Workers compensation is an insurance program which covers injuries and diseases that are work-related. Fault or negligence by the employer or the employee is not considered in the injured employee’s claim for benefits. The primary objective of the program is to return the injured employee to gainful employment as quickly as possible.
The district self-insures its workers compensation coverage. Employees are not covered by the Employers Insurance Company of Nevada (formerly known as SIIS). The Workers Compensation Unit of the Risk Management Department handles all claims.
Workers compensation coverage generally applies to injuries or diseases arising out of and in the course of employment, subject to the limitations and conditions of Nevada’s Industrial Insurance laws.
First, you must give written notice of your on-the-job injury or occupational disease to your supervising administrator by completing a "Notice of Injury or Occupational Disease" (Form C-1) within 7 days after the accident or having knowledge that your disease may be work-related. You and your supervisor must sign this form.
Second, if you sought medical treatment or were off work as a result of your on-the-job injury or occupational disease, you must file a "Claim for Compensation" (Form C-4) within 90 days after the accident or having knowledge that your disease may be work-related. This form must be completed and signed by you and your physician at the time of your initial medical examination.
For life-threatening conditions requiring immediate treatment, dial 911 or get medical care at the nearest hospital or emergency room. Notify your supervisor and complete the required forms as soon as possible thereafter.
You may be denied workers compensation benefits if you fail to file a Form C-1 or a Form C-4 in a timely manner.
Report all injuries no matter how insignificant they may seem to you at the time.
District personnel must:
- Render all necessary first aid.
- When necessary, provide transportation for the injured employee to the nearest medical facility for treatment.
An MCO is a Managed Care Organization that arranges for the provision of medical and health care services for injured employees. The MCO is responsible for handling all matters related to medical treatment. The MCO assists the injured employee with obtaining quality MEDICAL services. Risk Management staff evaluates claims for coverage applicability, monitors progress, assures timely and accurate payments, and all other claim ADMINISTRATION functions.
Workers compensation benefits may include medical treatment, lost time compensation, permanent partial disability, vocational rehabilitation, dependent’s payments in the event of death, and other claims-related expenses.
You can obtain medical care only from providers who are listed on the district-approved MCO provider network. Review the Preferred Provider Locations poster at your work site. Should you see a doctor not on the approved list, with the exception of an emergency, you will be responsible for the doctor’s bill. In most cases only one treating physician is allowed at any one time.
To have a prescription filled at no cost to you, you must select a pharmacy from the list approved by the district. For faster service, show your CCSD Employee picture ID or your copy of the Form C-4 to the pharmacy.
The district will pay the cost of your initial medical examination and one-week supply of prescription drugs whether your claim is accepted or not.
Subsequent bills associated with any authorized medical services and incurred as a result of an accepted claim will be paid by the district. An MCO provider of health care who accepts a patient for the treatment of an industrial injury or an occupational disease may not charge the patient.
The claim examiner must commence payment of a claim for compensation or deny responsibility for a claim within 30 days after your "Claim for Compensation" (Form C-4) is received.
You will receive disability compensation if you are certified disabled by your treating doctor due to an on-the-job injury or occupational disease for five or more consecutive calendar days, or five or more cumulative days within a twenty-day period. Compensation is paid retroactively to the first day of your disability.
Your disability compensation is 66 2/3 percent of your average monthly wage at the time of the injury, subject to a maximum limit set by the state.
Your TTD and sick leave benefits may be coordinated. When you are eligible at the same time for TTD and for any accrued sick leave benefit, you have the option to (1) continue to receive your normal school district salary in lieu of your disability compensation by using part of your accrued sick leave as income continuation supplement or (2) elect to receive only TTD benefits. If you choose option #2, you will not receive your normal paycheck and you must contact the Human Resources Division for a leave of absence.
If you are eligible for FML, all qualifying absences which may be related to your on-the-job injury or occupational disease will count concurrently toward the 12 week maximum provided for by the FML Act of 1993.
You must apply for a workers compensation leave of absence (CCSD Regulation 4127); or if released by your physician, return to work. However, if you have sufficient accumulated leave (sick or other authorized paid leave) for your recovery, a workers compensation leave of absence may not be necessary. Contact the Human Resources Division for additional information regarding FML and leave of absence.
Yes, the district’s temporary modified duty (TMD) program provides transitional employment to employees recovering from the effects of an on-the-job injury or occupational disease. It is designed to meet the temporary physical limitations set by the treating doctor.
If you are required to travel 20 miles or more one way, or 40 miles or more in one week, for medical treatment directly related to your on-the-job injury or occupational disease, you may be entitled to reimbursement for travel expenses. A claim for such reimbursement must be filed within 60 days after the travel took place. The travel reimbursement claim form (D-26) is available from the TPA, or by accessing form from the Nevada Industrial Insurance regulation Section. Do NOT wait until the end of treatment to seek reimbursement.
Your claim will be closed when you reach maximum medical improvement and after all benefits to which you may be entitled have been paid. The claim examiner will send you a written notice of its intention to close your claim when appropriate.
If you disagree with a written administrative determination made by the claim examiner, you may appeal by following the instructions in your determination letter within 70 days from the date of the determination. If you do not file a request for appeal timely, you may lose your right to appeal the determination.
If you have any questions regarding the administration of your claim, contact your claims examiner. If you have questions regarding the medical management of your claim, contact your MCO nurse case manager. For questions regarding temporary modified duty and coordination of disability benefits and accrued leave, contact the Risk Management department.
If you suspect an injured employee, a medical provider, or an employer is committing fraud, call the Office of the Attorney General’s Workers compensation Fraud Unit at 486-3777 or 1-800-266-8688.
Contact your claims examiner or access the Nevada Industrial Insurance Regulation Section.
The foregoing information is derived from Chapters 616A to 617 of the Nevada Revised Statutes and is provided for informational purposes only.