Workers’ Compensation Claim Kit – Nevada

Who will handle your claims?
Nevada claims are handled by a Third Party Administrator

Broadspire, a Crawford Company
7997 W Sahara Ave., Ste 101
Las Vegas, NV  89117

Phone:  505-938-3200
Fax:  678-937-8346

Billing Address:
PO Box 14348
Lexington, KY  40512-4348

The state of Nevada requires that the adjusters handling NV claims be located in the state of NV.

How to Report Workers’ Compensation Claims?
Although Broadspire handles our Nevada claims, the claims should be reported to Crum & Forster located via:

Fax: 1-877-622-6218
Phone: 1-800-690-5520
(7 day/24 hour toll free reporting line for all states)

In the event of a serious or fatal injury, notify the local claim office immediately by telephone.
Janet Rourke, Executive Specialist

What forms does the employer need to be aware of?

Click on this link for the Nevada Forms-

D1 – Informational Poster (Posting Notice)
Prominently display the notice where each employee is likely to see the notice on a regular basis. The Nevada posting notice is available on the Crum & Forster website.

D2 – Brief Description of Your Rights and Benefits
This should be given to an employee when they file a workers’ compensation claim.

D-2 Brief Description of Rights and Benefits

C1 – Notice of Injury or Occupational Disease: The employee should provide this written notice to the employer as soon as practicable, but within 7 days after the accident. The C1 should be filled out and signed by the employee, and signed by the supervisor. The employer should keep the original, and a copy should be given to the employee. In addition, a copy of the C-1 should be provided to the Claims Administrator. Lastly, this form should be kept on the jobsite for 3 years, as the state occasionally performs audits.

NV -Form C1

C3 – Employer’s Report of Industrial Injury or Occupational Disease: The employer must provide this completed, signed and dated form to the insurance carrier within 6 working days of receipt of the C-4 form (Employee’s Claim for Compensation/Report of Initial Treatment) per Nevada Revised Statute NRS 616C.045. Penalties/fines may be imposed for each violation of this section of the NRS (up to $1,000 per violation).

NV-Form C3

C4 – Employee’s Claim for Compensation / Report of Initial Treatment
This form is the physician’s responsibility. You do not need to provide this to the employee.

NV-Form C4

D8 – Employer’s Wage Verification Form
This form should be completed if the employee is off work for 5 days or more.

NV-D 8

What is the Waiting Period for Lost Wages in Nevada?
The waiting period is 5 consecutive or cumulative days. If the employee is off for more than 6 days, the first 5 days is paid retroactively.

What is the Choice of Physician Rules in Nevada?
In Nevada, an injured employee must seek treatment with a doctor on the preferred provider list. Our TPA, Broadspire utilizes First Health (PPO). Injured employees can go to any doctor they choose from the list & can change physicians one time without prior authorization from the insurer and only within the first 90 days of the claim. After that, if they want to change physicians, they must submit a written request to Broadspire – Nevada, and it must be approved before he/she can start treating with that doctor. You may contact Broadspire at 702-257-2240 to obtain recommended providers on the preferred provider list.

Additional Helpful Material

Nevada Employer Brochure

Nevada Time Frame for Claim Filing

Important Websites

Nevada Division of Industrial Relations:

Nevada WC Forms: Nevada WC forms

Multi-State Information: