Form D-17 Employee's Claim for Compensation - Uninsured Employer - Nevada

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Form D-17 Employee's Claim for Compensation - Uninsured Employer - Nevada

What Is Form D-17?

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 D-17?
A: Form D-17 is the Employee's Claim for Compensation - Uninsured Employer form in Nevada.

Q: What is the purpose of Form D-17?
A: The purpose of Form D-17 is to file a claim for compensation if your employer does not have workers' compensation insurance.

Q: Who can file Form D-17?
A: Employees who are injured while working for an uninsured employer in Nevada can file Form D-17.

Q: How do I file Form D-17?
A: You can file Form D-17 by completing the form and submitting it to the Nevada Department of Administration, Division of Industrial Relations.

Q: What information do I need to provide on Form D-17?
A: You need to provide information about your employer, your injury, and your employment history on Form D-17.

Q: What happens after I file Form D-17?
A: After you file Form D-17, the Division of Industrial Relations will investigate your claim and determine if you are eligible for compensation.

Q: Is there a deadline for filing Form D-17?
A: Yes, you must file Form D-17 within 180 days from the date of your injury, or within 90 days of when you knew or should have known that your employer was uninsured.

Q: What should I do if my employer refuses to pay compensation?
A: If your employer refuses to pay compensation, you should file Form D-17 to initiate the claims process.

Q: Can I get legal representation for my Form D-17 claim?
A: Yes, you have the right to legal representation for your Form D-17 claim.

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Form Details:

  • Released on June 1, 2018;
  • The latest edition provided by the Nevada Department of Business and Industry;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a printable version of Form D-17 by clicking the link below or browse more documents and templates provided by the Nevada Department of Business and Industry.

Download Form D-17 Employee's Claim for Compensation - Uninsured Employer - Nevada

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