What Is A Form MSC2 in North Carolina Workers' Compensation?

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Construction Worker Injured at Work in North CarolinaA Form MSC2 is a form used for the North Carolina Industrial Commission. It is a petition or request for an order referring a case or claim to a mediated settlement conference. This form request that the Industrial Commission order the case to a mediated settlement conference. The form is usually requested by the injured worker or the employer.

A mediated settlement conference is a hearing in which the parties appear and try to come to a resolution of the workers compensation case before an actual Industrial Commission hearing is held. The form MSC2 must be served on all parties regarding the workers compensation case.

After a review of the form MSC2 by a Commissioner or the Deputy Commissioner assigned to the case, the Commissioner or Deputy Commissioner may enter an order referring this case to a mediated settlement conference. The Commissioner or Deputy Commissioner will set a deadline as to when the mediated settlement conference should be completed.

What is Form EC100 of the North Carolina Industrial Commission?

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Dad & Son

Form EC 100 of the North Carolina industrial commission is a form requesting compensation to persons erroneously convicted of felonies. Normally, the North Carolina Industrial Commission has jurisdiction regarding workers who are injured on the job.  However, in 1997 the North Carolina General Assembly charged the North Carolina Industrial Commission with the administration of compensation or persons erroneously convicted of felonies and who were incarnated based upon the erroneous conviction.

If a person was incarcerated and placed in jail, and later it was determined that person was wrongfully incarcerated and was not guilty of the crime (felony) charged against them, they have the right to ask the State to compensate them for the time served in prison or jail. This is pursuant to North Carolina General Statute § 148-82.

Under Form EC 100, the person erroneously convicted of a felony must petition the North Carolina Industrial Commission for compensation for the time served in jail or prison for the felony. The petitioner must also state the grounds for their claim of compensation. In other words, why should they be compensated for their time in prison for a crime they did not commit? The petitioner must also attach a certified copy of the Judgment of Convictions which resulted in the prison or jail time and a copy of a Pardon of Innocence signed by the Governor of North Carolina.

Upon completion of Form EC 100, the petitioner should then mail one original and two copies of Form EC 100 to the North Carolina Industrial Commission. The North Carolina Industrial Commission will then determine if the petitioner is entitled to compensation. You can contact a workers’ compensation attorney and they will usually be able to assist you in this process as well.

What Is A MSC5 Report In North Carolina Workers Compensation?

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Workers' compensation questionsAn MSC5 report is the report from a mediator in a North Carolina worker’s compensation case. On this form, the worker’s compensation mediator reports on the results of the mediated settlement conference between the worker and his or her employer.

The mediator is a person assigned by the Industrial Commission or mutually chosen by the attorneys in the case. The majority of the time the mediator is a licensed attorney familiar with workers’ compensation laws. The mediator’s role is to attempt to come to a consensus or mediate the workers’ compensation case in which all parties hopefully come to a settlement before the case would proceed to an actual workers’ compensation hearing.

After the mediation, the mediator fills out Form MSC5 and returns it to the North Carolina Industrial Commission, regardless of the success or failure of the mediation.

In this form, the mediator reports whether the mediation was held, whether the mediation was completed, or why the mediation was not held. The mediator also reports the fees they should receive for the mediation in this North Carolina worker’s compensation case.

A majority of the North Carolina worker’s compensation mediated settlement conferences are successful in coming to a resolution of the case.

What Is A Form 28U In North Carolina Workers' Compensation?

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Arriving to North Carolina on RoadwayOnce you have received the doctor’s permission to do so, you can attempt a trial return to work (for no longer than a nine month period).  What happens if you, on your trial return to work, realize your work related injury is still not allowing you to complete your job?  If your trial return is unsuccessful, you have the right to request that your compensation continue.  Once you stop working you would need to immediately fill out Form 28U; Employee’s Request that Compensation be Reinstated After Unsuccessful Trial Return to Work (G.S. 97-32.1).

Form 28U will tell your employer, the insurance carrier, and the Industrial Commission you are still suffering from your work related injury and cannot continue work.  You will have to fill out a section explaining when you came back to work, how long your trial period lasted, and the reason why you can no longer work.   You will then take this form to your treating physician who will sign it if they believe your workers’ compensation injury is preventing you from continuing your trial return to work.  If your trial return to work is through a different employer, you must also fill out the “Employee’s Release and Request for Employment Information” section as well.

What Is A Form 31 in North Carolina Workers' Compensation?

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Research on a ComputerWorkers’ compensation payments are normally paid out on a weekly basis. Occasionally life throws us curveballs (family illness, loss of a spouse’s job, house or vehicle problems) and we need more than the weekly benefit that you are regularly receiving. So when that happens, can you get a lump sum payment for your workers’ compensation benefits?

In some cases, yes.  As long as your payment is continued for six weeks or more, you can fill out Form 31 (Application for Lump Sum Award).  In some cases, if the Industrial Commission deems it in your best interest or in the best interest of your dependents to get a lump sum reward; this lump sum can be in whole or in part but it cannot exceed the total amount you have been awarded.  There are also cases in which the Commission will approve a lump sum payment to prevent an undue hardship on the employer or his insurance carrier; this is done without prejudice to the employee or their dependents.

