Information For Carriers and Administrators
Forms
- Form 19 Employer's Report of Employee's Injury or Occupational Disease to the Industrial Commission
- Form 25N Notice to the Commission of Assignment of Rehabilitation Professional
- Form 26 Supplemental Agreement as to Payment of Compensation
- Form 26A Employer's Admission of Employee's Right to Permanent Partial Disability
- Form 26D Agreement for Payment of Unpaid Compensation in Unrelated Death Cases
Form 28 Return to Work Report Form 28B Report of Employer or Carrier/Administrator of Compensation and Medical Compensation Paid and Notice of Right to Additional Medical Compensation Form 28C Report of Employer or Carrier/Administrator of Compensation and Medical Compensation Paid Pursuant to Compromise Settlement Agreement Form 28T Notice of Termination of Compensation by Reason of Trial Return to Work Form 29 Supplemental Report to Form 19 for Fatal Accidents Form 30 Agreement for Compensation for Death Form 31 Application for Lump Sum Award Form 51 Annual Consolidated Fiscal Report of "Medical Only" or "Lost Time" Cases Form 51 Instructions Form 60 Employer's Admission of Employee's Right to Compensation Form 61 Denial of Workers' Compensation Claim Form 62 Notice of Statement of Modification of Compensation Form 63 Notice to Employee of Payment of Compensation Without Prejudice or Payment of Medical Compensation Without Prejudice Form 90 Report of Earnings Form 90 Report of Earnings (Spanish)
Filings Requiring Attorney Representation
Administrative motions practice filings that require attorney representation if filed on behalf of another person or entity include, but are not limited to, the following:
- Form 24 Application
- Response defending against Form 23 Application
- Response defending against Form 28U
- Response defending against Form 18M
- Medical motions, including motions to compel compliance with medical treatment or vocational rehabilitation
- Responses defending against medical motions
- Any other motion or response seeking relief or asserting a defense
NOTE: The unauthorized practice of law is illegal in North Carolina pursuant to Chapter 84 of the North Carolina General Statutes. The North Carolina State Bar website provides helpful information about the unauthorized practice of law. If you have procedural questions about administrative motions practice, you may contact Executive Secretary Meredith Henderson at meredith.henderson@ic.nc.gov.
Frequently Asked Questions
Denied Claims Questions
Yes. Pursuant to N.C. Gen. Stat. § 97-18(c) and (d), you should file a Form 61 with the Industrial Commission and send a copy of the Form 61 to the employee or the employee’s attorney of record, if any. You also should send a copy of the Form 61 to all known medical service providers.
Temporary Total Disability Compensation Questions
The weekly compensation rate for total disability benefits under the Workers’ Compensation Act is two-thirds of the employee’s “average weekly wage,” as defined in N.C. Gen. Stat. § 97-2(5), subject to a cap.
The cap is called the “maximum weekly compensation rate.” Pursuant to N.C. Gen. Stat. § 97-29(a) and N.C. Gen. Stat. §97-29)(i), the maximum weekly compensation rate is calculated annually and the new annual rate is effective as of January 1 each year.
The applicable cap on an employee’s weekly benefits for the entirety of the employee’s claim is the maximum weekly compensation rate for the year in which the employee’s injury occurred.
Pursuant to N.C. Gen. Stat. § 97-28, no compensation is due for the first seven days of lost time from work, unless the disability exceeds 21 days. Therefore, the first workers’ compensation disability payment issued to the employee by the employer or carrier will not include any workers’ compensation disability payments for days 1-7. Payment for days 1-7 will be due only if the employee’s disability has continued beyond 21 days.
Questions Regarding Termination or Suspension of Temporary Total Disability Compensation
It depends. Pursuant to N.C. Gen. Stat. § 97-29(b), an employee is not entitled to compensation under N.C. Gen. Stat. § 97-29 beyond 500 weeks from the first date of disability unless the employee has qualified for extended compensation under N.C. Gen. Stat. § 97-29(c). Therefore, no permission from the Industrial Commission is needed to terminate an employee’s weekly temporary total disability compensation after 500 weeks have passed from the first date of disability, if the employee has not been awarded extended compensation by the Industrial Commission.
Additionally, defendants may terminate temporary total disability compensation without Industrial Commission permission when an employee has returned to work for the same or different employer, subject to the Trial-Return to Work provisions set forth in N.C. Gen. Stat. § 97-32.1 and Rule 11 NCAC 23A .0404A.
Defendants also may terminate temporary total disability compensation without Industrial Commission permission when they timely contest a claim in which benefits were paid pursuant to the “payment without prejudice” provision set forth in N.C. Gen. Stat. § 97-18(d).
If, however, none of the three scenarios above applies, then weekly temporary total disability benefits cannot be stopped without Industrial Commission permission. Permission can be sought by filing a Form 24 Application to Terminate or Suspend Payment of Compensation pursuant to N.C. Gen. Stat. § 97-18.1 and Rule 11 NCAC 23A .0404. It should be noted that only an attorney can file a Form 24 on behalf of an employer or carrier because it is a legal filing. Adjusters and other employer or insurer representatives who are non-attorneys are not permitted to file a Form 24.
A copy of the Form 24 must be sent contemporaneously to the employee or the employee’s attorney of record, if any, and payments may be stopped only if the Industrial Commission approves the Form 24 Application.
Medical Treatment Questions
The employer or its insurance company provides and directs medical treatment pursuant to N.C. Gen. Stat. § 97-25, subject to any Industrial Commission orders. If an employee is dissatisfied with the medical treatment provided by the employer or carrier, the employee may file a medical motion with the Industrial Commission pursuant to N.C. Gen. Stat. § 97-25 and Rule 11 NCAC 23A .0609A.
Pursuant to N.C. Gen. Stat. § 97-25(e), an employee may obtain emergency medical treatment from a medical provider of the employee’s choice, and the reasonable cost of the emergency medical treatment shall be paid by the employer if so ordered by the Industrial Commission. In this situation, the employee should ask the Industrial Commission to order payment of the emergency treatment as soon as possible following receipt of the emergency medical treatment, unless the employer or carrier voluntarily agrees to pay for the emergency medical treatment.
An employee who travels 20 miles or more round trip for authorized medical treatment in a workers’ compensation case is entitled to mileage reimbursement to be paid by the employer or carrier at the IRS standard mileage rate for the year or other time period in which the travel occurred pursuant to Rule 11 NCAC 23J .0101(h). The employee should submit the request for mileage reimbursement to the employer or carrier/administrator on a Form 25T.