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Hurt on the Job? Forms That Need to be Completed for Possible Compensation

When you’re injured on the job in North Carolina, it’s enough to deal with just trying to recover. Let alone, trying to put food on the table and pay the light bill while you’re not able to work.

In order to try to help make those payments and to propel your worker’s comp claim from one step to the next, the North Carolina Industrial Commission (NCIC) will play a key role in your claims process. It is the state agency responsible for ensuring that you, your employer, and its insurance company are all playing by the rules and treating each other fair and square.

We know these rules from first-hand experience. Two of our workers’ compensation lawyers, Doug Berger and Matthew Harbin were formerly NCIC commissioners presiding over workers’ comp hearings. As a former four-term N.C. state senator, Mr. Berger helped write some of our workers’ compensation laws.

As with many large bureaucratic agencies, you will be required to fill out a number of forms during the course of your claim. Strict deadlines apply. If your forms are late, you can lose your claim rights.

People can often be confused and intimidated as to which forms to fill out and why. We get it. We fill them out all day every day. That’s one of the conveniences of having a workers’ compensation lawyer handle your case.

If you do not have a workers’ comp lawyer working on your behalf, and you’ve decided to try to tackle your claim on your own, we have compiled a list of some of the more common forms the North Carolina Industrial Commission requires.

NCIC Workers’ Compensation Forms

File Immediately After a Work Injury

Form 18

Your report of the injury. A Form 18 should be filed with the NCIC as soon as possible, but no later than two years from your date of injury. You should notify your employer immediately after you are injured, or as soon as is practical, and within 30 days of your injury. This form lets the NCIC and your employer know that you are requesting to be compensated for your injuries. If you do not file within the 30-day deadline (which begins the day you were injured), your claim may be dismissed after a period of time.

Form 19

Your employer’s report of the injury. Form 19 must be filed within five days of the employer’s knowledge that you were injured. Do not assume your employer will file this claim or file it within the deadline. We have seen employees’ claims get bogged down right from the start because this form was not filed or not filed on time. If you are able, we suggest you follow up, as there is no penalty to the employer if they do not file.

File to Determine Benefits Status and Amount

Form 60

If your employer accepts the claim, they need to file a Form 60 admitting responsibility and agreeing to pay full workers’ comp benefits (wage loss benefits and medical treatment).

Form 61

If your employer denies responsibility for your injury, they need to file a Form 61 stating the reasons why they are denying responsibility.

Form 62

Your employer or insurance carrier should file a Form 62 to make modifications to your weekly benefit amounts and the reasons for doing so.

Form 63

A Form 63 allows your workers’ comp insurance carrier to pay some of your medical bills, while they investigate your claim. However it does not obligate them to accept responsibility for your injury or to pay wage loss benefits.

File for Mileage Reimbursement

Form 25T

The insurance company may not always mention this mileage benefit to you. You should be aware that you are allowed reimbursement for mileage to medical appointments when you have to drive more than 20 miles round trip.

Returning to Work

Form 26A

Be vigilant when signing Form 26A. This form is typically used when you are able to continue working for your employer in your pre-injury job after your medical treatment has concluded. The insurance company fills out Form 26A utilizing the information from your doctor’s assigned permanent partial impairment rating. You will receive a lump sum based on a statutory formula, which is based on your weekly compensation rate and the part of your body that was injured. We have handled thousands of workers’ comp settlements. We can tell you from experience that it is prudent to have a worker’s comp lawyer on your side when finalizing your settlement amount.

We guarantee you the insurance company has their own lawyers to call on when
determining your settlement amount.

Request an NCIC Hearing

Form 33

If you believe you require a hearing before the North Carolina Industrial Commission, you can file Form 33 to request one.  Be forewarned. Your employer and the insurance company will almost certainly be represented by attorneys who will fight for their rights which could include not paying you benefits.

We do not recommend you go through an NCIC hearing without your own workers’ comp attorney to help try to even the battlefield on your behalf.

You Can Afford a James Scott Farrin Workers’ Comp Lawyer

Many of our clients come to us after trying to negotiate the workers’ comp bureaucracy with its many forms, deadlines, and confusing and seemingly conflicting information on their own. While we have helped many who threw in the towel mid-process, we suggest injured workers come to us right after their injury. You can see why. The NCIC clock starts ticking on Day 1 of your injury.

