Get Ncic 25n Online

Filling out the Ncic 25n Online is an important step in the workers' compensation process in North Carolina. This guide provides detailed instructions on how to complete each section of the form effectively and efficiently.

Follow the steps to complete the Ncic 25n Online form.

1. Click ‘Get Form’ button to access the Ncic 25n Online document. This will open the form in the editor for you to begin filling it out.
2. Begin by entering the IC file number in the designated field. This number usually relates to your specific case and is essential for identification.
3. Fill in the employer's code and carrier code, followed by the insurance carrier's name. This step helps to clarify which insurance company is handling the claim.
4. Provide the employer’s federal employer identification number (FEIN), and include both the employee's name and the employer's name in the specified fields.
5. Enter the employer's address, including the city, state, and zip code. Ensure this information is accurate to prevent any issues with correspondence.
6. List the home telephone number of the employee, along with their social security number. This information is essential for verification purposes.
7. Document the date of birth of the employee and the work telephone number where the employer can be reached.
8. Provide the details of the rehabilitation professional, including their name, telephone number, and fax number. This section is critical for communication regarding the case.
9. Describe the purpose of the rehabilitation assignment, specifying the date and type of injury. This ensures clarity regarding the professional's responsibilities.
10. Indicate which carrier, self-insured employer, or third-party administrator assigned the rehabilitation professional. Provide the relevant company name and the date completed.
11. Finalize the form by including the name of the individual completing it, their official title, and contact information. Be sure to sign the document to certify its accuracy.
12. Once all sections are completed, save your changes. You may choose to download, print, or share the form as necessary. Finally, remember to send the completed form to the North Carolina Industrial Commission.

Complete your Ncic 25n Online form today to ensure a smooth process in your workers' compensation claim.