A copy shall be provided to the employee and the employee s attorney of record if any. MAIL TO FORM 62 10/2006 PAGE 1 OF 1 NCIC - CLAIMS SECTION 4335 MAIL SERVICE CENTER RALEIGH NC 27699-4335 TELEPHONE 919 807-2502 HELPLINE 800 688-8349 WEBSITE HTTP //WWW.IC.
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How to fill out the Form 62 online
Filling out Form 62 is essential for reporting the reinstatement or modification of compensation under North Carolina's Workers' Compensation Act. This guide will provide clear, step-by-step instructions to assist users in completing the form online effectively.
Follow the steps to successfully complete Form 62 online.
- Press the ‘Get Form’ button to access the form, and ensure it opens in your preferred editor.
- Input the employer's Federal Employer Identification Number (FEIN) in the designated field. This number is essential for identifying the employer in the Workers' Compensation system.
- Fill in the employee's name, followed by the employer's name and address, ensuring all information is accurate and up-to-date.
- Complete the insurance carrier's information, including the policy number and the carrier’s address. Include the carrier's telephone number for any future inquiries.
- Enter the employee's date of birth and last four digits of their Social Security Number (SSN). Make sure to include the employee's sex and their home and work telephone numbers.
- Specify the date of injury, as well as the amount of compensation reinstated or modified. Clearly indicate whether it adheres to the sections of the General Statutes provided.
- Describe the reason for reinstatement in the designated field to provide context for the modification of compensation.
- Calculate the employee's average weekly wage, including any overtime and allowances. This information will help determine the weekly compensation rate.
- Specify the type of compensation being paid — whether temporary total or temporary partial — and indicate the relevant amounts.
- Finalize the form by signing it as the employer or carrier/administrator. Include the title and date of signing.
- After completing the form, save your changes. You can then download, print, or share the form as necessary.
Complete your documents online today to ensure compliance with the North Carolina Industrial Commission requirements.
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