Our contingency fee is the same whether you hire us from the beginning, middle, or toward the end. So you might as well take full advantage and hire us from the start. If we take your case, you don't pay an attorney's fee unless we recover compensation for you. And you only pay a percentage of the money you potentially recover.

If we don't recover for you, we won't charge you an attorney's fee.

NC Workers’ Compensation Lawyers Offer Free Evaluation

Of the more than 28,000 attorneys who are licensed in North Carolina, only 140 are N.C. Board Certified in workers’ compensation law*. Several of our workers’ comp attorneys are NC Board Certified Specialists in Workers' Compensation law.

If you have been injured on the job, take full advantage of the experience we have to offer. Don’t wait. Contact us right after your injury for a free case evaluation. As you can see, the forms alone are a lot to deal with, and we’d love to help you fight for the compensation you potentially deserve.

Contact us or call 1-866-900-7078 for your FREE case evaluation.

*Figures provided by the N.C. State Bar as of December, 2016.

 

Susan Vanderweert joined the Law Offices of James Scott Farrin in 2015 handling Workers’ Compensation cases, and is a North Carolina Board Certified Specialist in Workers' Compensation law. Prior to joining the Law Offices of James Scott Farrin, she represented the other side – insurance companies and employers – for more than 12 years.

Ms. Vanderweert earned her J.D. from the University of North Carolina School of Law at Chapel Hill, where she was Editor-in-Chief for the North Carolina Journal of International Law and Commercial Regulation. She earned a Master of Arts in Liberal Studies from Duke University and a Bachelor of Arts from the University of Minnesota Duluth, where she double majored in Political Science and Communication.

Throughout Ms. Vanderweert’s career she has practiced in the areas of Appellate Advocacy, Insurance Regulatory Matters, and Workers’ Compensation. While she has worked in a variety of capacities – journalism, public relations, and managing a variety of nonprofit professional associations and trade groups – nothing comes close to the satisfaction she gets from helping injured workers.

Contact Information

Raleigh Law Office

5848-100 Faringdon Place
Raleigh, NC 27609
Phone: 919-834-1184
Toll Free: 1-866-900-7078

Durham Law Office

280 South Mangum Street, Suite 400
Durham, NC 27701
Phone: 919-688-4991
Fax: 800-716-7881

Fayetteville Law Office

517 Owen Drive
Fayetteville, NC 28304
Phone: 910-488-0611
Toll Free: 1-866-900-7078

Charlotte Law Office

1001 Morehead Square Drive, Suite 350
Charlotte, NC 28203
Phone: 704-599-1078
Toll Free: 1-866-900-7078

New Bern Law Office

1505 South Glenburnie Rd, Unit P
New Bern, NC 28562
Phone: 252-634-9010
Toll Free: 1-866-780-3422

Greenville Law Office

702 G Cromwell Dr.
Greenville, NC 27858
Phone: 252-355-5205
Toll Free: 1-866-780-3227

Greensboro Law Office

300 N. Greene Street, Suite 850
Greensboro, North Carolina 27401
Phone: 336-665-7072
Toll Free: 1-866-900-7078

Goldsboro Law Office

214 South William Street, Suite 3
Goldsboro, NC 27530
Phone: (919)-731-2581
Toll Free: 1-866-900-7078

Henderson Law Office

514 Dabney Drive, Suite 200
Henderson, NC 27536
Phone: 252-492-4600
Toll Free: 1-866-900-7078

Roanoke Rapids Law Office

709 Julian R. Allsbrook Highway
Roanoke Rapids, NC 27870
Phone: 252-537-9670
Toll Free: 1-866-900-7078

Rocky Mount Law Office

3202 Sunset Avenue, Suite B
Rocky Mount, NC 27804
Phone: 252-937-4730
Toll Free: 1-866-900-7078

Sanford Law Office

703-B South Horner Boulevard
Sanford, NC 27330
Phone: 919-775-1564
Toll Free: 1-866-900-7078

Wilson Law Office

2315 Airport Blvd Suite A
Wilson, North Carolina 27896
Phone: 252-246-9090
Toll Free: 1-866-900-7078

Winston-Salem Law Office

301 N. Main Street, Suite 2409-C
Winston-Salem, NC 27101
Toll Free: 1-866-900-7078