Add Text To Legal North Carolina Workers' Compensation Forms For Free

A Form 18 establishes a legal claim of injury on your behalf if filed within two years of the date of injury or occupational disease, and gives the required written notice to the employer if a copy is submitted to the employer within 30 days of the injury.

Form 19. This is the first report of injury (FROI) that an employer submits when an employee has a claim.

Benefit Amount: Two-Thirds of Your Average Weekly Earnings In most cases, long-term employees can receive approximately two-thirds of their average weekly earnings as workers' compensation. This benefit provides financial stability while recovering from a workplace injury.

Form 25T - This is a form to List an Itemized Statement of Charges for Travel. Employees are entitled to reimbursement for mileage if the employee travels 20 miles or more round trip for medical treatment. Form 24 - This is an Application to Terminate or Suspend Payment of Compensation.

The easiest and safest way for an injured worker to meet both the notice and filing requirements is to file a Form 18 Notice of Accident with the NC Industrial Commission and to send a copy to the employer. Do not delay. If you are injured on the job you should file a Form 18 as soon as possible.

Form 33 ? Employee Form Form 33, Request That Claim Be Assigned For Hearing ? If your employer's workers' compensation insurance company has denied your claim or if they are unwilling to pay for certain needed medical care, an injured worker would need to file Form 33.

North Carolina Industrial Commission Form 22 is the Statement of Days Worked and Earnings of Injured Employee. This form contains a table wherein the hours worked and wages earned over the 52 weeks prior to the employee's injury are recorded.

A "Form 61" is the official North Carolina Industrial Commission form used by insurance companies to DENY workers' compensation claims. If you get a "Form 61" that means that your case is being declined or denied, and no further cash or medical benefits will be provided to you after the date on the Form 61.

How to fill out the North Carolina statement: Collect all necessary personal information, such as name, address, social security number, and date of birth. Include information about your employer, such as name, address, and Federal Employer Identification Number (FEIN).