Form C-4A Release of Medical and Other Information for Nevada Workers' Compensation Claims - Nevada

What Is Form C-4A?

This is a legal form that was released by the Nevada Department of Business and Industry - a government authority operating within Nevada. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form C-4A?A: Form C-4A is a release of medical and other information for Nevada workers' compensation claims.

Q: What is the purpose of Form C-4A?A: The purpose of Form C-4A is to authorize the release of medical and other information related to a workers' compensation claim in Nevada.

Q: What information is requested in Form C-4A?A: Form C-4A requests information such as the claimant's name, address, date of birth, and social security number, as well as details about the healthcare provider and the records being released.

Q: Who should complete Form C-4A?A: Form C-4A should be completed by the claimant or their authorized representative, such as an attorney or case manager.

Q: Are there any fees associated with submitting Form C-4A?A: No, there are no fees associated with submitting Form C-4A for workers' compensation claims in Nevada.

Q: How can I submit Form C-4A?A: Form C-4A can be submitted by mail, fax, or email to the appropriate workers' compensation claims processing office or insurance carrier.

Q: Can Form C-4A be used for claims outside of Nevada?A: No, Form C-4A is specific to workers' compensation claims in Nevada and may not be accepted for claims in other states.

Q: Are there any time limits for submitting Form C-4A?A: The specific time limits for submitting Form C-4A may vary depending on the individual case and should be discussed with the employer or insurance carrier.