Employer Toolkit - North Carolina
Your resource for State Specific Forms and Regulatory Links
Visit our Employer FAQ page for answers to employer related questions.
State Forms
Claim Forms
Authorization for Release of Medical Records
First Report of Injury [Form 19]
Initial Treatment Authorization
New Policyholder Welcome Packet - NC
No Injury Certificate
No Treatment Letter – Spanish
No Treatment Requested Letter
Notice of Accident to Employer and Claim of Employee, Rep, or Dependent [Form 18]
Notice to Injured Workers and Employers [Form 17]
Notice to Injured Workers and Employers [Form 17] - Spanish
Pharmacy Authorization - NC
Wage Statement of Days Worked and Earnings of Injured Employee [Form 22]
Links
Industrial Commission
NCRB ERM-14 – Electronic Submission Only