N.C. Gen. Stat. §97-93(a) requires employers in the State of North Carolina to carry insurance or prove financial ability to pay for benefits available under the Workers’ Compensation Act. The Industrial Commission reviews claims filed by injured workers to determine the employer’s insurance status. If the employer is determined to be uninsured, the employer will receive this letter and be placed on a hearing docket.

• three or more employees regularly employed in the same business or establishment, or
• one or more employees employed in activities which involve the use or presence of radiation, or
• if providing agriculture or domestic services, 10 or more full‑time nonseasonal agricultural workers regularly employed by the employer

See N.C. Gen. Stat. §§ 97-2(1), 97-2(3), 97-93

An employer must immediately report to its Workers’ Compensation insurance carrier any injury or occupational disease, or allegation by an employee of an injury or occupational disease, sustained in the course of employment for which the attention of a physician is needed or actually sought.

If an injury or alleged injury causes the employee to be absent from work for more than one day, or the employee’s medical expenses are greater than $2000.00, the employer or carrier must file with the Industrial Commission a Form 19 “Employer’s Report of Employee’s Injury to the Industrial Commission” within five days of learning of the injury or allegation.

If a Form 19 is filed with the Industrial Commission, the employer or carrier must provide a copy of the Form 19 to the employee, together with a blank Form 18 “Notice of Accident to Employer and Claim of Employee” for use by the employee.

All Employers or Carriers MUST file a Form 19 “Employer’s Report of Employee’s Injury to the Industrial Commission” within five days of learning of any injury or allegation of an injury. Employers should use the following form.

NEW!

This version of the Form 19 allows for filling out and submitting it on-line. You must have Adobe Reader version 7.0 or later and a valid e-mail address to submit this form on-line. Click Here to get the free Adobe Reader.

This Form 19 may be downloaded, printed, filled out and mailed into the NC Industrial Commission. Please read the attached instructions for required information and the mailing address.

NEW!

This version of the Form 18 allows for filling out and submitting it on-line. You must have Adobe Reader version 7.0 or later and a valid e-mail address to submit this form on-line. Click Here to get the free Adobe Reader.

This Form 18 may be downloaded, printed, filled out and mailed into the NC Industrial Commission. Please read the attached instructions for required information and the mailing address.

This form is used if there is a claim by an Employee, Representative, or Dependent for Lung Disease, Including Asbestosis, Silicosis, and Byssinosis (G.S. §97-53)

This form should be used if an employee wishes to apply for Additional Medical Compensation (G.S. §97-25.1) (Applicable to Injuries by Accident or Occupational Illness on or After July 5, 1994)