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Workers Compensation Forms

Workers Compensation

Workers compensation forms must be filled out correctly in order to receive benefits; using an experienced attorney can help. 

What sort of workers compensation forms will you need to file?

Incident Report

The incident report (form C-1) gives the basic information about your injury and treatment. You and your supervisor both sign this form. You must complete this form as soon as possible after your accident/injury and, in no event, later than 7 days.

See Steps to Take After Being Injured on the Job for more information on what to do right after the accident.

Claim for Initial Treatment

Remember to file and mail this form within 3 working days of getting treatment. Along with information required in the Incident Report, you will need to provide information about your company, insurance and your job. Additionally, you will need to have the doctor fill out and sign information about your injury, treatment and the result of X-Ray and other tests. Claims for medical treatment must be filed within 90 days of the accident/injury.

Request for Compensation

A third form, “Injured Employee’s Request for Compensation” (form D-6), is required to get paid for time lost on the job. This form also requires information about the accident and your employer and doctor’s appointments. In addition, you will need to explain:

  • Whether you have returned to work for that employer or another job.
  • If you have been disabled for five days or more.
  • When you can go back to work, or what type of work you can do.

Travel Reimbursement

If you traveled to go to appointments related to your injury, you will need another form (D-26) to claim reimbursement. For this form you will need:

  • Where you traveled.
  • Travel time and miles.
  • When you left and arrived.
  • Cost of meals and lodging.

Navigating the process of filling out worker’s compensation forms can be difficult, but an attorney with expertise in this area can help. To learn more about worker’s compensation in Nevada, contact Greenman, Goldberg, Raby, and Martinez Law Firm at 702-388-GGRM (4476).




Steps to Take After Being Injured on the Job Offer