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( Employee s Name Employer's Name Address Employer s Address City ( State ) ( Home Telephone Last 4 Digits of SSN Sex DRUG STORE Telephone Number City State Zip City State Zip Insurance Carrier ) Work Telephone M F XXX-XX- DATE Zip ) / Carrier's Address ( / Date of Birth ) ( Carrier's Telephone Number CITY ) Fax Number NAME OF DRUG & PRESCRIPTION NO. PHYSICIAN TOTAL This is to certify that the drugs listed above were related to my workers' comp.
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For 2022, employees are entitled to reimbursement of $0.585 per mile for travel for medical treatment occurring 1/1/22 through 6/30/22 and $0.625 per mile for travel for medical treatment occurring 7/1/22 through 12/31/22, provided they travel 20 miles or more roundtrip.
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 ... NC Industrial Commission Information for Employers nc.gov https://.ic.nc.gov › wcinsrqmt nc.gov https://.ic.nc.gov › wcinsrqmt
Employees are entitled to reimbursement for travel expenses when the travel is medically necessary and the mileage is 20 or more miles, round trip, at the business standard mileage rate set by the Internal Revenue Service per mile of travel and the actual cost of any tolls paid. Frequently Asked Questions (FAQs) - North Carolina Industrial Commission nc.gov https://.ic.nc.gov › faqs nc.gov https://.ic.nc.gov › faqs
2 years What Is the Time Limit for Workers' Compensation Claims? The statute of limitations for a workers' compensation claim in North Carolina is 2 years from the date of the work injury. What Is the NC Statute of Limitations for Workers' Comp Claims? whitleylawfirm.com https://whitleylawfirm.com › blog › workers-comp-claim... whitleylawfirm.com https://whitleylawfirm.com › blog › workers-comp-claim...
To calculate your disability benefits, you need to know your weekly wage and your impairment rating. Under North Carolina's Workers' Compensation Act, the limit for total disability benefit compensation is two-thirds of your pre-injury weekly wage.
65.5 cents per mile as of January 1, 2023 56 cents per mile as of January 1, 2021. 57.5 cents per mile as of January 1, 2020. 58 cents per miles as of January 1, 2019.
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 Compensation | NC DOI ncdoi.gov https://.ncdoi.gov › consumers › business-insurance ncdoi.gov https://.ncdoi.gov › consumers › business-insurance
Form 25T - This is a form to List an Itemized Statement of Charges for Travel. Employees are entitled to reimbursement for mileage if the employee travels 20 miles or more round trip for medical treatment. Form 24 - This is an Application to Terminate or Suspend Payment of Compensation.
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