N.C. Notice of Compensation for Injured Workers and Employers. This form MUST be clearly displayed if you have workers` compensation insurance or if you qualify as a self-insured person. (N.C Gen. Stat. §97-93). (Click here for the Spanish form 17.) This Form 18 can be downloaded, printed, completed and sent to the NC Industrial Commission. Please read the attached instructions for the required information and mailing address. Click here for a list of forms primarily used by workers` compensation claimants. Employers are required to provide this form whenever an employee has received a report of an occupational injury or illness. This form MUST be completed in full by the employee and submitted to the Industry Commission in addition to Form 19. Similar to 12A, forms can be submitted electronically. The Commission requires that the subject line of the email be marked with the SCWCC file number followed by the submitted form.

The following table provides information about e-filing, including the email addresses used. To check when each form is due and other forms that result in fines, I recommend using the five best form fines from Ashley Kirkham`s S.C. Workers` Comp. Commission. As soon as possible, inform an appropriate manager of your employer or the owner of your business that you have suffered a workplace accident. If you can report your injury in person, do so. If you are unable to report your injury due to your medical condition, ask a family member, friend or health care provider to notify your employer of the injury as soon as possible. Under Rule 11 NVC 23A.0108, which comes into force on February 1, 2016, all documents submitted to the Industry Board in workers` compensation cases must be submitted electronically. (Employees without legal representation are not required to submit their application electronically.) The Commission has updated all of its forms to facilitate electronic submission. Click here to access the Electronic Document Filing Portal (EDFP) for instructions on uploading documents to the EDFP and paying invoices online with the Industrial Commission. The completed form can be sent to: NC Industrial Commission1236 Mail Service CenterRaleigh, NC 27699-1236ATTN: Medical Rehabilitation Nurses If the application meets one of the two exceptions listed above, Form 19 can be downloaded, printed, completed and sent to N.C. Industrial Commission, faxed to the N.C.

Industrial Commission at 919-715-0282, or emailed to forms@ic.nc.gov. Please note that if the claim does not meet any of the above exceptions, Form 19 will be returned without processing and an FROI must be filed by EDI. Communication to the Commission on the secondment of rehabilitation professionals. Please complete this form completely and be sure to provide the I.C number for the claim. Please submit the Commission as indicated on the form. Note: Please email completed forms to forms@ic.nc.gov. Now it`s time to review your claims in South Carolina to confirm that all forms and reports have been filed in accordance with the law. This includes all forms or reports to which the Commission is entitled during the period from 23 November 2019 to 30 April 2020. The most common fine is $200.00 for failing to file a return on time.

Common forms that receive a fine of $200.00 include: Form 17, Form 18, Form 20, Form 15 and Form 12A (Initial Violation Report). Therefore, not checking your claims can be a costly mistake. Beginning May 1, 2020, the Workers` Compensation Board of South Carolina will impose fines on reports and forms that were not filed in time for their respective due dates. The Commission briefly suspended the imposition of fines at the end of November 2019 during the implementation of KERMIT. All common forms of the NC Industrial Commission can be found here. Most are in PDF format and require Adobe Reader to view or print. Certain forms may be completed and printed for electronic filing in accordance with NVC Rule 11 23A.0108 with effect from February 1, 2016. NOTE: Since the Industry Commission uses an electronic document management system to electronically scan and store all forms we receive and any other correspondence, we require that all forms be submitted on a white paper. NO form on colored paper will be accepted. That`s where you start if you have a claim. This form MUST be completed in its entirety and submitted to the Industry Commission if you have been injured on the job. (Note: Please email the completed forms to forms@ic.nc.gov.) The HC Workers` Compensation Board has recently made a number of changes to certain board forms that will come into effect on March 1, 2019.

After this date, the updated forms must be used, otherwise the Commission will return the form without modifying it. Approval for rehabilitation professionals to receive medical records of ongoing treatment. Please complete the form completely, sign it and send it to the rehabilitation professional named on the form. Click here for the Spanish form 25C Click here to view the Commission`s full communication, which includes further changes to the forms that deal more with lawyers and disputes. Please do not hesitate to contact us if you have any questions or concerns regarding these changes. Tell your doctor that your injury is related to your job and the name of your employer. This information allows the health care provider to bill for treatment as a workers` compensation claim. Medical Rehabilitation Nurses Section Reference Form. Please use this form to request assistance from the Medical Rehabilitation Nurses Section. Fill out the form completely and be sure to provide the I.C number for the claim if possible. and email the completed form to rehab.referrals@ic.nc.gov.

By clicking here, you can access a list of the forms used by the Department of Nursing and Medical Rehabilitation. . To establish a claim for COVID-19-related occupational disease under the NCWCA, an employee must demonstrate: 1) that the employment has put them at a higher risk of developing the disease than the general public and 2) that the employment has caused them to contract the disease. . If there is no local employer or designated third-party health care provider, seek medical care that meets your medical needs. Depending on your situation, adequate medical care may be provided by your GP or a hospital emergency room. Certificate of Advance Payment of Processing Fees for the Compromise Agreement Your employer may have a health care provider on your construction site and, if necessary, report to that health care provider if this is in accordance with your employer`s instructions. Application for Reinstatement of Disability Award Payment (G.S. § 97-18(k)) Employee, Representative or Parent Claim for Lung Diseases, Including Asbestosis, Silicosis and Byssinosis (G.S. § 97-53) Employee Additional Medical Claim (G.S. § 97-25.1) Jennifer H. Newman is an employee who practices workers` compensation defense and employers and their carriers against claims and disputes throughout the year South Carolina.

Prior to attending law school, she worked as a paralegal for a plaintiffs` law firm, which gave her a unique insight into the claims management process from all angles. Read Jenny`s biography Report your injury to your employer and seek appropriate medical treatment. Employee`s Claim for Supplementary Medical Compensation (G.S. §97-25.1) (Applicable to injuries caused by an accident or occupational disease as of July 5, 1994). Request for termination or suspension of compensation payment Follow your doctor`s instructions for medical treatment. The goal of the workers` compensation system in North Carolina is to make sure you get good health care to restore the health and work capacity you had before your injury. .