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North Carolina Form Center

Welcome to the most extensive library of workers' compensation forms available anywhere. Almost 3,000 forms are available for your immediate download and use. Our forms, all of which have been custom programmed by WorkersCompensation.com for Type & Save functionality, are available for individual purchase below.

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		(form17) N.C. Workers’ Compensation Notice to Injured Workers and Employers - 2/09
		(form17s) Información Sobre Compensación Laboral y Instrucciones para Patronos y Empleados - 3/04
		(form18) Notice of Accident to Employer and Claim of Employee, Representative, or Dependent for Workers' Compensation Benefits - 8/1/08
		(forma18) Notice Of Accident To Employer And Claim Of Employer Employee, Representative, Or Dependent - 8/08
		(form18a) Form 18 with Instructions (both in PDF format). (These instructions were prepared by the Industrial Commission's Ombudsman Section) - 8/6/08
		(form18b) Claim by Employee, Representative, or Dependent for Lung Disease, Including Asbestosis, Silicosis, and Byssinosis - 5/02
		(form18m) Employee's Application for Additional Medical Compensation - 2/01 (Applicable to Injuries by Accident or Occupational Illness on or After July 5, 1994)
		(form19) Employer’s Report of Employee’s Injury or Occupational Disease to the Industrial Commission - 8/1/08
		(form21) Agreement for Compensation for Disability - 10/06
		(form21s) Acuerdo de Remuneración por Incapacitación - 9/04
		(form22) Statement of Days Worked and Earnings of Injured Employee - 10/06
		(form24) Application to Terminate or Suspend Payment of Compensation - 2/01
		(form25a) Certification of Complete Medical Reports - 9/05 (to be filed with Form 21 or Form 26 for approval of a permanent partial disability rating)
		(form25c) Authorization for Rehabilitation Professional to Obtain Medical Records of Current Treatment - 1/04
		(form25cs) Permiso al Especialista de Rehabilitación Médica para Obtener Reportes Corrientes del Tratamiento Médico - 4/06
		(form25n) Notice to the Commission of Assignment of Rehabilitation Professional - 8/04
		(form25p) Itemized Statement of Charges for Drugs - 2/01
		(form25r) Evaluation for Permanent Impairment - 8/1/08
		(form25t) Itemized Statement of Charges for Travel - 7/08
		(form26) Supplemental Agreement as to Payment of Compensation - 8/1/08
		(form26a) Employers Admission Of Employee’s Right To Permanent Partial Disability - 8/1/08
		(form26d) Agreement for Payment of Unpaid Compensation in Unrelated Death Cases - 2/01
		(form28) Return to Work Report - 2/01
		(form28b) Report of Employer or Carrier/Administrator of Compensation and Medical Compensation Paid and Notice of Right to Additional Medical Compensation - 11/03
		(form28c) Report of Employer or Carrier/Administrator of Compensation and Medical Compensation Paid Pursuant to a Compromise Settlement Agreement - 11/03
		(form28t) Notice of Termination of Compensation by Reason of Trial Return to Work - 2/01
		(form28u) Employee's Request That Compensation Be Reinstated After Unsuccessful Trial Return to Work - 6/02
		(form29) Supplementary Report for Fatal Accidents - 2/01 (First Report of Accident must also be made in every case).
		(form30) Agreement for Compensation for Death - 11/01
		(form30a) Notice of Award - 8/08
		(form30d) Award Approving Agreement for Compensation for Death - 11/01
		(form31) Application for Lump Sum Award Agreement for Compensation for Death - 2/01
		(form33) Request That Claim Be Assigned for Hearing - 2/01
		(form33s) Petición que la Demanda sea Asignada a una Audiencia - 9/04
		(form33r) Response to Request That Claim Be Assigned for Hearing - 2/01
		(form36) Subpoena for Witness - 10/05
		(form42) Application for Appointment of Guardian Ad Litem - 2/01
		(form44) Application for Review - 4/08
		(form51) Annual Consolidated Fiscal Report of "Medical Only" or "Lost Time" Cases - 6/05
		Instructions for filling out Form 51 - N/D
		(form60) Employer's Admission of Employee's Right to Compensation Pursuant to - 8/1/08
		(form61) Denial of Workers' Compensation Claim - 10/06
		(form62) Notice of Reinstatement or Modification of Compensation - 10/06
		(form63) Notice to Employee of Payment of Compensation Without Prejudice - 8/1/08
		(form87a) Affidavit of Accrued Arrearages - 3/03
		(form87c) Certificate of Accrued Arrearages or Certified Accounting of Award - 7/08
		(form87s) Statement of Accrued Arrearages - 7/08
		(form90) Report of Earnings - 2/01
		(checklist) Health Benefit Plans and Medical Costs Internal Checklist for the Review of Compromise Settlement Agreements - 2/05
		(nurseref) Workers' Compensation Nurses Section Referral Form - 11/07
		(deathben) Claim for Benefits Under the Law Enforcement Officers', Firemen's, Rescue Squad Workers' and Civil Air Patrol Members' Death Benefits Act - 6/05
		(form42) Application for Appointment of Guardian Ad Litem - 2/01
		(frmec100) Claimant's Petition for Compensation - 8/97
		(formt-1) Claim for Damages Under Tort Claims Act, - 2/01
		(formt-3) Release of Tort Claim - 5/02
		(formt-44) Application for Review - 6/00
		(indigentappeal) Petition to Appeal as an Indigent - N/D
		(indigentsue) Petition to Sue as an Indigent - N/D
		(msc2) Petition for Order Referring Case to Mediated Settlement Conference - N/D
		(msc4) Designation of Mediator - 9/01
		(msc5) Report of Mediator - 9/01
		(msc6) Mediator's Declaration of Interest and Qualifications - 6/05
		(msc7) Report of Evaluator - 9/01
		(msc8) Mediated Settlement Agreement - 1/09
		(wcmsques) Workers’ Compensation Medical Status Questionnaire - N/D

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