Autofill Legal North Carolina Workers' Compensation Forms For Free

A "Form 61" is the official North Carolina Industrial Commission form used by insurance companies to DENY workers' compensation claims. If you get a "Form 61" that means that your case is being declined or denied, and no further cash or medical benefits will be provided to you after the date on the Form 61.

Form 18. This is where you begin when you have a claim. This form MUST be filled out completely and submitted to the Industrial Commission when you have been injured on the job. (Note: Please e-mail completed forms to forms@ic.nc.gov.)

A worker may submit a written report to his or her supervisor, or the worker may choose to file a Form 18 with the North Carolina Industrial Commission, then submit a copy of the form to the employer.

NC First Report of Injury Form 19. Employers should complete this form and send to their insurance company each time an injury occurs. Owners and Officers of corporations should complete this form to exclude themselves from workers' compensation coverage.

Form 33 - This is the Request that Claim Be Assigned for Hearing. This form can be filed to request a hearing if you have a dispute with your employer concerning your medical care or other issues. This form can also be filed if you are not receiving all, or some, of the benefits to which you are entitled.

If your employer denies your claim for workers' compensation benefits, you have the right to request a hearing with the North Carolina Industrial Commission. To do so, you file a Form 33 ? Request for Hearing with the North Carolina Industrial Commission.