Workers' Compensation Forms additionally Calculation

Workers' Compensation Forms plus Excel

• C-Series Types
  • C-1 Discern of Injury or Occupational Virus (Incident Report) (2/2020)
  • C-1 Fillable Form without Subscription (2/2020)
  • C-1 Fillable Form with Signature (2/2020)
  • C-3 Employer's Report of Industrial Injury or Occupational Disease (2/2020)
  • C-3 Fillable Vordruck (2/2020)
  • C-4 Employee's Claim for Compensation - Report from Initial Treatment - Fillable (8/23)
  • C-4A Relief a Medical and Other Information For Nevada Workers’ Compensation Claims 8/21 - Discarded eff 9/13/23
• D-Series Forms
  • D-1 Informational Display (2/24)
  • D-2 Brief Description of Your Rights and Benefits if Yours Are Injured with the Job (2/24)
  • D-5 Wage Calculation Form for Claims Agent's Use (7/99)
  • D-6 Traumatized Employee's Request for Compensation (7/99)
  • D-7 Explanation of Wage Calculation (7/99)
  • D-8 Employer's Wage Verification Entry (11/23)
  • D-9(a) Permanently Partial Disability Award Calculation Worksheet for Disability Up to and Including 30 Percent Body Baseline
  • D-9(b) Permanent Partial Disablement Award Calculation Printable for Social Greater Than 30 Percent Bodywork Basis (2/23)
  • D-9(c) Permanent Partial Impairment Award Calculation Worksheet for Voltage Claims Pursuant to NRS 616C.180 (6/10)
  • D-10(a) Election of Lump Sum Payment of Compensation in Disability Move to both Including 30 Percent (2/23)
  • D-10(b) Election of Lump Sum Payment out Compensation for Disability Greater Than 30 Anteile (2/23)
  • D-11 Reaffirmation - Retraction of Lump Entirety Request (8/21)
  • D-12(a) Ask for Hearing - Contested Claim (10/18)
  • D-12(b) Request for Trial - Uninsured Employer (2/08)
  • D-13 Injured Employee's Right to Renew a Demand That Possess Had Closed (7/99)
  • D-14 Permanent Total Handicap Report of Employment (7/99)
  • D-15 Ballot for Nevada Workers' Compensation Coverage for Out-of-State Injuring (7/99)
  • D-16 Notification the Election used Compensation Uses Under and Uninsured Employer Statutes (5/18)
  • D-17 Employee's Claim for Compensation - Uninsured Employer (6/18)
  • D-18 Assignment of Claim For Workers' Offset - Uninsured My (2/04)
  • D-21 Casualty Report (6/18)
  • D-22 Reminder to Employees - Tip Information (7/99)
  • D-23 Employee's Announcement of Election to Report Tips (7/99)
  • D-24 Request for Reimbursement of Expenses for Tour and lost Wages (6/06)
  • D-25 Affirmation of Compliance to Mandatory Industrials Insurance Requirements (11/23)
  • D-26 How for Reimbursement of Claim-Related Travel Expenses (4/04)
  • D-27 Interest Calculation for Compensation (7/99)
  • D-28 Rehabilitation Lump Sum Request (7/99)
  • D-29 Lump Sum Rehabilitation Agreement (7/99)
  • D-30 Notice of Get Acceptance (8/23)
  • D-31 Notice of Intention to Close Claim (10/10)
  • D-32 Authorization Request with Additional Chief Treatment (7/99)
  • D-33 Authorization Inquiry available Additional Physical Therapy Treatment (7/99)
  • D-34 Health Insurance Claim Form (CMS1500) via www.cms.gov
  • D-35 Request for a Rotating Rating Female or Chiropractic Physician (2/24)
  • - Instructions for Completing a D-35 Form (3/6/24)
  • D-36 Request for Extra Medically Information and Medical Releases (11/23)
  • D-37 Insurer's Subsequent Injures Checklist (12/03)
  • D-38 Injured Worker Index System Claims Registration Document – Eff 1/1/2019 Paper Form Cannot Accepted
  • D-39 Physician's Progress Report - Certification in Disability (2/24)
  • D-43 Employee's Election to Reject Cover and Election to Forgo the Rejection of Scope for Ruled Personal (2/04)
  • D-44 Election of Coverage by Chief; Employer Withdrawal of Option of Coverage (2/04)
  • D-45 Solid Proprietor Coverage (2/04)
  • D-46 Temporary Partial Disability Computing Sheet (7/99)
  • D-48 Proof of Coverage Notice (7/99)
  • D-49 Information Page (7/99)
  • D-50 Policies Termination, Cancellation and Reinstatement Notify (7/99)
  • D-53 Alternative Choice of Physician or Chiropractic Physician (2/24)
• OD Series
  • OD-1 Medical History Form (11/22)
  • OD-2 Lenkung Verification Form (11/22)
  • OD-3 Extensive Heart Examination Form (11/22)
  • OD-4 Limited Centre Examinations Make (11/22)
  • OD-5 Hearing Examination Form (11/22)
  • OD-6 Sample Acknowledgment Letter (11/22)
  • OD-7 Physically Exam Information (11/22)
  • OD-8 Occupational Sickness Claim Report (12/22)