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10 Most Common NC Workers' Compensation Forms

As an employer or employee in the state of North Carolina, it is crucial to have a comprehensive understanding of the workers' compensation system and the various forms that are commonly used. The workers' compensation process can be complex and overwhelming, but familiarizing yourself with the key documents can help ensure a smoother experience for all parties involved. Below is a brief explanation of the 10 most common North Carolina Workers' Compensation forms.

1. Form 18 - Notice of Accident to Employer and Claim of Employee

This is the primary form used by employees to notify their employer of a work-related injury or illness. It includes information about the injured worker, the date and circumstances of the accident, and the nature of the injury. Employers are required to file this form with the North Carolina Industrial Commission within 30 days of receiving notice of the claim.

2. Form 19 - Employer's Report of Employee's Injury or Occupational Disease to the Industrial Commission

Employers are responsible for completing this form and submitting it to the North Carolina Industrial Commission within 5 days of receiving notice of an employee's work-related injury or illness. The Form 19 provides details about the injured worker, the accident, and any medical treatment that has been provided.

3. Form 22 - Statement of Days Worked & Earnings of Employee

This form is used to show days worked and earnings of employees. This information is crucial for determining the appropriate amount of weekly compensation benefits.

4. Form 18M - Employee's Application for Additional Medical Compensation
 

5. Form 21 - Agreement for Compensation for Disability

This form is used to document an agreement between the employer/insurance carrier and the injured worker regarding the payment of compensation benefits. It must be approved by the North Carolina Industrial Commission.

6. Form 26 - Supplemental Report of Injury and Compensation Claims

Employers or insurance carriers use this form to report changes in the injured worker's condition, such as a return to work, a change in the employee's average weekly wage, or the suspension or reinstatement of compensation benefits.

7. Form 26A, Employer's Admission of Employee's Right to Permanent Partial Disability

8. Form 28 - Return to Work Report

Employers or insurance carriers use this form to report when an injured worker has returned to work, either in their regular position or in a modified or transitional duty role.

9. Form 33 - Request that Claim be Assigned for Hearing

Employees, employers, or insurance carriers can use this form to request a hearing before the North Carolina Industrial Commission to resolve a dispute related to a workers' compensation claim.

10. Form 60 - Employer's Admission of Employee's Right to Compensation

This form is used by employers or insurance carriers to acknowledge an employee's right to receive workers' compensation benefits for a work-related injury or illness.

Understanding these 10 common North Carolina Workers' Compensation forms is crucial for both employers and employees to navigate the workers' compensation system effectively. By familiarizing yourself with the purpose and requirements of each form, you can ensure that you are in compliance with the relevant laws and regulations, and that you are able to efficiently manage the claims process. If you have any questions or concerns about these forms or the workers' compensation system in general, it is recommended to consult with a NC workers' compensation attorney for assistance.