Michael F. Easley, Governor
Pamela T. Young, Chair

Bernadine S. Ballance, Commissioner
Buck Lattimore, Commissioner
Laura K. Mavretic, Commissioner
Danny L. McDonald, Commissioner
Christopher Scott, Commissioner
Dianne C. Sellers Commissioner

North Carolina
Industrial Commission

MEMORANDUM

TO:         All Interested Parties

FROM:   Pamela T. Young, Chair

DATE:    January 16, 2008

RE:         Acknowledgment of the Form 25N

The Medical Rehabilitation Nurses Section is responsible for reviewing and acknowledging all Form 25N submissions pursuant to the N.C. Industrial Commission Rules for Utilization of Rehabilitation Professionals in Workers’ Compensation Claims, Rule IV. E. The Nurses Section receives a high volume of Form 25Ns daily, often without Industrial Commission file numbers (I.C. File #). Because there are no I.C. File Numbers, the Industrial Commission does not have jurisdiction over the claim and the Nurses Section is unable to properly file the forms into injured workers’ files. Therefore, effective immediately, 25N forms that lack an assigned I.C. File # related to injuries greater than sixty (60) days old will not be acknowledged or returned by the Nurses Section.

A carrier should file a Form 19—Report of Injury for assignment of an I.C. File # if it anticipates the need for rehabilitation so that the Nurses Section can acknowledge the Form 25N. The 60-day period is allowed in an effort to prevent delays in medical care while awaiting the assignment of the I.C. File # by the Claims Section of the N.C. Industrial Commission. A carrier should make every effort to avoid placing rehabilitation professionals in situations where they are asked to provide services for cases that are not legally under the jurisdiction of the N.C. Industrial Commission.


Click here for Rules for Utilization of Rehabilitation Professionals in Workers’ Compensation Claims.


N.C. Industrial Commission ·   4340 Mail Service Center ·   Raleigh, NC 27699-4340
Main Phone: (919) 807-2500 ·   Fax: (919) 715-0282
NCIC Home Page:
http://www.ic.nc.gov/