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Form C-4 Employee's Claim for Compensation / Report of Initial Treatment - Nevada
What Is Form C-4?
This is a legal form that was released by the Nevada Department of Health and Human Services - a government authority operating within Nevada. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form C-4?
A: Form C-4 is the Employee's Claim for Compensation/Report of Initial Treatment form in Nevada.
Q: What is the purpose of Form C-4?
A: The purpose of Form C-4 is to report an initial treatment for a work-related injury or illness and initiate a claim for workers' compensation benefits.
Q: Who needs to file Form C-4?
A: Employees who have suffered a work-related injury or illness and seek workers' compensation benefits need to file Form C-4.
Q: What information is required on Form C-4?
A: Form C-4 requires information such as the employee's personal details, details of the injury or illness, medical treatment received, and relevant insurance information.
Q: When should I file Form C-4?
A: Form C-4 should be filed as soon as possible after the injury or illness occurs, preferably within 90 days.
Q: What happens after I file Form C-4?
A: After filing Form C-4, your claim for workers' compensation benefits will be reviewed, and further steps will be taken to determine your eligibility and the extent of benefits you may receive.
Q: Can I get assistance in filling out Form C-4?
A: Yes, you can seek assistance from your employer, an attorney, or a workers' compensation representative to help you fill out Form C-4.
Q: Is there a deadline for submitting Form C-4?
A: There is no specific deadline for submitting Form C-4, but it is recommended to file it as soon as possible after the injury or illness occurs.
Q: What should I do if there are changes in my condition or treatment after filing Form C-4?
A: If there are changes in your condition or treatment after filing Form C-4, you should notify the relevant parties, such as your employer, the workers' compensation insurance carrier, or the Nevada Department of Business and Industry, Office of the Labor Commissioner.
Form Details:
- Released on August 1, 2021;
- The latest edition provided by the Nevada Department of Health and Human Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form C-4 by clicking the link below or browse more documents and templates provided by the Nevada Department of Health and Human Services.
