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Get Form 19 - Diocese Of Charlotte

Opy of this Form 19 accompanied by a blank Form 18 must be given to the employee. It does not satisfy the employee s obligation to file a claim. The filing of this report is required by law. This form MUST be transmitted to the Industrial Commission through your Insurance Carrier. To the Employee: This Form 19 is not your claim for workers compensation benefits. To make a claim, you must complete and sign the enclosed Form 18 and mail it to Claims Administration, N.C. Industrial Commission,.

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