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Maximum disability compensation in Nevada is 66-2/3 percent of the Average Monthly Wage (NRS 616A. 065 and 616C. 475). If the earned wage on the dateof injury was less than $6,096.60 per month, compensation is 66-2/3 percent of the actual earned wage.
Filing A Workers' Compensation Claim The C-4 form is titled \u201cEmployee's Claim for Compensation/Report of Initial Treatment\u201d. The physician fills out their part of the form, and sends a copy to your employer and the insurer. Be sure to get a copy for your records.
Workers' compensation, a no-fault insurance plan, provides guaranteed financial payments for work related injuries and illnesses. Financial compensation includes lost wages (i.e. temporary disability payments), medical bills, and lump sum permanent disability payments.
The C-3 Employee Claim form allows workers to make a claim for compensation benefits with the New York Workers' Compensation Board. It gathers your personal information, your work position in the company, the type of injury or illness you received while on the job, and whether you obtained medical treatment.
Settlements are calculated based on a combination of lost wages, medical expenses, future medical expenses, specific loss, scarring, and more. Because factors vary so widely from case to case, it's nearly impossible to provide an average workers' comp settlement amount.
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Form C-3 Employer's Report Of Industrial Injury or Occupational Disease. As soon as you have been notified of a work-related injury, please fill out this form and submit it to EMPLOYERS. This form must be completed within 10 days from notice of an accident. Fatalities must be reported within 24 hours.
EMPLOYEE'S CLAIM FOR COMPENSATION/REPORT OF INITIAL TREATMENT. FORM C-4.
Form C-3 Employer's Report Of Industrial Injury or Occupational Disease. As soon as you have been notified of a work-related injury, please fill out this form and submit it to EMPLOYERS. This form must be completed within 10 days from notice of an accident. Fatalities must be reported within 24 hours.
Under Nevada law, you must report your injury within seven days. To make a claim, you will need to have a doctor sign off on your initial treatment. This will require a specific form. You must complete this form and have it signed and turned in within 90 days of your injury to make a workers' comp claim.
The compensation due is calculated on a calendar day basis, and paid at the rate of 66 2/3% of the average monthly wage, subject to the statutory limitation that creates a maximum average monthly wage benefit that is 150% of the state-calculated average monthly wage.

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