Should you wish to use your lump sum to buy property of any kind, you must specify that in your request and provide three estimates of the value of the property and add that to your Form 31 as an attachment.  When filling out your Form 31, you will be asked to name all of your dependents, any outstanding bills and the amounts owed, along with a detailed reason stating the purpose of your request.  Upon filling out the form, you will serve this form to the insurance carrier and a copy to the Industrial Commission.

What Is A Form 33R in Workers’ Compensation?

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North Carolina Workers' Compensation InformationWhen an employee files a Workers’ Compensation claim, there is a chance the claim can be denied. If it is denied, the employee or their medical provider can request a hearing with the Industrial Commission. To do this, they must fill out and submit either a Form 33 (Request that Claim Be Assigned for Hearing) or a Form 33I (Intervenor’s Request That Claim Be Assigned for Hearing). Within 45 days of receiving either of these two forms a Form 33R (Response To Request That Claim Be Assigned For Hearing) must be filed. The original form must be sent to the Industrial Commission and copies must be sent to all parties involved in the case.

Form 33R is to be filled out by the self-insured employee, insurance carrier or counsel for the defendant. This form must include a statement that explains the basis of the disagreement between the parties, including specific issues that are accepted or denied by either party. The date of the injury, the body part that was injured, and the city and county where the injury occurred must also be included on this form. This form also has a place to list the names and addresses of all witnesses who will need to testify at the hearing. When a hearing date is set, the subpoenas for these witnesses should be sent to the person who filed out Form 33R and that person will get them to the Sheriff’s office so that they can be delivered to the witnesses.

What Is A Form 63 in Workers’ Compensation?

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North Carolina Industrial Commission Form 63 is the Notice to Employee of Payment of Compensation Without Prejudice or Payment of Medical Benefits Only Without Prejudice.

This form is submitted to the NCIC when an employer provides payments and/or medical benefits to an employee.  By filing this form, the receipt of payment or medical benefits from the employer does not necessarily end the investigative process or mean that the employer accepts liability. The benefits can be provided while an investigation is still ongoing. By submitting this form, an employer is not automatically accepting guilt or liability by providing benefits to the employee.

What Is A Form 62 in North Carolina Workers’ Compensation?

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North Carolina Industrial Commission (NCIC) Form 62 is the Notice of Reinstatement or Modification of Compensation. If under any circumstances the payment of total or partial disability benefits have been suspended this form must be completed and submitted to the NCIC. A copy must also be provided to the employee and his or her attorney of record. On the form the employer will record the amount of compensation to be paid and the reason for reinstating payment.

What Is A Form 25N In A North Carolina Workers' Comp Case?

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StethescopeForm 25N is a form used by the North Carolina Industrial Commission regarding the assignment of a Rehabilitation Professional.  This is usually a registered nurse, who must be qualified according to North Carolina Industrial Commission Rehabilitation Rules.  Once the Rehabilitation Professional has been assigned pursuant to Rule 25N, the Rehabilitation Professional becomes a type of “case manager” for the injured worker and coordinates their medical and vocational rehabilitation.

The Rehabilitation Professional must make independent and professional judgment regarding the plan for the rehabilitation of the injured worker.  The Rehabilitation Professional is not allowed to be a direct care giver for the injured worker, but assist and coordinates with the treating physicians and other care givers.

What Is A Form 30 In A North Carolina Workers Compensation Case?

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EKG ImageForm 30 is an Agreement for Compensation for Death. This form is used when an employee passes away because of an accident at work and his or her dependents or next of kin are petitioning for compensation for the deceased. Each dependent or next of kin, the plaintiff’s attorney, employer and insurance carrier or administrator must agree to the information provided and all of their signatures are required on this form. All parties must agree the employer and deceased employee were bound by provisions of the North Carolina Workers’ Compensation Act.

The date of the employee’s accident and the date of their death must be included, along with the average weekly wage of the employee and their weekly compensation rate. All the dependents or next of kin who are entitled to receive compensation must be listed on this form. If they are not listed on the form they may not receive future compensation. They must provide their name, address, date of birth, age, relationship and indicate if they are a whole or partial dependent or next of kin to the deceased.

The employer and carrier must then state the weekly rate they are going to pay the dependents or next of kin and how long they will pay it for. Depending on if the dependents or next of kin are a widow/widower, widow/widower with minor children, minor children only, whole dependent other than widow/widower or minor children or partial dependent will determine how long and the amount that they would receive.  Everyone except the partial dependent will receive the weekly rate that was previously listed and the partial dependent will receive the weekly rate multiplied by the percentage of support provided by the deceased.

All parties must also agree that the widow/widower was or was not able to support themselves after the death because of physical or mental disability and if they will or will not continue to receive benefits during their lifetime or until remarriage.  The employer and its carrier also agree to pay burial expenses and must list the amount they are agreeing to pay.

A Form 30 must be submitted to the Industrial Commission along with a completed Form 30D Award Approving Compensation for Death. Several other documents, if appropriate, must also be submitted to the Commission along with the completed Form 30. These documents are the death certificate, marriage certificate, divorce decree, birth certificate if a minor, Form 42 Application for Appointment of Guardian Ad Litem and Form 29 Supplemental Report for Fatal Accidents.

If a loved one has been killed in a workplace accident it is critical you speak with a qualified workers’ compensation attorney before signing any documents. At Duncan Law we offer a free, no strings attached, consultation where we can sit down with you and other loved ones and discuss which route will ensure you and your family maximize the amount of compensation you can recover.