What is Form 29 in Workers’ Compensation?

North Carolina Workers' Compensation InformationNorth Carolina Industrial Commission (NCIC) Form 29 is the Supplemental Report for Fatal Accidents. This form must be completed in any case where an injury or occupational disease results in the death of an employee. The employer must submit this form in conjunction with Form 19, Employer’s Report of Employee’s Injury or Occupational Disease to the Industrial Commission, to the NCIC. It is required that Form 19 be filed within 5 days of the employer receiving knowledge of the injury or disease in question; Form 29 must then be filed within 45 days of the employee’s death.

In addition to the information regarding the employer and the deceased employee, Form 29 requires the employer to provide the date of the accident and the date of the employee’s death. The employer must list the deceased employee’s dependents or next of kin, the immediate cause of the employee’s death, and the burial expenses that are authorized.

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