Nc workers comp form form 2026

The document is a Notice of Accident to Employer and Claim of Employee form required by the North Carolina Industrial Commission under the Workers' Compensation Act. It outlines the necessary information for reporting an injury or occupational disease, including employee and employer details, description of the incident, and medical treatment received. The form must be filed within two years of the injury, with specific instructions for both employees and employers regarding notification and documentation.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the IC File #, which is essential for tracking your claim. This number will be provided in a return letter.
Fill in the Employee’s Name and Address fields accurately, ensuring all details are correct for future correspondence.
Complete the Employer's Name and Address sections, including City, State, and Zip Code.
Provide your Social Security Number and Date of Birth. Indicate your sex as required.
In the Insurance Carrier section, enter the Policy Number and Carrier’s Address along with their contact information.
Describe the injury or occupational disease clearly, including specific body parts affected and how it occurred.
Indicate your occupation at the time of injury and provide details about medical treatment received, weekly wage, and work hours.
If you are unable to sign, ensure that another authorized person signs on your behalf. Retain a copy for yourself and send signed copies to both the Industrial Commission and your employer.

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What is a c11 form for workers comp?

C-11: Employers Report of Injured Employees Change in Status. Report any change in a claimants work status as soon as it occurs to NYSIF by submitting Form C-11, including return to work, discontinuance of work, decrease in regular working hours or reduction of wages.

How long can you be on workmans comp in NC?

Lost wage compensation is payable if an employee is unable to work for more than 7 days. Temporary total and partial disability benefits are paid for up to 500 weeks until you return to work.

How is workers comp settlement calculated in NC?

Apply the two-thirds rule: Calculate two-thirds of the comparable employees average weekly earnings to determine the workers comp wage benefit for the injured employee.

Does workers comp pay for pain and suffering in NC?

Unlike the tort/negligence system, which allows recovery for pain and suffering, NC workers compensation laws focus mainly on economic losses, such as lost earning potential and medical treatment.

What is a form 33 workers compensation nc?

Form 33: Request That Claim Be Assigned for Hearing. If your workers compensation claim has been denied, you may appeal by requesting a hearing before the North Carolina Industrial Commission.