North Carolina Workers' Compensation Information



Please Note: for Claims assistance or questions about coverage and exemptions You will need to call one of the numbers listed below.

Also be aware that the Workers' Compensation Assistance Offices in different states may go by different names such as "Industrial Accidents".
These are the only numbers that we are aware of and have available for North Carolina Workers' Compensation.

North Carolina Workers' Compensation Telephone Directory


North Carolina Industrial Commission: 919-807-2501

Vocational Rehabilitation: 800-689-9090

Workers' Compensation Information: 919-716-1700

Claims Administration - Phone & Email Address: 919-716-1700

Industrial Commission Workers' Compensation (Info) - Toll Free & Email Address: 800-688-8349

Fraud and Insurance Compliance Hotline: 888-891-4895

Clerk of the Industrial Commission: 919-807-2583

Trial Court Administrator: 919-807-2528

Request Audio Recording of Hearing - Phone & Email Address: 918-807-2504

Teleconference: 888-363-4735

Legal Assistant to Deputy Commissioner Mary Claire Brown & Hullender: 980-523-9987

Paralegal to Deputy Commissioner Theodore S. "Ted" Danchi: 919-807-2653

Legal Assistant to Deputy Commissioner Larry Hall : 919-807-2543

Paralegal to Deputy Commissioner Kevin V. Howell: 919-807-2653

Legal Assistant to Deputy Commissioner Larry Hall & Ashley M. Moore : 919-807-2543

Legal Assistant for Contempt Matters: 919-807-2518

Paralegal to Deputy Commissioner William W. "Bill" Peaslee: 919-807-2653

Legal Assistant to Deputy Commissioner Thomas H. Perlungher : 910-862-6011

Legal Assistant to Deputy Commissioner Layla T. Santa Rosa : 336-293-9242

Legal Assistant to Deputy Commissioner Tiffany Mack Smith: 980-523-9988

Legal Assistant to Deputy Commissioner David Mark Hullender: 980-523-9987

Legal Assistant to Deputy Commissioner Erin F. Taylor: 980-523-9988

Legal Assistant to Deputy Commissioner Jesse M. Jay Tillman: 980-523-9988

Legal Assistant to Deputy Commissioner Celeste Harris & Tyler Younts: 336-293-9242

Assistant Clerk of the Industrial Commission : 919-807-2608

Trial Court Administrator: 919-807-2528

Compliance Director: 919-716-1735

Compliance - Assistant Director: 919-716-1738

Compliance Officer: 919-716-1703

Compliance Officer: 919-716-1702

Compliance Officer : 919-716-1708

Compliance Officer: 919-716-1704

Compliance Assistant/Safety Education Section: 919-716-1707

Compliance Paralegal - (M-R): 919-716-1732

Compliance Paralegal - (G-L): 919-716-1730

Compliance Paralegal/Accounting Clerk (A-F): 919-716-1729

Compliance Paralegal - (S-Z Symbols or Numbers): 919-716-1729

Department of Justice: 919-716-6831

Executive Secretary to Special Deputy Commission: 919-807-2575

Trial Court Administrator to Full Commission Chair - Phillip A. Badour III: 919-807-2514

Executive Assistant to Full Commission Chair Phillip A. Baddour, III: 919-807-2647

Full Commission Chief Operating Officer: 919-807-2688

Industrial Commission Administrative Officer (vacant at present): 919-807-2648

Mediation Section - Administrative Assistant: 919-807-2620

Compromise Settlement Agreements (Clinchers): 919-807-2578

Industrial Commission Workers Compensation: 919-807-2501

Chief Deputy Commissioner Tammy R. Nance: 919-807-2542

Department of Insurance Commissioner Mike Causey: 855-408-1212

Insurance (State) Fraud - Toll Free: 888-680-7684

IT Section Support/Repairs: 919-754-6000

IT Section Support/Repairs - Toll Free: 800-722-3946

Webmaster : 919-807-2630

Chief Legal Assistant to Chief Deputy Commissioner Nance & Commissioner Harris: 919-807-2529

Special Deputy Commissioner Melissa Botiglione: 919-807-2546

Special Deputy Commissioner Marshall L. Wright: 919-807-2501

Legal Assistant to Deputy Commissioner Brown: 980-523-9987

Legal Assistant to Deputy Commissioner Lori A. Gaines & Thomas H. Perlunger: 910-862-6011

