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department avatarWorker's Compensation Claims

Frequently Asked Questions

Q: What is worker's compensation?

Q: How doesCCSD provide worker's compensation coverage for its employees?

Q: Where will my claims be managed?

Q: What injuries or diseases are covered?

Q: What should the employee do if they have an on-the-job injury or occupational disease?

Q: Should an injury be reported to the supervisor even if it is a small one?

Q: What are CCSD’s duties when an employee is injured?

Q: What is the difference between an MCO and a TPA?

Q: What doctor may I see?

Q: What about filling a prescription?

Q: How about payment of medical bills?

Q: How much time does the TPA have to accept or deny a claim?

Q: When is temporary total disability (TTD) compensation paid?

Q: How is TTD compensation computed?

Q: Can sick leave be used while on TTD to receive full pay?

Q: How is Family and Medical Leave (FML) affected by workers compensation?

Q: Can CCSD accommodate light duty/ modified work release?

Q: Does the injured employee get reimbursed for travel expenses?

Q: When is a claim closed?

Q: What are the injured employees appeal rights?

Q: What can I do to put worker's compensation fraud out of business?

Q: How do I report a suspected exposure to bloodborne pathogens?

 


Q: What is worker's compensation?

Worker’s 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.

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Q: How does CCSD provide worker's compensation coverage for its employees?

CCSD is self-insured and is contracted with Sierra Nevada Administrators, Inc. (SNA) a local third-party administrator to manage the claims. CCSD worker's compensation staff can be reached at 702-799-0060.

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Q: Where will my claims be managed?

Employee claims are managed by SNA in Las Vegas, NV. The mailing address and phone numbers are:

4828 S. Pearl Street
Las Vegas, NV 89121
Direct Line: 702-799-0060
Fax Number: 702-799-2995

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Q: What injuries or diseases are covered?

Worker’s Compensation coverage generally applies to injuries or diseases arising out of and in the course of employment.

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Q: What should the employee do if they have an on-the-job injury or occupational disease?

First the employee must give written notice of the on-the-job injury or occupational disease to your supervisor by completing a “Notice of Injury or Occupational Disease” (Form C-1) within 7 days after the accident or having knowledge that their disease may be work-related. This form must be signed by the employee and their supervisor.

Second, if the employee has sought medical treatment or was off work as a result of the on the job injury or occupational disease, they must file a “Claim for Compensation” (Form C-4) within 90 days after the accident or having knowledge that their disease may be work-related. This form must be completed and signed by the employee and their physician at the time of their initial medical examination.

For life-threatening conditions requiring immediate treatment, dial 911 or get medical care at the nearest hospital or emergency room. The injured worker should notify their supervisor and complete the required forms as soon as possible thereafter.

Worker’s compensation benefits may be denied if the employee fails to file a Form C-1 or a C-4 Form in a timely manner.

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Q: Should an injury be reported to the supervisor even if it is a small one?

Employees should report all injuries no matter how insignificant they may seem at the time.

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Q: What are CCSD’s duties when an employee is injured?

CCSD personnel must:

  • Render all necessary first aid.
  • When necessary, provide transportation for the injured employee to the nearest medical facility for treatment.
  • Completion of the Employer’s Report of Injury (C-3), within 6 days of receipt of the C-4.

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Q: What is the difference between an MCO and a TPA?

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.

A TPA is a Third-Party Administrator hired by an employer like CCSD to provide administrative services and manages worker’s compensation claims. The TPA is responsible for claim investigation, claim acceptance, claim closure, and other matters related to claim administration.

MCO is for MEDICAL and TPA is for CLAIM ADMINISTRATION.

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Q: What doctor may I see?

You can obtain medical care only from providers who are listed on the CCSD approved MCO provider network. Should you see a doctor not on the provider list, with the exception of an emergency, you will be responsible for the doctors’ bill. In most cases only one treating physician is allowed at any one time.

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Q: What about filling a prescription?

To have a prescription filled at no cost to you, you must select a pharmacy from the list approved by CCSD. For faster service, show your Employee ID or any picture ID with your recent pay stub to the pharmacy. You will receive a pharmacy CCSD card once your claim is accepted by the TPA. Temporary cards, through Optum, can be found at the approved medical provider’s office who conducted the initial care.

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Q: How about payment of medical bills?

CCSD will pay the cost of your initial medical examination, if obtained at a designated occupational health clinic, and one-week supply of prescription drugs whether the TPA accepts your claim or not.

Subsequent medical bills incurred as a result of an accepted claim will be paid in full by CCSD. An MCO provider of health care who accepts a patient for treatment of an industrial injury, or an occupational disease may not charge the patient.

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Q: How much time does the TPA have to accept or deny a claim?

The TPA must accept or deny responsibility for a claim within 30 days after your “Claim for Compensation” (Form C-4) is received.

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Q: When is temporary total disability (TTD) compensation paid?

You will receive disability compensation if you are certified disabled by your treating or attending 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.

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Q: How is TTD compensation computed?

Disability compensation is 66 2/3 percent of the injured employees average monthly wage at the time of the injury, subject to a maximum limit set by regulation.

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Q: Can sick leave be used while on TTD to receive full pay?

See CCSD Leave Choice Option Form for more information involving this and related subjects. Make sure the form is completed and provided to your site's payroll manager for proper coordination.

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Q: Can CCSD accommodate light duty/ modified work release?

Yes, CCSD has instituted a Return-to-Work program for its injured employees. It is designed to meet temporary work restrictions set by the treating doctor.

If CCSD cannot accommodate a permanent work restriction as a result of an on-the-job injury or occupational disease, vocational rehabilitation services (to include retraining) may be provided.

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Q: How is Family and Medical Leave (FML) affected by workers compensation?

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.

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Q: Does the injured employee get reimbursed for travel expenses?

If the injured employee is required to travel 20 miles or more one way, or 40 miles or more in a week, for medical treatment directly related to the on the job injury or occupational disease, they 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 Sierra Nevada Administrators, Inc. The injured employee should not wait until the end of treatment to seek reimbursement.

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Q: When is a claim closed?

The claim will be closed when the injured employee reaches maximum medical improvement. Sierra Nevada Administrators, Inc. will send a written notice of its intention to close the claim.

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Q: What are the injured employees appeal rights?

If they disagree with a written administrative determination made by Sierra Nevada Administrators, Inc. they may appeal by following the instructions on the determination letter within 70 days after the date on which the notice is mailed.

If they disagree with a medical decision rendered by the MCO, they may appeal by submitting a formal complaint to the MCO. Within 14 days after receipt of the formal complaint, the MCO will conduct a hearing and issue a written determination.

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Q: What can I do to put workers compensation fraud out of business?

If you suspect an injured employee, a medical provider, or an employee is committing fraud, call the Office of the Attorney General’s Workers’ Compensation Fraud Unit at (702) 486-3777 in southern Nevada or (800) 266-8688.

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Q: How do I report a suspected exposure to bloodborne pathogens?

When a suspected exposure incident occurs at a CCSD worksite, these procedures are to be followed:

  • The employee should initiate appropriate first aid for themselves and seek help if necessary.
  • Employees who have an exposure must be tested for contagious disease within 72 hours of the exposure for the claim to be accepted. Contact 702-799-NURS (6877) to set up the initial appointment with an approved physician.
  • Fill out a “Notice of Injury or Occupational Disease” (Form C-1)
  • Send the completed Form C-1 to CCSD Risk Management

 

(The descriptive material contained on this web page is derived from Chapters 616A to 617 inclusive, of the Nevada Revised Statues and is provided for informational purposes only.)