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I Have This Friend Who...Got Hurt On The Job
By Herb Santos, Jr.
You are at a barbeque and as the resident attorney, you are approached by every person who wants to ask you a quick legal question. You want to help the person and provide them with an answer which makes sense and is a correct interpretation of the law. But what happens when the question surrounds a rule of law which you have some understanding, but not a complete understanding? This new column will provide a basic synopsis of the law surrounding a common legal question. Think of it as Barbeque Law 101. One caveat…always end the conversation with a recommendation that the "friend" contact an attorney who practices in the specific area of law for a complete legal analysis of the "friend's" situation.
This article's topic: I have this friend who got hurt on the job. Does he need to do anything? The short answer is yes.
The first thing every employee who is injured on the job needs to do is complete a Notice of Injury or a C-1. Under Nevada law, if an injury or occupational disease (OD) arises out of and in the course of employment, the injured employee must provide written notice to the employer as soon as practicable, but no later than seven days after the accident or OD. NRS 616C.015. The employer is supposed to keep the appropriate forms to fill out. If they do not have a form, direct them to www.dir.nv.usand then to the workers' compensation section. A C-1 form can be downloaded along with all workers' compensation forms. If the "friend" does not have computer access, advise them to write a letter to their employer and detail the following information: name, social security number, telephone number, date of accident, time of accident, place where the accident occurred, what was injured, how the accident occurred, names of witnesses, whether they received first aid or medical treatment, then sign it and date it. Advise them to make a copy and give the original to the employer. Tell the "friend" to have the employer sign a copy as received by them and have it dated.
The second requirement is the completion of the C-4. The claim is actually commenced when the insurer receives the C-4. This document is maintained by the doctors. The employee fills out the top part of the form and the doctor fills out the bottom part. The employee has to be very careful when filling out the form; they should never guess at an answer. Any discrepancy in the answers by the injured employee will probably result in a denial of the claim. A "Claim for Compensation" (Form C-4) must be completed within 90 days after an accident or OD. The treating physician or chiropractor must, within three working days after treatment, complete and mail to the employer, the employer's insurer and third-party administrator, the C-4. The employer must complete and mail to its insurer or third-party administrator an "Employer's Report of Industrial Injury or Occupational Disease" (Form C-3), within six working days after receipt of a Claim for Compensation. If an employee has not received a determination letter from the Insurer within 30 days of when the C-4 was completed, he should call the Insurer to inquire as to whether and when they received the C-4. If the employee does not know who the insurer is and cannot get the information from the employer, they should call the Division of Insurance Regulations who can then provide the employee with the information.
What happens if the employee did not file the claim within 90 days? What happens if it was not reported within seven days? Under NRS 616C.025, an employee is barred from recovering compensation if he fails to file a notice of injury pursuant to NRS 616C.015 or a claim for compensation pursuant to NRS 616C.020. The following are the four exceptions to the rule: the injury to the employee or another cause beyond his control prevented him from providing the notice or claim; the failure was caused by the employee's or dependent's mistake or ignorance of fact or of law; the failure was caused by the physical or mental inability of the employee or the dependent; or the failure was caused by fraud, misrepresentation or deceit. In addition, an injured employee must file a claim for compensation under NRS 616C.020(1) within 90 days of the accident regardless of whether the injured employee seeks medical treatment within the 90-day period. See Barrick v. Peterson, 116 Nev. 541, 2 P.3d 250 (2000). Finally, if the employee files a notice of an injury pursuant to NRS 616C.015 after his employment has been terminated for any reason, there is a rebuttable presumption that the injury did not arise out of and in the course of his employment.
So now you know what an employee has to do to get the claim going. The next advice for the "friend" is to talk to an attorney who specializes in workers' compensation law. The rules and regulations governing workers' compensation can be tricky. One missed determination by the insurance company can have far-reaching effects on future benefits.
Herb Santos, Jr., Esq. is a sole practitioner in Reno and is currently a Sustaining Member of NTLA and is a member of the NTLA Board of Governors. He practices primarily in the area of personal injury and workers' compensation law.