- Affirmation Of Compliance With Mandatory Industrial Insurance Requirements {D-25}
- Application For Reimbursement Of Claim Related Travel Expenses {D-26}
- Assignment To Division For Workers Compensation Benefits {D-18}
- Authorization Request For Additional Chiropractic Treatment {D-32}
- Authorization Request For Additional Physical Therapy Treatment {D-33}
- Complaint Form (Northern Inusurers)
- Complaint Form (Southern Insurers)
- Election For Nevada Workers Compensation Coverage For Out Of State Injury {D-15}
- Election Of Coverage By Employer And Employer Withdrawal Of Election Of Coverage {D-44}
- Election Of Lump Sum Payment Of Compensation {D-10a}
- Election Of Lump Sum Payment Of Compensation For Disability Greater Than 30 Percent {D-10b}
- Employees Claim For Compensation - Uninsured Employer {D-17}
- Employees Claim For Compensation Report Of Initial Treatment {C-4}
- Employees Declaration Of Election To Report Tips {D-23}
- Employees Election To Reject Coverage And Election To Waive Rejection Of Coverage For Excluded Persons {D-43}
- Employers Report Of Industrial Injury Or Occupational Disease {C-3}
- Employers Wage Verification Form {D-8}
- Fatality Report {D-21}
- Firefighters And Police Officers Extensive Heart Examination {OD-3}
- Firefighters And Police Officers Hearing Examination {OD-5}
- Firefighters And Police Officers Limited Heart Examination {OD-4}
- Firefighters And Police Officers Lung Examination {OD-2}
- Firefighters And Police Officers Medical History {OD-1}
- Health Insurance Claim Form {D-34}
- Index Of Claims System Claim Registration {D-38}
- Informational Poster - Displayed By Employer {D-1}
- Injured Employees Request For Compensation {D-6}
- Insurers Subsequent Injury Checklist {D-37}
- Interest Calculation For Compensation Due {D-27}
- Lump Sum Rehabilitation Agreement {D-29(1)}
- Notice Of Claim Acceptance {D-30}
- Notice Of Election For Compensation Benefits Under Uninsured Employer Statutes {D-16}
- Notice Of Injury Or Occupational Disease Incident Report {C-1}
- Notice Of Intention To Close Claim {D-31}
- Occupational Disease Claim Report {OD-8}
- Permanent Partial Disability Award Calculation Work Sheet {D-9a}
- Permanent Partial Disability Award Calculation Work Sheet For Disability Over 30 Percent Body Basis {D-9b}
- Permanent Total Disability Report Of Employment {D-14}
- Permanent Work Related Mental Impairment Rating Report Work Sheet {D-9c}
- Physician And Chiropractor Progress Report Certification Of Disability {D-39}
- Policy Termination-Cancelation-Reinstatement Notice {D-50}
- Proof Of Coverage Notice {D-48}
- Reaffirmation Retraction Of Lump Sum Request {D-11}
- Rehabilitation Lump Sum Request {D-28}
- Request For Additional Medical Information And Release Form {D-36}
- Request For Hearing - Contested Claim {D-12a}
- Request For Hearing - Uninsured Employer {D-12b}
- Request For Reimbursement Of Expenses For Travel And Lost Wages {D-24}
- Request For Rotating Rating Physician Or Chiropractor {D-35}
- Sample Letter {OD-6}
- Sole Proprietor Coverage {D-45}
- Temporary Partial Disability Calculation Worksheet {D-46}
- Wage Calculation Form For Claims Agents Use {D-5}