| Form No. |
Form Title |
Price |
Buy Now |
| C-3 |
Employer’s Report of Industrial Injury or Occupational Disease. |
$27.99 |
|
| C-4 |
Employee’s Claim for Compensation/Report of Initial Treatment. |
$27.99 |
|
| D-5 |
Wage Calculation Form for Claims Agent’s Use. |
$27.99 |
|
| D-6 |
Injured Employee’s Request for Compensation. |
$27.99 |
|
| D-7 |
Explanation of Wage Calculation. |
$27.99 |
|
| D-8 |
Employer’s Wage Verification Form. |
$27.99 |
|
| D-9(a) |
Permanent Partial Disability Award Calculation Worksheet. |
$27.99 |
|
| &D-9(b) |
Permanent Partial Disability Award Calculation Worksheet for Disability Over 25 Percent Body Basis. |
$27.99 |
|
| D-9(c) |
Permanent Partial Disability Worksheet for Stress Claims Pursuant to NRS 616c.180. |
$27.99 |
|
| D-10(a) |
Election of Method of Payment of Compensation. |
$27.99 |
|
| D-10(b) |
Election of Method of Payment of Compensation for Disability Greater than 25 Percent. |
$27.99 |
|
| D-11 |
Reaffirmation/Retraction of Lump Sum Request. |
$27.99 |
|
| D-12(a) |
Request for Hearing – Contested Claim. |
$27.99 |
|
| D-12(b) |
Request for Hearing – Uninsured Employer. |
$27.99 |
|
| D-13 |
Injured Employee’s Right to Reopen a Claim Which Has Been Closed. |
$27.99 |
|
| D-14 |
Permanent Total Disability Report of Employment. |
$27.99 |
|
| D-15 |
Election for Nevada Workers’ Compensation Coverage for Out-of-State Injury. |
$27.99 |
|
| D-16 |
Notice of Election for Compensation Benefits Under the Uninsured Employer Statutes. |
$27.99 |
|
| D-17 |
Employee’s Claim for Compensation – Uninsured Employer. |
$27.99 |
|
| D-18 |
Assignment of Claim for Workers’ Compensation – Uninsured Employer. |
$27.99 |
|
| D-21 |
Fatality Report. |
$27.99 |
|
| D-22 |
Notice to Employees – Tip Information. |
$27.99 |
|
| D-23 |
Employee’s Declaration of Election to Report Tips. |
$27.99 |
|
| D-24 |
Request for Reimbursement of Expenses for Travel and Lost Wages. |
$27.99 |
|
| D-25 |
Affirmation of Compliance with Mandatory Industrial Insurance Requirements. |
$27.99 |
|
| D-26 |
Application for Reimbursement of Claim-Related Travel Expenses. |
$27.99 |
|
| D-27 |
Interest Calculation for Compensation Due. |
$27.99 |
|
| D-28 |
Rehabilitation Lump Sum Request. |
$27.99 |
|
| D-29 |
Lump Sum Rehabilitation Agreement. |
$27.99 |
|
| D-30 |
Notice of Claim Acceptance. |
$27.99 |
|
| D-31 |
Notice of Intention to Close Claim. |
$27.99 |
|
| D-32 |
Authorization Request for Additional Chiropractic Treatment. |
$27.99 |
|
| D-33 |
Authorization Request for Additional Physical Therapy Treatment. |
$27.99 |
|
| D-34 |
CMS 1500 Billing Form. |
$27.99 |
|
| D-35 |
Request for a Rotating Rating Physician or Chiropractor. |
$27.99 |
|
| D-36 |
Request for Additional Medical Information and Medical Release. |
$27.99 |
|
| D-37 |
Insurer’s Subsequent Injury Checklist. |
$27.99 |
|
| D-38 |
Injured Worker Index System Claims Registration Document. |
$27.99 |
|
| D-39 |
Physician’s Progress Report – Certification of Disability. |
$27.99 |
|
| D-43 |
Employee’s Election to Reject Coverage and Election to Waive the Rejection of Coverage for Excluded Persons. |
$27.99 |
|
| D-44 |
Election of Coverage by Employer; Employer Withdrawal of Election of Coverage. |
$27.99 |
|
| D-45 |
Sole Proprietor Coverage. |
$27.99 |
|
| D-46 |
Temporary Partial Disability Calculation Worksheet. |
$27.99 |
|
| D-48 |
Proof of Coverage Notice. |
$27.99 |
|
| D-49 |
Information Page. |
$27.99 |
|
| D-50 |
Policy Termination, Cancellation and Reinstatement Notice. |
$27.99 |
|
| D-52 |
Alternative Choice of Physician or Chiropractor. |
$27.99 |
|
| D-53 |
Special Note |
$27.99 |
|
| OD-1 |
Firemen and Police Officers’ Medical History Form. |
$27.99 |
|
| OD-2 |
Firemen and Police Officers’ Lung Examination Form. |
$27.99 |
|
| OD-3 |
Firemen and Police Officers’ Extensive Heart Examination Form. |
$27.99 |
|
| OD-4 |
Firemen and Police Officers’ Limited Heart Examination Form. |
$27.99 |
|
| OD-5 |
Firemen and Police Officers’ Hearing Examination Form. |
$27.99 |
|
| OD-6 |
Firemen and Police Officers’ Sample Letter. |
$27.99 |
|
| OD-7 |
Information Regarding Physical Examinations for Firemen and Police Officers. |
$27.99 |
|
| OD-8 |
Occupational Disease Claim Report |
$27.99 |
|
| C-4 |
Employee’s Claim for Compensation/Report of Initial Treatment; |
$27.99 |
|
| D-12(b) |
Request for Hearing – Uninsured Employer; |
$27.99 |
|
| D-16 |
Notice of Election for Compensation Benefits Under the Uninsured Employer Statutes; |
$27.99 |
|
| D-17 |
Employee’s Claim for Compensation – Uninsured Employer |
$27.99 |
|
| D-18 |
Assignment of Claim for Workers’ Compensation – Uninsured Employer |
$27.99 |
|
