Step-by-Step Worker’s Compensation Claim Filing Instructions

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 rmic-group@unlv.edu.

  • An employee has 90 days to seek medical treatment after submitting a C-1 form should their condition worsen.

Additional Information

  • 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.

  • Complete the C-1 form and forward it to Risk Management & Safety via UNLV Secure File Transfer or fax (702-895-5227).
  • CSN, NSC, and external email users without a “@unlv.edu” email can register for an account to send secure files.
    • Click “Log In to Secure File Transfer” box and follow the instructions.
  • After you log in to the UNLV Secure File Transfer website, email the documents to workerscompforms@unlv.edu. Add the worker’s name in the “Message” box.
  • It is important that you securely email any document containing HIPAA and PII information, including the C-1.
  • The C-1 must be submitted within seven days from the date of the accident. NRS 616C.015
Form C-1

Form D-2 – Brief Description Of Your Rights and Benefits If You Are Injured On The Job

The D-2 form provides basic information of your rights and benefits relating to workers' compensation pursuant to NRS 616C.050.

Download and print a copy for the employee to retain for their records.

Form D-2

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.
Form C-4

Workers’ Compensation Witness Form

Fax the completed form to 702-895-5227 or email to workerscompforms@unlv.edu.

Workers’ Compensation Witness Form