Michael F. Easley, Governor
Buck Lattimore, Chairman

Stephen T. Gheen
Chief Deputy Commissioner
Office: 919-807-2540
Home: 919-384-1292

Bernadine S. Ballance, Commissioner
Thomas J. Bolch, Commissioner
Laura K. Mavretic, Commissioner
Christopher Scott, Commissioner
Dianne C. Sellers, Commissioner
Pamela T. Young, Commissioner

North Carolina
Industrial Commission




TO:         All Interested Parties

FROM:   Stephen T. Gheen, Chief Deputy Commissioner

DATE:    February 3, 2004

RE:         Important Notice: Filing of Form 19s

Internal audits of Form 19 filings with the Industrial Commission reveal that a substantial number of Form 19s are not properly completed when filed. A change of procedure is being implemented. The purpose of this memorandum is to explain the change.

The internal audit reveals that the largest omissions on the Form 19 are failure to complete the employer code and carrier code sections. Staff members have been routinely returning the Form 19s to the appropriate party requesting entry of the missing data. The limited staff available to process returning Form 19s has reached a critical mass in being able to process the number of returns. The large volume not only reduces available staff time for other important tasks, but also appears to delay benefit payments in some compensable cases.

N.C. Gen. Stat. § 97-92(a) and (e) provides that employers shall provide information on the Form 19 as required by the Industrial Commission. An incomplete Form 19 does not meet the statutory mandate. Failure to do so can result in sanctions of not less than Five Dollars ($5.00) and not more than Twenty-five Dollars ($25.00).

Effective Monday, February 24, 2004, the Statistics Section of the Industrial Commission will issue an administrative sanction order for each Form 19 improperly completed. The administrative sanction order may be appealed to the Deputy Commissioner Section as any other administrative order. Where staff can complete omitted information; particularly the employer code and carrier code, the Form 19 will not be returned but a sanction order will be issued. If staff cannot complete the omitted information, the administrative sanction order and the From 19 will be returned for proper completion.

Effectively immediately and extending through February 23, 2004, staff will complete information on Form 19s when possible rather than return the Form 19. No administrative sanction orders will be issued during this period to afford employers, carriers and third party administrators an opportunity to develop compliance procedures. If staff cannot complete the missing information, the Form 19 will be returned.

A copy of this memorandum is being sent to all insurance carriers in the Industrial Commission’s facsimile database. In addition, counsel representing employers, carriers and third party administrators are requested to advise their clients of the change of procedure outlined above. Counsel for self-insured employers should particularly advise their clients as the Industrial Commission does not have a general data base of self-insured employer facsimile addresses.

If you should have questions or concerns regarding this procedure, please feel free to call me. Communication initially by email would be preferred, but not required, at gheen@ind.commerce.state.nc.us.

Thank you. I remain in your service.


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