This is one of the official workers' compensation forms for the the state of North Carolina
Workers Compensation In North Carolina Agreement Form 19
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How to fill out Workers Compensation In North Carolina Agreement Form 19?
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FAQ
Filling out a DWC-1 form is actually pretty straightforward....On the form, you will need to only fill out the Employee section, which asks for basic information:Name, date, and address.Date and location of injury.Brief description of injury.List of injured body parts.Social Security Number.
HOW DO YOU CALCULATE WHAT AN INJURY RATING IS WORTH? It is usually simple to calculate how much an injury rating is worth. Just multiply the injury percentage rating by the employee's compensation rate, and then multiply that result by the number of weeks assigned to the injured body part.
Eight Steps to Take When Filing Your N.C. Workers' Compensation ClaimNotify your employer of your work-related injury orally and in writing as soon as possible.See a doctor.Describe your work-related injury or illness to the doctor.With 30 days, report the injury to your employer in writing.Follow doctor's orders.More items...
All U.S. employers must properly complete Form I-9 for each individual they hire for employment in the United States. This includes citizens and noncitizens. Both employees and employers (or authorized representatives of the employer) must complete the form.
Your employer is required to report an injury to their Workers' Compensation insurance carrier for an injury sustained in the course of employment where the attention of a physician is needed or actually sought.
More info
Forms. Compensation Program.Please note: Your claim for benefits does not start with your employer's filing of Form 19. You should also receive from your employer a form to fill out. Completed copy must always accompany Form 21.