Form 18m 2026

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The document is an application form for employees in North Carolina seeking additional medical compensation under the Workers' Compensation Act due to injuries or occupational diseases. It requires details about the employee, employer, and insurance carrier, as well as a statement from the treating physician regarding the need for further medical care. The form must be submitted to the Industrial Commission along with any supporting documentation.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the employee’s name and address in the designated fields. Ensure accuracy as this information is crucial for processing.
Fill in the employer's name and address, along with the insurance carrier details. This section helps establish the context of your claim.
In Section A, provide the date of injury and a brief reason for requesting additional medical compensation. If you have supporting documentation, indicate whether it is attached.
Sign and date the form at the bottom of Section A. If applicable, include your attorney's contact information.
If you choose to complete Section B, have your treating physician fill out their details and sign to certify your need for additional medical care.

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