This form is a case information progress report which details the status of the file.
Nevada Personal Injury Progress Report
State:
Multi-State
Control #:
US-PI-0233
Format:
Word;
Rich Text
Instant download
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Description
How to fill out Personal Injury Progress Report?
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FAQ
Unfortunately, you do not get to choose your own doctor when you've been injured on the job; your employer chooses the doctor. If you feel that you are being released from care too soon or that you need different medical care, a workers' compensation attorney can have you evaluated by a trusted physician.
Nevada Workers' Compensation Requirements 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.
6 Injured Employee's Request for Compensation (7/99)
Complete the Notice of Injury or Occupational Disease, Form C-1. You must fill out this form and turn it in to your employer within one week of your injury. If your work-related injury requires medical treatment, you will need to fill out Form C-4, Employee's Compensation Report of Initial Treatment.
Workers' Compensation Benefits May Include The Following: Permanent Total Disability (PTD); Vocational Rehabilitation; Payment to your dependent's in the event of your death; and. Other claims-related benefits or expenses (i.e., mileage)
"NOTICE OF INJURY OR OCCUPATIONAL DISEASE"
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.
Inform the medical provider that you were injured at work. The C-4 form starts the workers compensation claim process. The employee has 90 days from the date of injury to seek medical treatment. ( NRS 606C.020) The bottom half of the C-4 must be completed and signed by a medical provider.