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At Workers' Compensation Shop.com we attempt to offer free access to workers' compensation forms, applications and guides for Nevada. We strive to keep our library up to date with the latest versions of every form you may need.
As with all the information we provide about state workers' comp rules please verify the accuracy of this information with the Nevada Department of Business and Industry.
If you have questions about a workers' comp form feel free to contact a specialist at T888-611-7467. We want to be your source for workers' compensation information, rates and quotes in Nevada.
Nevada Acord 130 Workers' Compensation Application.
The standard Acord 130 application form for workers' comp coverage in Nevada.
Nevada First Report of Injury Form
First Report of Injury Form. Employers should complete this form and send to their insurance company each time an injury occurs.
Nevada Application for Exclusion/Rejection for Sole Proprietors
Sole Proprietors should complete this form to include/exclude themselves from a workers' compensation policy.
Nevada Application for Exclusion/Rejection for Workers' Compensation Insurance
Complete this form if you are an employee and would like to be reject coverage, or Waive the rejection.
Election of Coverage for Out of State Injury
Complete this form if you suffer a work related injury while working out of state.
Employee Claim Form
This is the employee claim form for file for a Workers' compensation claim.
Notice of Injury or Occupational Disease
TComplete this incident report, and both the employer and employee should keep a copy in their records.
Application Form to Elect Leave Choice Options
Complete this form to elect how to handle personal leave time compensation.
Notice of Election for Compensation - Uninsured Employer
Complete this form if you have suffered from a work related injury and your employer is not covered by workers' compensation insurance.
Rights and Benefits of Injured Employees
Brief Description of Your Rights and Benefits If You Are Injured on the Job or have an Occupational Disease.
Each state has its own laws and requirements regarding when and how employers are allowed to opt-out of coverage under their workers' compensation policy. Some states make it easier than others because they don't require anything to be filed. Other states require special inclusion or exclusion affidavit documentation. Failure to comply often causes employers to have to pay premium on themselves even when they wanted to be excluded form coverage.
A waiver of subrogation means that a business and their insurance company is foregoing all rights to file suit, or seek damages, from another business. This is common in the construction industry as builders attempt to protect their company from negligence. A workers' comp waiver of subrogation does not prevent an injured employee from filing a lawsuit for damages. This coverage typically add about $100 to the cost of a work comp policy.
A Certificate of Insurance is a document that serves as evidence of insurance or proof of coverage. Certificates indicate your current coverages and policy limits. Insurance Agencies issue on an insured's behalf and they often list a third party as a certificate holder. This means they should be notified if a policy cancels prior to expiration. Requests for any special wording should be carefully checked against the policy language before being added to a certificate as they can create legal issues with coverage.
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State Resources for Nevada
Nevada Department of Business and Industry
Division of Industrial Relations400 W King St, Suite 400Carson City, NV 89703775-684-7260 http://dirweb.state.nv.us/
National Council on Compensation Insurance (NCCI)
901 Penninsula Corporate CircleBoca Raton, FL 33487-1362800-622-4123 https://www.ncci.com/
Workers' compensation insurance is required by law for Nevada employers.
Nevada forms and applications such as owners inclusion or exclusion forms are sometimes updated by the state. Contact us if you need help or can't find the workers' compensation form your need for Nevada.
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