Paralegal to Deputy Commissioner Wes Saunders: 919-807-2653

Full Commission General Counsel Michelle Denning: 919-807-2654

Full Commission Rulemaking Coordinator: 919-807-2654

Full Commission Executive Assistant: 919-807-2647

Industrial Commission Medical Rehabilitation Nurses Section Referral Form Request: 919-807-2616

IC Mandatory Course (For Rehabilitation Professional) class availability & registration: 919-807-2616

IC Criminal Investigations & Employee Classification Division Chief Samuel Constance: 919-716-1736

Special Deputy Commissioner Lucy Austin: 919-807-2584

Special Deputy Commissioner Kimberly Fennell: 919-807-2561

Special Deputy Commissioner Alexandra Hagerty: 919-809-2670

Special Deputy Commissioner Michael Kelly: 919-807-2670

Special Deputy Commissioner Tony Lucas: 919-807-2612

Special Deputy Commissioner Jessica Parker: 919-807-2554

Industrial Commission Support Staff Tiffany Davalos Forms 23 & 24 Applications: 919-807-2657

Industrial Commission Support Staff Kimberly Allmond General Questions: 919-807-2580

Industrial Commission Support Staff Kimberly Allmond - Procedures Pending Cases: 919-807-2580

Industrial Commission Support Staff Kimberly Allmond 3rd Party Distributions: 919-807-2580

Industrial Commission Support Staff Kimberly Allmond General & Medical Motions: 919-807-2580

Industrial Commission Support Staff Kimberly Allmond Motions to Withdraw/Substitute: 919-807-2580

IC Crim. Invest. & Emp. Classification Div. Investigative Spec. Catherine Ittermann: 919-716-1701

IC Crim. Invest./ Employee Classification Division Investigator Chase L. Foss: 828-234-8733

IC Director of Employee Classification Section (Vacant): 888-891-4895

IC Crim. Invest. & Emp. Classification Div. Admin. Spec. Regina Henry: 919-716-1737

IC Crim. Invest./ Employee Classification Division Investigator Gerald Stephens: 336-212-9669

IC Crim. Invest./ Employee Classification Division Investigator Stig Larson: 910-709-0053

IC Crim. Invest./ Employee Classification Division Investigator Lindsey A. Tote: 919-610-8263

Compliance Officer : 919-716-1705

Electronic Document Filing Portal (EDFP) Assistance: 919-807-2695

OSHA North Carolina State Plan - Jurisdiction over Private & Public Employees: 919-707-7806

Forms & Publications


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Some "Revision Dates" may be displayed as part of the Description.

As of Monday, September 18, 2017, the Industrial Commission will no longer accept certain documents from adjusters including, but not limited to, Form 24 Applications, Responses to Form 23 Applications, Responses to Form 28Us or Responses to 18Ms. Per the Commission's announcement, they will also not accept Motions filed by adjusters, including, but not limited to, Motions to Compel Compliance with Medical Treatment, Motions to Compel Compliance with Vocational Rehabilitation, Responses to Medical Motions or any other requests for relief. However, the Commission will continue to accept Form 26As, Form 60s and agreements regarding death benefits entered into by the adjuster.

Effective February 1, 2016, all documents filed with the Industrial Commission in workers compensation cases must be submitted electronically. Employees without legal representation are not required to file electronically. The Commission has updated all of its forms to facilitate e-filing.

