability benefits to make up the difference.
If you are found to be totally and permanent disabled, you will receive two-thirds of your average monthly wages for as long as you are totally disabled. Certain injuries, such as total blindness or amputation of both legs, are so severe that they are considered total permanent disabilities. Other injuries may also qualify, but in general, the worker must not be able to obtain gainful employment.
For partial disability, your doctor will evaluate you and assign a percentage to your overall impairment, from 1% to 100%. For injuries on January 1, 2000 and later, you will receive 0.6% of your average monthly wage for each 1% impairment. For example, if you have a disability rating of 50%, you will receive 30% of your average monthly wages. You will continue to receive monthly permanent disability payments until the age of 70. (Workers who are older than 65 will generally receive payments for five years.)
What if My Claim Is Denied?
If your workers’ comp claim has been denied, or the insurance company is disputing any portion of your claim, you have appeal rights under state law. The first step is filing an appeal with Department of Administration within 70 days of the denial. A Hearing Officer will hear from both sides and issue a decision in your case. If you disagree with the Hearing Officer’s decision, you may file an appeal with an Appeals Officer within 30 days.
For more information on the appeals process, see our article on appealing a denial of your Nevada workers’ comp claim.