NORTH CAROLINA INDUSTRIAL COMMISSION

Help Line: (800) 688-8349, (919) 807-2501, or infospec@ic.nc.gov
Fraud and Insurance Compliance Hotline: (888) 891-4895 or fraudcomplaints@ic.nc.gov

For Injured Workers

If You Have Been Injured At Work

First Steps

Report your injury to your Employer and seek out appropriate medical treatment.

Your employer may have a health care provider on your work site and if consistent with your employer’s instructions present yourself to that health provider if appropriate.

If you do not have access to an on-site health provider, your employer may have instructed you to present yourself to a designated health care office in case of work related injuries. If appropriate to the seriousness of your injury, report to that facility.

If there is no employer on-site or designated off-site health care provider, seek medical care appropriate to your medical needs. Depending on your circumstances, appropriate health care may be obtained from your family doctor or a hospital emergency room.

Second

Tell your health care provider that your injury is related to your work and the name of your employer. This information allows the health care provider to bill treatment as a Workers’ Compensation claim.

Third

As soon as possible, inform an appropriate manager of your employer or the owner of your company that you have experienced a work related accident. If you can personally report your injury, do so. If you are unable to report your injury because of your medical condition, have a family member, friend or health care provider notify your employer of the injury as soon as possible.

Fourth

As soon as practical after the accident, and within thirty days, give written notice to your employer. A simple written statement giving the date of the accident and a brief description of the injury is all that is necessary. If you cannot write the letter, have a friend or family member write it for you and send it to the employer. Keep a copy of the letter for your records.

Fifth

Follow your physician’s instructions for medical treatment. The goal of the Workers’ Compensation System in North Carolina is to ensure that you get good health care to restore you as nearly as possible to the health and ability to work that you had prior to your injury.

Following these five simple steps will ensure that your injury is properly reported, you receive appropriate health care quickly and that your employer can initiate workers’ compensation medical benefits.

ATTENTION EMPLOYEES AND EMPLOYEE REPRESENTATIVES:

Information regarding the workers’ compensation carrier for your employer may be obtained from the Industrial Commission in one of the following three manners:

  1. Searching the Insurance Coverage Search System;
  2. You have filed a Form 18 asserting a claim against the employer.
  3. The employer or carrier has filed a Form 19 reporting your injury.

The Industrial Commission sends out an acknowledgement letter when a Form 18 is processed that contains information about the insurance carrier. However, if you have not yet received an acknowledgement letter and you need this information, you may contact the Industrial Commission. It is not required that you provide insurance carrier information when completing a Form 18 if you do not have that information.

Employee Forms

Any claim by an employee must begin by filling out and submitting a form to the NC Industrial Commission. Below is a partial list of available forms. (Note: Please e-mail completed forms to forms@ic.nc.gov.)

Form 18

This is where you begin when you have a claim. This form MUST be filled out completely and submitted to the Industrial Commission when you have been injured on the job.

Form 18 for Electronic Submission

This version of the Form 18 allows for filling out and submitting it on-line. You must have Adobe Reader version 7.0 or later and a valid e-mail address to submit this form on-line. Click Here to get the free Adobe Reader.

Standard Form 18 With Instructions

This Form 18 may be downloaded, printed, filled out and mailed into the NC Industrial Commission. Please read the attached instructions for required information and the mailing address.

Form 18B

This form is used if there is a claim by an Employee, Representative, or Dependent for Lung Disease, Including Asbestosis, Silicosis, and Byssinosis (G.S. §97-53)

Form 18M

This form should be used if an employee wishes to apply for Additional Medical Compensation (G.S. §97-25.1) (Applicable to Injuries by Accident or Occupational Illness on or After July 5, 1994)

Additional Forms

Please click here to visit the Forms page for a complete listing of all the available
NC Industrial Commission Forms

Note: Please e-mail completed forms to forms@ic.nc.gov.