Nevada Workers’ Compensation Insurance Laws – A Legal Guide

Unlike odds in Las Vegas, your health isn’t something you should roll the dice on. Fortunately, Nevada workers’ compensation law ensures that any employee who experiences a work-related injury has coverage.

A form of no-fault insurance, workers’ compensation will pay for medical bills, lost wages, and even lump sum disability payments. In return, an employee forfeits the right to sue their employer over an injury.

In most cases, the system is mutually beneficial. However, it’s important to be aware of all the ins-and-outs of Nevada workers’ compensation benefits.

Keep reading our guide to learn the information you need to know to get help when facing a work-related injury.

Workers’ Compensation Nevada Requirements

The first requirement in a Nevada workers’ compensation claim is to prove your injury directly resulted from a work-related activity. Workers’ comp does not cover losses caused by incidents unrelated to work.

Because Nevada’s workers’ compensation insurance is no-fault, it doesn’t matter whether you caused the accident. As long as you can prove more likely than not your injury was work-related, you may qualify for a workers’ comp claim.

To start your claim, you must first notify your employer within seven days of your injury through an Incident Report. To request medical care, fill out an Employee’s Claim for Compensation form (Form C-4) to speak with an employer-provided specialist.

Who is Required to Carry Workers’ Comp in Nevada?

With a few exceptions, all employers with at least one employee must carry workers’ comp insurance in Nevada.

In Nevada, the definition of an employee is anyone who works for another, whether lawfully or not (NRS §616A.105). This holds true whether there was a written or oral agreement, or simply expressly implied terms of employment.

Nevada is more inclusive in some ways than other states as to whom they call an “employee” or “worker”. That’s because Nevada considers sole proprietors, independent contractors, subcontractors (and their employees), all to be workers an employer must cover.

According to Nevada workers’ compensation law, the state also requires employers to cover for:

• Undocumented alien workers and minors
• Elected and appointed paid public officers
• Members of boards of directors
• Performing musicians for hire

If an employer refuses to carry a Nevada workers’ compensation policy, they may be liable to fines up to $15,000. They’re also risking a civil lawsuit as the injured worker has the right to sue for their injuries.

Whatever insurance premiums employers must pay may most likely be much less than damages from a personal injury lawsuit. Especially because there are no caps on personal injury claims in Nevada.

Who is Exempt from Workers’ Comp?

While every business in Nevada must provide workers’ comp for their employees, there are a few exceptions (NRS §616A.110). Employers in Nevada don’t have to include coverage for:

• Workers in interstate commerce positions over which Nevada state laws have no jurisdiction
• Household or domestic employees
• Agricultural/horticultural workers
• Clergy members
• Real estate brokers
• Casual employees (meaning employment not lasting more than 20 days or paying over $500)
• Employees who are temporarily working in Nevada but have insurance in their home state
• Workers in jobs covered by private death benefits and disability plans (in companies established pre-1947)

If you’re unsure if you need coverage for an employee, you can always check with the State of Nevada Department of Business & Industry Industrial Relations (DIR).

Employer Penalties for Noncompliance

According to the Nevada DIR, there are steep penalties for not having a workers’ compensation plan. These may include:

• Fines up to $15,000
• Mandates to close the business until they obtain workers’ comp insurance
• Financial responsibility for all costs arising from the work-related injury
• Potential criminal penalties for claims resulting in substantial bodily harm or death (NRS §616D.200)

Basically, if you plan to do business in Nevada and hire employees, you will need a workers’ compensation policy.

The good news is that employers may easily purchase insurance from a private carrier with Nevada licensure. Businesses may also apply for self-insured employer status with the Nevada Division of Insurance.

How to File a Workers’ Compensation Claim in Nevada

The primary step if you experience a workplace injury is to assess the severity. If it needs immediate attention, do not hesitate — call 911 or get to urgent care/emergency right away.

Though you won’t yet have employer permission, you don’t want to delay getting the help you need. Tell the doctor it’s a work-related injury and ask for detailed records. Also note that it’s illegal for a doctor to bill you if your injury is a work-related emergency.

If your injury/illness doesn’t require instant medical treatment, then you’ll first need to report your injury to your employer.

While every case is different, in general you should follow these steps at the onset of a work-related condition:

1. Report your injury or illness to your supervisor ASAP. You must do this within 90 days of the accident or condition start date. But sooner is better.
2. Ask for a “Notice of Injury or Occupational Disease” (C-1 Form). Both you and your supervisor must complete, sign, and date this form within seven days of your reported injury/illness.
3. Request a list of insurer-authorized doctors/chiropractors from your employer. Unfortunately, with this system you don’t get to choose your doctor. So, it’s important that you find out which providers are permissible before seeking additional treatment.
4. Get a “Report of Initial Treatment” (C-4 Form) at your first appointment. While you can fill out the first part of this, you’ll need your doctor to complete the rest. The doctor must also file this report within three days of your visit (NRS §616C.040).
5. Wait for a determination. Your employer’s insurer has 30 days from this point in which to approve or deny your claim.

