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Address of Plaintiff or Plaintiff's Attorney. Name of Defendant or Defendant's.

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Eight Steps to Take When Filing Your N.C. Workers' Compensation Claim Notify your employer of your work-related injury orally and in writing as soon as possible. ... See a doctor. ... Describe your work-related injury or illness to the doctor. ... With 30 days, report the injury to your employer in writing. ... Follow doctor's orders.

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.

FORM 22 – Application for Company Information Updates and Registration Cancellations 1. Company Name: 2. Change to Company Inf. Page 1. STATE OF CALIFORNIA.

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.

Workers' Compensation Forms All Employers or Carriers MUST file a Form 19 “Employer's Report of Employee's Injury to the Industrial Commission” within five days of learning of any injury or allegation of an injury.

Under North Carolina law, every injured worker — or their official representative — should report an accident to an employer immediately or as soon as it is practicable. The notice must be given within 30 days of the date of the accident.

Form 22 is used in workers' compensation claims to calculate the injured employee's average weekly wage and resulting weekly disability compensation rate based on earnings for the 52 weeks prior to the date of injury.

The Industrial Commission administers the Workers' Compensation Act, the Tort Claims Act, the Childhood Vaccine-Related Injury Act, the Public Safety Employees' Death Benefits Act, the Act to Compensate Individuals Erroneously Convicted of Felonies, and the Eugenics Compensation Program.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232