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C-240 Employer's Statement of Wage Earnings Preceding Date of Accident.
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.
For each percent of impairment, you will receive 0.6% of your average monthly wage at the time of your injury. For example, suppose you have 10% impairment, and your average monthly wage is $2,400. Your permanent partial disability award would be calculated as follows: (. 006) x $2,400 x 10 = $144 per month.
For each percent of impairment, you will receive 0.6% of your average monthly wage at the time of your injury. For example, suppose you have 10% impairment, and your average monthly wage is $2,400. Your permanent partial disability award would be calculated as follows: (. 006) x $2,400 x 10 = $144 per month.
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.
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Compensation Rates An injured employee is entitled to a compensation rate equal to two-thirds of the average weekly wage (AWW) in New York State for the 52-week period immediately prior to the date of accident. The rate is subject to prescribed maximums and degree of disability.
For each percent of impairment, you will receive 0.6% of your average monthly wage at the time of your injury. For example, suppose you have 10% impairment, and your average monthly wage is $2,400. Your permanent partial disability award would be calculated as follows: (. 006) x $2,400 x 10 = $144 per month.
EMPLOYEE'S CLAIM FOR COMPENSATION/REPORT OF INITIAL TREATMENT. FORM C-4.
The only situations in which an employer would not be required to provide coverage are: If the business is owned by one individual and there are no employees, leased employees, borrowed employees, part-time employees, unpaid volunteers, or subcontractors.
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.

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