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Filing A Workers' Compensation Claim The C-4 form is titled ?Employee's Claim for Compensation/Report of Initial Treatment?. The physician fills out their part of the form, and sends a copy to your employer and the insurer. Be sure to get a copy for your records.
Form C-4 ? Employee's Claim for Compensation/Report Of Initial Treatment. C-4 will be filled out and completed at the medical facility. It is not necessary to download this form. Inform the medical provider that you were injured at work.
EMPLOYER'S REPORT OF INDUSTRIAL INJURY.
INJURED EMPLOYEE'S REQUEST FOR COMPENSATION.
"NOTICE OF INJURY OR OCCUPATIONAL DISEASE" (Incident Report)
In Nevada it is required by law to provide workers' compensation coverage if you have one or more employees. Sole Proprietors and Partners are excluded from coverage by default, but may elect to include themselves for coverage.
"NOTICE OF INJURY OR OCCUPATIONAL DISEASE" (Incident Report)