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North carolina 18m form

North carolina 18m form 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 by accident or occupational diseases. It requires details about the employee, employer, and the nature of the claim, along with optional supporting documentation from a treating physician.

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Click ‘Get Form’ to open the North Carolina 18M form in the editor.
Begin by filling in your personal information, including your name, address, and contact details. Ensure accuracy as this information is crucial for processing your application.
In Section A, state the date of your injury and provide 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 you have an attorney, include their name and address.
If applicable, complete Section B with your treating physician's information. They should certify their relationship to you and detail any additional medical care needed.
Once completed, send the original form along with any attachments to the Industrial Commission as instructed. You can also share a copy with your employer or carrier/administrator.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (225 Votes)
2017	4.4 Satisfied (221 Votes)
2001	4 Satisfied (23 Votes)

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