This is one of the official workers' compensation forms for the the state of North Carolina
North Carolina Report of Compensation and Medical Compensation for Workers' Compensation
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FAQ
If you've been injured as a result of your work, you should be able to collect workers compensation benefits.Your employer or its workers' comp insurance company does not have to agree to settle your claim, and you do not have to agree with a settlement offer proposed by your employer or its insurance company.
If an injury or alleged injury causes the employee to be absent from work for more than one day, or the employee's medical expenses are greater than $2000.00, the employer or carrier must file with the Industrial Commission a Form 19 Employer's Report of Employee's Injury to the Industrial Commission within five days
The actual amount of the weekly Temporary Total Disability or Permanent Total Disability benefit paid to a disabled employee is 2/3rds of the Average Weekly Wage. This is referred to as the compensation rate. The compensation rate is capped at an amount set yearly by the NC Industrial Commission.
An employee's death may be covered by workers' compensation in NC if it is related to a workplace injury by accident or occupational disease, and occurs within 1) six years from the date of an injury or onset of disability related to an occupational disease, or 2) two years from a final determination of disability.
Workers' Comp laws in NC provide injured workers medical treatment for their injuries as well as wage replacement when they are disabled. Unlike the tort/negligence system which allows recovery for pain and suffering NC workers' compensation laws provide coverage primarily for economic losses.
In most states, the employer or insurance company must decide whether you're eligible for workers' comp benefits promptly or within a reasonable time period. Some states also have strict deadlines for approving or denying a claimoften between 14 and 30 days.
So it is 66 and two thirds percent of your average weekly wage that you're entitled to for workers compensation benefits. That is what's called your compensation rate. So the amount that you'll receive when you're unable to work is two thirds of your average weekly wage.
Settlements are calculated based on a combination of lost wages, medical expenses, future medical expenses, specific loss, scarring, and more. Because factors vary so widely from case to case, it's nearly impossible to provide an average workers' comp settlement amount.
A Form 18 establishes a legal claim of injury on your behalf if filed within two years of the date of injury or occupational. disease, and gives the required written notice to the employer if a copy is submitted to the employer within 30 days of the. injury.