Navigating a workers’ compensation case in North Carolina involves understanding and utilizing various forms provided by the North Carolina Industrial Commission (NCIC). These forms document key aspects of a claim, ensuring compliance with state laws and facilitating communication between the injured worker, employer, insurer, and the North Carolina Industrial Commission (NCIC). Below is an overview of some of the most commonly used NCIC forms and their purposes.
Form 18: Notice of Accident to Employer
Form 18 is the initial form that an injured worker must file to notify the employer and the NCIC about a workplace injury. Filing this form within two years of the injury or the date of the last payment of compensation may preserve the worker’s claim rights. It provides details of the incident, including the date, nature of the injury, and circumstances, forming the foundation of the workers’ compensation claim.
Form 19: Employer’s Report of Employee’s Injury or Occupational Disease
Employers are required to complete Form 19 when an employee reports a workplace injury. This form captures basic details about the incident, the nature of the injury, and any initial medical treatment provided. It is submitted to the NCIC and serves as a record of the employer’s acknowledgment of the injury.
Form 60: Employer’s Admission of Employee’s Right to Compensation
Form 60 is filed when an employer or insurance carrier accepts (or agrees to cover) the employee’s workers’ compensation claim. This admission includes details about the injury and confirms that the employer accepts liability for benefits including payment for medical treatment and wage loss benefits.
Form 61: Denial of Workers’ Compensation Claim
If an employer or insurer denies the claim, they must file Form 61. This form explains the reasons for the denial, such as a lack of evidence of a workplace injury or a determination that the injury is not covered under workers’ compensation laws. A denied claim can be appealed by the injured worker.
Form 63: Notice to Employee of Payment Without Prejudice
Form 63 allows the employer or insurer to begin paying benefits while continuing to investigate the claim.
This form has two key designations:
- Medical Only: The employer or insurer agrees to pay for medical treatment but does not yet accept full liability for the claim.
- Payment of Temporary Total Disability (TTD) and Medicals: This indicates payment of both wage loss and medical benefits while retaining the right to later deny the claim after further investigation.
Form 33: Request for Hearing
When disputes arise, Form 33 is used to request a formal hearing before the NCIC. This might occur if there is a disagreement about the compensability of the injury, the amount of benefits, or other aspects of the claim. It marks the beginning of the litigation process.
Form 33R: Response to Request for Hearing
Form 33R is the employer or insurer’s response to Form 33. It outlines their position on the issues raised and provides their arguments or defenses.
Form 26A: Agreement as to Payment of Permanent Partial Disability (PPD) Benefits
Form 26A is used to document the agreement between the employee and employer/insurer regarding payment of permanent partial disability benefits. It confirms that the worker is entitled to specific compensation for permanent injuries, such as partial loss of use of a body part. There are times where accepting a settlement on a Form 26A is the right way to proceed and other times when there may be other and better remedies for an injured worker. You should consult an experienced workers’ compensation attorney before signing any kind of settlement agreement.
Understanding these forms and their purposes is essential for injured workers, employers, and attorneys involved in workers’ compensation claims in North Carolina. Filing the appropriate forms accurately and on time ensures smoother handling of the case and compliance with legal requirements.
