|Michael F. Easley, Governor
Buck Lattimore, Chairman
Thomas J. Bolch, Commissioner
Laura K. Mavretic, Commissioner
Christopher Scott, Commissioner
Dianne C. Sellers, Commissioner
Pamela T. Young, Commissioner
TO: All Interested Parties
FROM: Executive Secretary Tracey H. Weaver
DATE: April 15, 2005
RE: Important Notice Regarding Filing of Forms 24
many of you are already aware, the staff in the Office of the Executive
Secretary at times returns Form 24
Applications to Terminate or Suspend Payment of Compensation and Form 24
Responses to the appropriate parties requesting entry
of missing information. In order to avoid having a Form 24 returned, please
submit it in proper form:
1. Use the latest version of the Form 24 (the 2/01 revision), which is located on the “NCIC Forms” section of the Commission’s web page. The use of outdated versions of the Form 24 is not acceptable. It is particularly important that the form have the correct “Mail to” and ombudsman’s contact information at the bottom right of each page.
2. Fill out the entire top section of the form, to the extent possible, including the I.C. File number and carrier code.
3. Enter the correct date by which the employee must respond to the Form 24. This is particularly important in cases when employees do not have legal counsel.
Fill out the entire Section A.
At the top of Page 2 of the form,
note the service of the Form 24 and all attached documentation on the employee at
his/her current mailing address, and the employee’s counsel of record,
Sign and date the Form 24 in the
space provided, and provide a legible
printed name. Claims adjustors, please provide a telephone extension at which
you can be reached for the informal telephone hearing, should one be set.
Provide documentation to support the grounds for filing the Form
In order to avoid having a Form 24 Response returned, please submit it in proper form:
Fill out the entire Section B.
Sign and date the Form 24 Response
in the space provided.
order to process Forms 24 in an efficient manner, while heeding the due process
concerns of N.C.
Gen. Stat. §97-18.1, the Executive Secretary’s staff must ensure that
Forms 24 are being properly executed. Due to the continuous flow of Forms
staff cannot set aside or contact parties on Forms
24that are improperly filled out, but must rather return them with a memo explaining the deficiency with the filing.
The Executive Secretary’s staff will continue to return improperly executed Forms 24 and Form 24 Responses. The issue of whether to accept an improperly executed Form 24 or Form 24 Response as having been filed on its original filing date, or on the later date on which it is returned to the Commission in proper form, will remain in the sound discretion of the Special Deputy Commissioner who issues the decision on the Form 24, based on the specific circumstances of each case.
copy of this memorandum is being sent to all insurance carriers and attorneys in
the Commission’s facsimile database. In addition, counsel representing
employers, carriers, and third party administrators are requested to advise
their clients of the concerns outlined above. Particularly, counsel for
self-insured employers should advise their clients of these concerns, as the
Commission does not maintain a general database of self-insured employer
The Office of the Executive Secretary is making every
effort to expedite the Form 24 process. Your cooperation is appreciated.