Loading
Form preview picture

Get NC Form 18 2008-2024

North Carolina Industrial Commission IC File NOTICE OF ACCIDENT TO EMPLOYER AND CLAIM OF EMPLOYEE REPRESENTATIVE OR DEPENDENT G.S. 97-22 THROUGH 24 Emp. Code Carrier Code Employer FEIN The I. C. File is the unique identifier for this injury. It will be provided by return letter and is to be referenced in all future correspondence. The Use Of This Form Is Required Under The Provisions of The Workers Compensation Act Employee s Name Address Employer s Address City State Zip M Social Security Number F / Sex Insurance Carrier Policy Number Carrier s Address Carrier s Telephone Number Carrier s Fax Number Work Telephone Home Telephone Telephone Number Date of Birth EMPLOYEE This form must be filed with the Industrial Commission within two years of the date of injury or occupational disease or your claim may be barred. Notice shall be given to the employer immediately after the accident or as soon as practicable and within 30 days. Employee should retain one signed copy of this notice mail one signed copy to the Industrial Commission at the address below and provide one signed copy to employer. Signature of Check One Employee Attorney Representative or Dependent Date Completed EMPLOYER This notice is being sent to you in compliance with requirements of the North Carolina Workers Compensation Act in order that the medical services prescribed by the Act may be obtained and if disability extends beyond 7 days duration or if death ensues compensation may be paid according to law. FOR IC USE ONLY FORM 18 8/08 PAGE 1 OF 1 MAIL TO NCIC - CLAIMS ADMINISTRATION RESEARCHER CC DATA ENTRY 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 NOTICE OF ACCIDENT TO EMPLOYER AND CLAIM OF EMPLOYEE REPRESENTATIVE OR DEPENDENT G*S* 97-22 THROUGH 24 Emp* Code Carrier Code Employer FEIN The I. C. File is the unique identifier for this injury. It will be provided by return letter and is to be referenced in all future correspondence. The Use Of This Form Is Required Under The Provisions of The Workers Compensation Act Employee s Name Address Employer s Address City State Zip M Social Security Number F / Sex Insurance Carrier Policy Number Carrier s Address Carrier s Telephone Number Carrier s Fax Number Work Telephone Home Telephone Telephone Number Date of Birth EMPLOYEE This form must be filed with the Industrial Commission within two years of the date of injury or occupational disease or your claim may be barred* Notice shall be given to the employer immediately after the accident or as soon as practicable and within 30 days. This form should also be used for occupational disease claims however for asbestosis silicosis and byssinosis Form 18B is to be used* Notice is hereby given as required by law that the above-named employee sustained an injury or contracted an occupational disease on described as follows Time of Injury at Date required. Describe the injury or occupational disease City and County including the specific body part involved e*g* right hand left hand Describe how the injury or occupational disease occurred Occupation when injured Nature of employer s business Number of days out of work due to injury Medical treatment received Yes No Weekly wage Number of hours worked per day Days worked per week NOTE If employee is unable to sign this form another may sign for him* This form should be typed or printed by hand in black ink if possible. .

How It Works

form 18 workers comp rating
4.9Satisfied
40 votes

Tips on how to fill out, edit and sign Workers compensation forms nc online

How to fill out and sign Nc form 18 workers compensation online?

Get your online template and fill it in using progressive features. Enjoy smart fillable fields and interactivity. Follow the simple instructions below:

The times of distressing complicated legal and tax forms have ended. With US Legal Forms the entire process of filling out legal documents is anxiety-free. A powerhouse editor is right at your fingertips providing you with a wide range of beneficial tools for submitting a NC Form 18. These tips, in addition to the editor will guide you with the whole process.

  1. Click the Get Form option to start enhancing.
  2. Activate the Wizard mode in the top toolbar to have extra recommendations.
  3. Fill every fillable field.
  4. Ensure that the data you fill in NC Form 18 is updated and correct.
  5. Include the date to the form using the Date option.
  6. Click the Sign icon and make an electronic signature. You will find three available alternatives; typing, drawing, or uploading one.
  7. Re-check each and every area has been filled in properly.
  8. Select Done in the top right corne to save or send the document. There are several alternatives for getting the doc. An attachment in an email or through the mail as a hard copy, as an instant download.

We make completing any NC Form 18 less difficult. Use it now!

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.

Video instructions and help with filling out and completing workmans comp form 18

Use our fast video guideline for finishing Form online. Turning to paperless is the only way to save your time for more essential duties in the digital age.

North carolina industrial commission forms FAQ

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.

Keywords relevant to nc industrial commission form 60

  • form 18 fillable
  • industrial commission forms
  • form 18 north carolina industrial commission
  • nc workers comp form
  • fillable form 18
  • form 18 nc workers compensation
  • ncic form 18
  • form 18 nc industrial commission
  • industrial commission form 18
  • workers comp form 18
  • form 18 ncic fillable
  • nc workers compensation form 18
  • workers comp nc form 18
  • workers compensation nc form 18
  • ncdol form 18
If you believe that this page should be taken down, please follow our DMCA take down processhere.
Ensure the security of your data and transactions

USLegal fulfills industry-leading security and compliance standards.

  • 
                            VeriSign logo picture

    VeriSign secured

    #1 Internet-trusted security seal. Ensures that a website is free of malware attacks.

  • Accredited Business

    Guarantees that a business meets BBB accreditation standards in the US and Canada.

  • 
                            TopTenReviews logo picture

    TopTen Reviews

    Highest customer reviews on one of the most highly-trusted product review platforms.