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Workers’ Compensation

If you are injured by accident or exposed to a blood borne pathogen or bodily fluid on the job, report it to your supervisor immediately and contact the 24/7 Employee Injury Call Center at (877) 764-3574.

An injury or an occupational disease and/or exposure must be reported to your employer within 7 calendar days from the date of accident on the Notice of Injury or Occupational Disease, Form C-1. Please also review the Brief Description of Rights and Benefits, Form D-2 at this time. Calling the hotline does not take the place of completing the C-1 form. Reporting a claim to your employer and contacting the 24/7 Hotline is not the same as filing a claim.

You must seek medical treatment and complete the Claim for Compensation/Physician’s Report of Initial Injury, Form C-4, within 90 days from the date of injury. The C-4 form is the legal document for filing a claim in Nevada. The Release of Medical and Other Information for Nevada Workers’ Compensation Claims, Form C-4A, is also available here.

If you wish to seek medical attention, you must take the Physician’s Disability Statement Form (PDS) with you to each medical appointment (this includes the initial visit as well as all on-going treatment visits). It is your responsibility to obtain the Physician’s Disability Statement Form from your department prior to seeking medical attention. Failure to do so could affect the approval of your claim, as well as approval of time off due to the injury. This statement is to be completed by the attending physician on the date of treatment and provided to you. It is your responsibility to make sure that the physician fills the form out completely. You must present the completed statement to your supervisor as evidence of continued disability from work or ability to return to work. Please refer to the instructions for completion of the Physician’s Disability Statement Form.

You may be entitled to reimbursement for travel expenses directly related to your injury. If you are required to travel 20 miles or more (one way), or 40 miles or more in one week, for medical treatment directly related to your occupational injury or disease, you may be reimbursed for the cost of that transportation in accordance with NAC 616.582. You must file a claim by completing a D-26 form for reimbursement with Clark County’s Third-Party Administrator within 60 days after the travel takes place. The request for reimbursement must include the exact dates of travel, your destinations (both ways), and the exact number of miles traveled to each destination.

• Workers’ Compensation Frequently Asked Questions
• Workers’ Compensation Claims Processing Time Frames
• Clark County Injured Workers’ Guide
• Workers’ Compensation Preferred Provider Directory

Contact Risk Management at: Phone: 702-455-4544 Fax: 702-455-3084 Email: WorkComp@ClarkCountyNV.gov

For additional information, please refer to the Department of Industrial Relations website.

Rx Help Desk Phone Number – (800) 563-8438