What is Form 18B in a North Carolina Workers Compensation Case?

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Workers' Compensation Doctor Looking at X-RayForm 18B is titled Claim by Employee, Representative or Dependent for Benefits for Lung Disease. This form is to be filled if an employee has been diagnosed with lung disease that was caused by employment and wants benefits for it.  In this case, lung disease includes asbestosis, silicosis and byssinosis. They must include the date of diagnosis, provide the doctor who made the diagnosis and attach all pertinent medical records for the diagnosis. This is similar to a traditional Form 18 but, instead, is intended only for the purposes of cases resulting in lung disease.

The employee must disclose the place of employment that they were working at that pertains to the diagnosis of the lung disease. They must also include their employment history for every job where exposure may have occurred so that the Industrial Commission can check into each of them. It is important in cases like this that the place of employment that caused the lung disease be properly determined because they will be the ones issuing the benefits to the employee.

The employee must also disclose the name and address of every doctor and/or hospital that they had been treated in for the 20 years prior to the diagnosis. They must also put for what purpose they were treated if they know. Signing this form gives any of those doctors and hospitals to release any medical records to parties that are reviewing their workers compensation claim. It is very important that this form is filed out correctly so that anyone reviewing the claim knows which physicians they need to be in contact with.

As with all other forms dealing with a worker’s compensation claim, the original of this form must be returned to the Industrial Commission. A copy of the signed form should be furnished to their employer and they employee should of course keep a copy of the completed form for their records.

What is Form 60 in Workers’ Compensation?

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Father and Daughter on ComputerNorth Carolina Industrial Commission (NCIC) Form 60 is the Employer’s Admission of Employee’s Right to Compensation. This form is completed by the employer in order to specify the injuries that they are assuming responsibility for and the amount of compensation that they agree to pay. In the form, the employer will detail the date of the injury or occupational disease in question, and the body parts affected. The employer will also report whether or not the employee was paid for the entire day on which the injury occurred. The employer must report that employee’s average weekly earnings. It is very important to note that this amount must include overtime pay and also account for additional compensation such as fringe benefits. If the insurance company does not accurately reflect your average weekly wage then you should have your attorney request the insurance company to fill out a Form 22. The employer must provide the NCIC with the original copy of a Form 60 and also must provide the employee and his/her attorney, if applicable, with a copy. Having a Form 60 filed in your workers’ compensation case means the employer’s insurance company has accepted your workers’ compensation claim.

What is Form 44 in Workers Compensation?

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North Carolina FlagNorth Carolina Industrial Commission (NCIC) Form 44 is the Application for Review.  This form must be completed by either a defendant or plaintiff who wishes to appeal a decision by the Deputy Commissioner of the NCIC.  The first step for the appellant should be to send a letter of intent to appeal to the NCIC. The NCIC will then supply the appellant with Form 44.  The reasons for the appeal must be specifically defined on the form.  Any issues not addressed on the form will be considered abandoned, and the appellant cannot argue those issues in front of the full commission.  As a result, it is important to cover all potential issues when completing the form.

The appellant will have 25 days from the date the transcript is received from the NCIC to file Form 44.  When contesting errors on the transcript, it is important to cite the specific error, preferably citing the page on which the error occurs. Along with Form 44, the appellant should submit a brief in support of the challenge, not to exceed 35 pages in length. If a brief is not submitted to the NCIC, the party will not be allowed oral arguments before the full commission.  Three copies of Form 44 and the brief, if included, must be submitted to the NCIC with a copy sent to the appellee.  The appellee will have 25 days from service of the appellant’s brief to submit a response brief.  As with the appellant, if the appellee does not submit a brief the party will not be allowed to provide oral arguments to the full commission.  The appellee will provide three copies of any response to the NCIC with a copy served on the appellant.  It is important to note that during the appeal process, no new evidence will be heard, unless the Commission decides to make an allowance.

What is Form 36 in Workers Compensation?

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North Carolina Workers' Compensation QuestionsNorth Carolina Industrial Commission Form 36 is a Subpoena for Witness. The document is addressed to the sheriff of the applicable county. The form details the name of the individual being summoned to appear in front of the North Carolina Industrial Commission and the date, time and location of the witness’ scheduled appearance. The subpoena may also include information about documents that must be brought by the witness to the hearing including medical records, communications with the employer or employee, etc. The form notes specifically that failure to comply with the subpoena may result in sanctions as provided by law.  As a result, a subpoena by the North Carolina Industrial Commission, not unlike a subpoena to appear in court, should be taken seriously.

What is Form 29 in Workers’ Compensation?

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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.

What is Form 25C Under North Carolina Worker’s Compensation Law?

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Lady Justice with the Sun Behind CloudsForm 25C is a document prescribed under North Carolina Workers’ Compensation laws.  Form 25C is signed by the injured employee and gives medical providers authorization to release the employee’s medical records relating to the injury sustained in a workers’ compensation accident to a rehabilitation professional.

The employer or insurance company may hire a rehabilitation professional to monitor an injured employee’s medical treatment. The rehabilitation professional may attend medical visits with the injured employee and discuss the medical condition and proposed treatment of the injured worker with the physician, therapist or other healthcare professional.  The rehabilitation professional is usually a registered nurse or other licensed medical professional who reports back to the insurance company or employer on the medical condition and treatment of the injured worker.  The rehabilitation professional is presumed to be an unbiased third party who reports the injured worker’s medical facts to the insurance company or employer and also helps the injured employee understand the proposed treatment.  The injured worker and the employer are entitled to a copy of all reports.

What is a Functional Capacity Evaluation In A North Carolina Workers’ Compensation Case?

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A Functional Capacity Evaluation (also called a FCE) is a test performed by a physician or other health care professional to determine an injured worker’s ability to perform a job and to determine their limitations after having been injured on the job. Healthcare professionals perform this standardized test to determine the worker’s functional impairment, assess the success of treatment, and to determine their ability to perform at a job in the present or future. However, completing a FCE without being represented by an attorney may put you and your case in a difficult situation.

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What is Form 25N Regarding Worker’s Comp in North Carolina?

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Workers' Compensation Nurse Case Manager | 25NForm 25N is a form used by the North Carolina Industrial Commission regarding the assignment of a Rehabilitation Professional.  This is usually a registered nurse or a licensed professional counselor who must be qualified under the North Carolina Industrial Commission Rehabilitation Rules.  Once the Rehabilitation Professional has been assigned pursuant to Rule IV of the Industrial Commission Rules for Utilization of Rehabilitation Professionals in Workers’ Compensation Claims, the Rehabilitation Professional becomes a “case manager” for the injured worker and coordinates the medical and vocational rehabilitation care provided to the worker.

The Rehabilitation Professional must make independent and professional judgment regarding the plan for the rehabilitation of the injured worker.  The Rehabilitation Professional is not to be influenced by the employer and insurance company or the injured worker and his or her attorney.  The Rehabilitation Professional is not allowed to be a direct care giver for the injured worker but is there to assist and coordinate the care with the treating physicians and other providers.