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SELF-INSURED EMPLOYER OR CARRIER MAIL TO FORM 60 8/1/08 PAGE 1 OF 1 NCIC - CLAIMS ADMINISTRATION 4335 MAIL SERVICE CENTER RALEIGH NORTH CAROLINA 27699-4335 MAIN TELEPHONE 919 807-2500 HELPLINE 800 688-8349 WEBSITE HTTP //WWW.IC. North Carolina Industrial Commission IC File EMPLOYER S ADMISSION OF EMPLOYEE S RIGHT TO COMPENSATION G*S* 97-18 b Emp* Code Carrier Code Carrier File The Use Of This Form Is Required Under The Provisions of The Workers Compensation Act Employer FEIN Employee s Name Address Employer s Address City Insurance Carrier - Policy Number State Home Telephone Zip M Social Security Number F Sex / Work Telephone Telephone Number Carrier s Address Date of Birth Carrier s Telephone Number Fax Number TO DEFENDANTS Describe with particularity the body part s or condition s for which you are admitting liability and compensability. TO EMPLOYEE Your employer admits your right to compensation for an injury by accident on occupational disease on date Specify body part s involved ....

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Those businesses that employ three or more employees are required to carry workers compensation insurance except agricultural employment with fewer than 10 employees, certain sawmill and logging operations and all domestic employees are exempt.

Workers' comp generally handles wage replacement for the time you have to spend off work during your recovery. Generally, the percentage of your wage workers' comp pays in North Carolina is around two-thirds, or 66%, of your regular wages.

The First Report of Injury is one of the forms you must fill out for any work related Injury, Illness, or Near Miss. This form along with the Worker's Compensation Form 19 will be used for Worker's Compensation consideration. Return the completed and signed form to EHS Box 8007.

MMI is an important point along the workers' comp timeline. Once the employee is deemed to have reached MMI, they are eligible to apply for a permanent disability award based on permanent bodily injury or loss of earnings.

Workers' Compensation Forms All Employers or Carriers MUST file a Form 19 “Employer's Report of Employee's Injury to the Industrial Commission” within five days of learning of any injury or allegation of an injury.

The North Carolina Workers' Compensation Act requires that all businesses that employ three or more employees, including those operating as corporations, sole proprietorships, limited liability companies and partnerships, obtain workers' compensation insurance or qualify as self-insured employers for purposes of paying ...

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.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232