Download As Pdf Legal North Carolina Workers' Compensation Forms For Free

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.

North Carolina Industrial Commission Form 22 is the Statement of Days Worked and Earnings of Injured Employee. This form contains a table wherein the hours worked and wages earned over the 52 weeks prior to the employee's injury are recorded.

Workers have just 30 days to notify their employer of a work-related injury or illness. A written report of the workplace accident must be submitted to your employer as soon as possible (ideally well before 30 days have elapsed).

Those businesses that employ three or more employees are required to carry workers compensation insurance except agricultural employment with fewer than 10 employees, certain sawmill and logging operations and all domestic employees are exempt.

(b) Any employer required to secure the payment of compensation under this Article who refuses or neglects to secure such compensation shall be punished by a penalty of one dollar ($1.00) for each employee, but not less than fifty dollars ($50.00) nor more than one hundred dollars ($100) for each day of such refusal or ...

Form 19 - This is the Report of Injury form to be completed by your employer. Form 18 - This is the Injured Worker Notice of Accident Claim form to be completed and filed with the Industrial Commission by you when you have been injured on the job.