Claims Kit
Nebraska
Forms
State Compliance Information
Penalties for Late Reporting 48-144.04
Any employer, workers' compensation insurer, or risk management pool who fails, neglects, or refuses to file any report required is guilty of a Class II misdemeanor for each failure, neglect, or refusal.
Physician Selection Rule 50 48-120 (2)
There are rules about whether the employee or employer chooses the doctor. The employee has the right to select a physician who has maintained the medical records of the employee (or an immediate family member) when the employer notifies the employee of this right. If the employee does not have or does not choose such a physician, then the employer may select the physician. The initial choice of physician, when chosen by the employee or employer after the employer notifies the employee of the right to choose, can only be changed when both the employee and the employer agree on the change or the Nebraska Workers’ Compensation Court orders the change. If the employer does not give proper notice to the employee regarding the right of selection, then the restrictions on changing physicians do not apply and the employee has the right to select any physician. The employee also may select a physician to perform a major surgical operation or in cases involving dismemberment.
“Physician” means any person licensed to practice medicine and surgery, osteopathic medicine, chiropractic, podiatry, or dentistry in the State of Nebraska or in the state in which the physician is practicing
Reporting of Claim by Employer 48-144.01, Rule 29
In every case of reportable injury the employer or its insurer must file a report of injury with the Nebraska Workers' Compensation Court within 10 days after the employer or insurer has been given notice of or has knowledge of the injury.
Except as otherwise approved by the administrator of the compensation court, all first reports of injuiy or illness must be filed electronically. In limited circumstances and with approval of the administrator, the reports may be filed by a paper form. Such forms are available only upon request to the administrator.
Posting Requirements
The only posting notice required by the Nebraska Workers' Compensation Act is for employers of certain agricultural operations. An agricultural operation no longer subject to the Nebraska Workers' Compensation Act (or an agricultural operation that has previously voluntarily chosen to provide workers' compensation insurance coverage for its employees) may elect to return to exempt status by posting a written or printed notice. Such notice is not provided by the Nebraska Workers' Compensation Court. The notice must state that the employer will no longer carry workers' compensation insurance for the employees and the date coverage will end. This notice must be posted continuously in a conspicuous place at all employment locations of the employees for at least 90 days. After the 90 day posting period has passed, the employer may then cancel the workers' compensation policy. Failure to provide this notice voids an employer's attempt to return to exempt status.
In addition to the notice requirements for terminating coverage, every employer who is exempt under the Act and does not voluntarily elect to provide workers' compensation insurance coverage must give all employees the following written notice at the time of hiring:
In this employment you will not be covered by the Nebraska Workers' Compensation Act and you will not be compensated under the act if you are injured on the job or suffer an occupational disease. You should plan accordingly. Failure to provide this notice subjects an employer to liability and inclusion in the Act for all unrelated employees.
Posters & Brochures
Documents Provided by CopperPoint
Portal User Help
Pharmacy First Fill - ENG/SPA
Change of Address
Witness Statement - ENG/SPA
Accident Report - ENG/SPA
Gramm-Leach-Bliley Act (GLBA) Privacy Notice
Return To Work
Return To Work Transitional Employment Offer Template - ENG/SPA
Return To Work Policy Guide
Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
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Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com