If you have been injured at work and are attempting to attain NC Workers’ Compensation benefits, you will have to file at least one and become familiar with several of the below forms. This post discusses the eight most commonly used NC Workers’ Comp forms and when to use them. The Bishop Law Firm represents injured workers in Raleigh, NC and surrounding areas. We do not get paid unless we win.
NC Workers’ Compensation Commonly Used Forms
Form 18 – Employee Form
If you have been injured at work, you should file a Form 18, Notice of Accident to Employer and Claim of Employee… with the NC Industrial Commission. This form alerts the NCIC and your employer that you have been injured. So after you are injured you should send a copy of the Form 18 to the NCIC; your employer and also keep a copy for your records. The 2nd page of Form 18 does contain some instructions so please read them if you are unclear on how to fill out the form.
Please be careful when you fill out this form. Making sure you put the correct day for your injury, the body part that was injured, and how the accident happened. If you are not clear on this form this may come back to haunt you later if you have to go to a NC Workers’ Compensation hearing. If you do not know your employer’s workers’ compensation insurance company and can not find out you can simply leave that section blank.
Form 19 – Employer Form
While Form 18 is required from the employee, a Form 19, Employer’s Report of Employee’s Injury or Occupational Disease to the Industrial Commission, is required from the employer. If the employee has missed one day of work due to their injury, the employer must file with the NCIC and give a copy of this form to the injured employee. But employees should note that they must file their own Form 18 in order to have a NC Workers’ Compensation claim.
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. This form (as listed on the form itself): does not constitute an agreement. In addition, this form does not specify the type of treatment the employer’s insurance company has agreed to pay for.
Also read NC Workers’ Compensation Weekly Benefits
Form 61 – Employer Form
Form 61, Denial of Workers’ Compensation Claim – If your employer’s workers’ compensation company denies that you have been hurt and have a payable claim they will file this form with the NCIC. This form means that you will receive no compensation for your missed time from work or medical treatment unless you can convince the NCIC to overturn this decision at hearing (or at the mediation that comes prior to the hearing).
Form 63 – Employer Form
Form 63, Notice to Employee of Payment of Compensation with prejudice or payment of medical benefits only without prejudice – If the employer files this form with the NCIC, they have provisionally accepted the claim. They can choose to pay medical and indemnity or medical only. In summary, the employer is saying that they are investigating the claim and this form gives them 90 days to do so.
Form 25P and 25T – Employee Forms
Form 25P, Itemized Statement of Charges for Drugs and 25T, Itemized Statement of Charges for Travel should be completed when an injured employee has accrued expenses for medication or travel for medical treatment (if they have traveled more than 20 miles roundtrip) in accepted claim. This form should be sent to the injured worker’s employer’s workers’ compensation insurance company.
Form 33 – Employee Form
Form 33, Request That Claim Be Assigned For Hearing – If your employer’s workers’ compensation insurance company has denied your claim or if they are unwilling to pay for certain needed medical care, an injured worker would need to file Form 33. This form requires information about your injury, employer and your source of disagreement with them. If the employer has completely denied your claim with Form 61, filing for a hearing is your only recourse. If the insurance company has approved some medical treatment but not all of your treatment this form needs to be carefully filled out.
Also read NC Workers’ Compensation Hearings
NC Workers’ Compensation uses many forms besides the above. Knowing when to file a form can be imperative for your case. If you have having problems understanding a form or knowing which form to fill out, contacting a NC Workers’ Compensation Lawyer may be your best move. The Bishop Law Firm represents injured workers in Raleigh, Cary, Fayetteville, Durham, Rocky Mount, Wilson, Smithfield, Louisburg, Chapel Hill, Roanoke Rapids, and surrounding areas in North Carolina. We do not get paid unless we win your case and we offer free case reviews by phone, (919) 615-3095.