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How to fill out Nevada Workers’ Compensation C-4 Form

C-4 From – How to Avoid Mistakes When Completing the Form C-4

When handling workers’ compensation claims, we often encounter improper entries on the C-4 form. Any mistakes you make on the C-4 form at the start of the claim can result in complications for you, the injured worker, that remain throughout the claim.

However, by following a few simple tricks, you can easily get through this barrier and fully recover all the benefits you need under Nevada’s workers’ compensation system.

Download the Form C-4 here

Demographics: Simple but Important

The first part of the form is pretty straightforward: do be sure to complete all the basics, i.e., name, address, birth date, height, weight, etc. Most people get this part right on there C-4 Form, and of course, something like your gender will hardly cost you your claim.

When we get down to the critical stuff, things can get hairy. The eighth line down is where the vital information starts.

Nevada C-4 Form

The Date of Injury – Ensure that this is the exact day you were injured and hopefully the day you notified your employer about your injury!

Judges will often believe that an injury did not occur because the injured employee casually put down facts that an aggressive defense attorney later refuted.

Date Employer notified – Things start to get complicated on the C-4 Form here. The rules state you are to report your injury “as soon as practically possible, but within seven days.”

The time frame is so short because you have the burden of proving your injury occurred at work instead of at home. If you wait, it becomes to prove.

Let’s assume you hurt your back and then go home, hoping that you can sleep it. When you wake up the next day, if your back is still in severe pain, one could argue that your back pain resulted from you sleeping poorly. Therefore, how do you prove that you injured your back at work?

The most critical piece of advice? Report your injury immediately!

Even if you think you will recover without going to the doctor. You cannot turn back time. Without a report, you have no claim. According to Nevada law, a C-1 form, “Notice of Injury or Occupational Disease Incident Report”, needs to be completed and returned to your employer for all occupational injury/disease claims.

If your employer doesn’t have a C-1 form handy or if you cannot print one yourself, write it on anything like a napkin or a scrap of paper if needed.

Taking Care of the Rest: What Else are You Responsible for Completing on the C-4 Form?

Fill out the rest of C-4 Form Carefully and with accurate dates, data, and a witness to the accident if applicable.

The last half of the C-4 Form is filled out by the doctor. Make sure that you review his entries before you leave the hospital. Many doctors are in a rush and can make mistakes on the form.

Remember that you didn’t want to be injured in the first place. You don’t want to return to the hospital due to a clerical error. Therefore, ensure that the doctor has fully completed the rest of the form.

By following these tricks for the C-4 Form, you will find that you can avoid many common pitfalls for injured workers in Nevada. We have only covered the topic of workplace accidents here.

As always, if you require an experienced, aggressive personal injury attorney in Nevada workers’ compensation procedures, our assessments are free, and we will be happy to answer all of your questions. Give us a call at