To submit a worker’s compensation claim, follow the step-by-step instructions below to ensure accurate filing and timely processing.
Step 1: Seek Medical Treatment
An employee injured while on the job requiring medical treatment should visit a local urgent care facility or emergency room. During the visit, the employee must:
Inform the treating physician that the injury occurred while at work.
Ensure that a C-4 form is completed by the attending physician.
Request a doctor’s note (required) to support an absence from work under a workers' compensation claim.
Step 2: Report The Injury
All injuries, including incidents where an employee does not require medical treatment, must be reported by submitting a C-1 form within seven days from the day the incident occurred. The form must be signed by an employee’s supervisor before sending it to email@example.com.
An employee has 90 days to seek medical treatment after submitting a C-1 form should their condition worsen.
Once Risk Management & Safety receives an employee’s C-1 and/or C-4 form, a department representative will contact the employee and provide the claim number and other pertinent information.
CorVel Corporation, NSHE's third-party administrator, will handle the claim.
Injury reporting involves the employee, their supervisor, and UNLV Risk Management & Safety.
Form C-1 - Notice Of Injury Or Occupational Disease
The C-1 is completed by the injured employee or supervisor for all accidents and injuries.
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.
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.
The medical provider will give you a copy of this form and will forward a copy to the workers' compensation office and/or the third-party administrator. NRS 616C.040.
If you are treated at a medical facility that is not on the approved workers compensation provider list, be sure to check with the workers' compensation office to ensure that the C-4 form has been received from the out of network facility.
Your claim cannot be processed for a workers’ compensation claim without the completed C-4 form.