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North Carolina Industrial Commission IC File # REQUEST THAT CLAIM BE ASSIGNED FOR HEARING Emp. Code # Carrier Code # Carrier File# The Use Of This Form Is Required Under The Provisions of The Workers.

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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.

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.

Form 18. This is where you begin when you have a claim. This form MUST be filled out completely and submitted to the Industrial Commission when you have been injured on the job. (Note: Please e-mail completed forms to forms@ic.nc.gov.)

Form 60 – Employer Form Form 60, Employer's Admission of Employee's Right to Compensation – If your employer's workers' compensation insurance company agrees that you have been injured at work and that injury is one that you can be compensated for, then the insurance company will admit that you are due compensation.

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.

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 ...

Form 33 - This is the Request that Claim Be Assigned for Hearing. This form can be filed to request a hearing if you have a dispute with your employer concerning your medical care or other issues. This form can also be filed if you are not receiving all, or some, of the benefits to which you are entitled.

Workers have just 30 days to notify their employer of a work-related injury or illness. A written report of the workplace accident must be submitted to your employer as soon as possible (ideally well before 30 days have elapsed).

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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
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
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