Types of Workers’ Compensation Benefits in Nevada

Various forms of workers’ comp benefits are available to injured employees in Nevada. The assignment of these benefits depend upon the severity of your injury or illness.

Some of the potential benefits may include:

• Medical treatment. This includes doctor and surgery bills, but also things like prescription drugs, diagnostic tests, and blood work. It also will cover physical therapy, chiropractic care, and assistive devices (like wheelchairs or crutches).
• Temporary Total Disability/Temporary Partial Disability (TTD/TPD). This is money for lost wages while recovering from the injury. TTD kicks in when a worker misses five or more work days, covering two-thirds of a worker’s average weekly wage up to a fixed ceiling. TPD becomes available when an employee can work, but at a lower capacity than before the injury.
• Permanent Partial Disability (PPD). These benefits come into play when an employee suffers a permanent injury but it only partially impairs their work ability.
• Permanent Total Disability (PTD). If a doctor determines that an injured employee can never return to work, then PTD benefits become available.
• Vocational Rehabilitation. This may include treatment like occupational therapy, but also money to retrain the employee for a different career.
• Dependent’s payments in the event of death. If an employee passes away as a result of their injury/illness, then workers’ comp gives death benefits to surviving kin. This includes spouses, children, parents, or siblings.
• Other claims-related benefits or expenses. Basically, if it’s a medical expenditure that’s necessary for your recovery from a work-related illness or injury, it will be coverable. Claimants should fill out an Application for Reimbursement of Claim Related Travel Expenses form.

Injuries Under Nevada Workers’ Comp Law

The primary criteria determining if an injury qualifies for workers’ comp is that it happens because of the employee’s job.

Beyond that there are certain types of injuries that are more likely to qualify for coverage. These include:

• Accidental injuries. This means that some event at work like a fall or accident has left a worker with an injury. This includes things like broken bones, cuts, burns, limb loss, etc.
• Occupational diseases. These refer to illnesses that develop or worsen because of work. Examples include conditions emanating from the inhalation of toxic chemicals, long-term exposure to loud noise, or repetitive strain injuries.
• Pre-existing conditions. If an employee has a pre-existing condition that’s made markedly worse because of work conditions, a workers’ compensation claim may receive approval. However, the amount a claimant receives may be reduced due to the source of the condition being pre-existing.
• Mental health injuries. In the past these weren’t usually a part of workers’ comp claims. However, in recent years Nevada workers’ compensation laws cover mental health injuries resulting from work-related stress or trauma. Examples may include PTSD, anxiety, and depression.

Finally, in order for a Nevada workers’ comp claim to receive approval, the injury must not be:

• Self-inflicted or intentional
• Due to horseplay or fighting
• Because the employee is under the influence of drugs or alcohol
• In violation of company policy

The Nevada Going-and-Coming Rule

Another exclusion from workers’ comp coverage comes in the form of injuries an employee sustains while commuting. The Nevada going-and-coming rule generally prevents employees from receiving workers’ comp due to injuries to or from work.

The caveat here is that the worker must work in one location. There are other rules if someone is driving a company vehicle to a work location at the direction of their employer. Or if they’re running a special errand and the injury occurs then.

In general, however, commuting doesn’t count as acting within the course and scope of employment at your job.

Proving a Work Injury in Nevada

To qualify for workers’ comp, a Nevada worker need only show that their injury happened within their scope of employment. In layman’s terms, that means “while doing their job”.

In other words, the employee doesn’t have to show negligence or liability on the part of the employer. However, to request workers’ comp, an injured worker must follow correct protocol, which means submitting claims and forms on time.

On the flip side, employers are unable to defend against a workers’ compensation claim. That is, unless they can show the worker’s injury did not fall within the scope of their employment or duties.

This no-fault insurance system in Nevada generally protects both parties as long as they’re being honest. Anyone thinking of levying a false claim just to get benefits should remember that there are stiff penalties for workers’ comp fraud.

How to Submit a Nevada Workers’ Compensation Appeal

If you feel your employer is mishandling your claim or it’s erroneously denied by an insurer, you still have rights.

Nevada workers’ compensation law requires insurers to provide the right to appeal through the Nevada Department of Administration, Hearings Division.

This division is set up to resolve disputes in claims. If you disagree with a claim determination, you may appeal the decision:

• Within 70 days from the date of the insurer’s determination.
• Within 30 days of rejection from a Managed Care Organization (MCO).

Workers’ comp laws can get very confusing, especially at the point of an appeal. It’s also possible that you didn’t receive approval because your injury wasn’t work-related or you were late filing. Getting a lawyer at this juncture is vital so you don’t end up losing on a technicality.

Consult a Workers’ Comp Attorney to Maximize Your Claim

If you have a pending Nevada workers’ comp claim, it’s a good idea to consult with an attorney.

Workers’ compensation cases are tricky and having someone in your corner who knows Nevada’s laws can only help!

Plus, the legal professionals in our network mostly work under contingency. That means their services will cost you nothing up-front, and only a small percentage if you win.

Let us help connect you with a lawyer in your area today! We want to get you the coverage you need so you can focus on healing and returning to work.