(form19) Employer's Report of Employee's Injury or Occupational Disease to the Industrial Commission 1/20
(form29) Supplemental Report for Fatal Accidents 3/20
(form18) Notice of Accident to Employer and Claim of Employee, Representative, or Dependent 3/22
(forma18) Notice of Accident to Employer and Claim of Employee, Representative, or Dependent (Spanish) 3/22
(form18b) Claim by Employee, Representative, or Dependent for Lung Disease, Including Asbestosis, Silicosis, and Byssinosis 3/20
(form18m) Employee's Application for Additional Medical Compensation(Applicable to Injuries by Accident or Occupational Illness on or After July 5, 1994) 3/20
(form21) Agreement for Compensation for Disability 3/21
(form21s) Agreement for Compensation for Disability (Spanish) 3/07
(form22) Statement of Days Worked and Earnings of Injured Employee 3/20
(form23) Application to Reinstate Payment of Disability Compensation 3/20
(form24) Application to Terminate or Suspend Payment of Compensation 3/20
(form25c) Authorization for Rehabilitation Professional to Obtain Medical Records of Current Treatment 3/20
(form25cs) Authorization for Rehabilitation Professional to Obtain Medical Records of Current Treatment (Spanish) 3/20
(form25n) Notice to the Commission of Assignment of Rehabilitation Professional 3/20
(form25p) Itemized Statement of Charges for Drugs 3/20
(form25pr) Request for Preauthorization of Medical Treatment 1/15
(form25r) Evaluation for Permanent Impairment 5/17
(form25t) Itemized Statement of Charges for Travel 6/22
(form26) Supplemental Agreement as to Payment of Compensation 3/21
(form26a) Employers Admission of Employee's Right to Permanent Partial Disability 3/21
(forma26a) Employers Admission of Employees Right to Permanent Partial Disability-Spanish 3/21
(form26d) Agreement for Payment of Unpaid Compensation in Unrelated Death Cases 3/20
(form26i) Medical Provider Dispute Resolution Questionnaire N/D
(form28) Return to Work Report 3/20
(form28b) Report of Employer or Carrier / Administrator of Compensation and Medical Compensation Paid and Notice of Right to Additional Medical Compensation 3/20
(form28c) Report of Employer or Carrier / Administrator of Compensation and Medical Compensation Paid Pursuant to a Compromise Settlement Agreement 3/20
(form28t) Notice of Termination of Compensation by Reason of Trial Return to Work 3/20
(form28u) Employee's Request that Compensation be Reinstated After Unsuccessful Trial Return to Work 3/20
(form30) Agreement for Compensation for Death 12/20
(form30a) Notice of Award 3/20
(form30d) Award Approving Agreement for Compensation for Death 3/20
(form31) Application for Lump Sum Award 3/20
(form33) Request that Claim be Assigned for Hearing 3/21
(form33s) Request that Claim be Assigned for Hearing (Spanish) 10/17
(form33i) Intervenor's Request that Claim be Assigned for Hearing 3/21
(form33Ifeeform) Certification of Payment of Processing Fee for the Form 33I N/D
(form33r) Response to Request that Claim be Assigned for Hearing 3/18
(form36) Subpoena for Witness 6/18
(form42) Application for Appointment of Guardian Ad Litem 3/20
(form44) Application for Review 10/19
(form51) Annual Consolidated Fiscal Report of "Medical Only" or "Lost Time" Cases 2/17
Instructions for filling out Form 51 N/D
(form60) Employer's Admission of Employee's Right to Compensation 3/20
(form61) Denial of Workers' Compensation Claim 3/20
(form62) Notice of Reinstatement or Modification of Compensation 3/20
(form63) Notice to Employee of Payment of Compensation Without Prejudice or Payment of Medical Benefits Only Without Prejudice 3/20
(form87a) Affidavit of Accrued Arrearages 3/20
(form87c) Certificate of Accrued Arrearages or Certified Accounting of Award 3/20
(form87s) Statement of Accrued Arrearages 3/20
(form90) Report of Earnings 12/20
(frmec100) Erroneous Conviction - Claimant's Petition for Compensation 11/19
(msc1) Consent Order for Mediated Settlement Conference 3/22
(msc2) Petition for Order Referring Case to Mediated Settlement Conference 3/22
(msc3) Order for Mediated Settlement Conference 3/22
(msc4) Designation of Mediator 3/22
(msc5) Report of Mediator 3/22
(msc6) Mediator's Declaration of Interest and Qualifications 3/22
(msc7) Report of Evaluator 10/17
(msc8) Mediated Settlement Agreement 6/18
(msc9) Mediated Settlement Agreement - Alternative Form 6/18
(formt-1) Claim for Damages under Tort Claims Act 3/21
(formt-3) Release of Tort Claim 3/19
(formt-42) Application for Appointment of Guardian Ad Litem 3/21
(formt-44) Application for Review 3/19
(csachecklist) Health Benefit Plans and Medical Costs Internal Checklist for the Review of Compromise Settlement Agreements 5/14
(cert pay) Certification of Payment of Processing Fee for CompromiseSettlement Agreements N/D
(indigentappeal) Petition to Appeal as an Indigent Person N/D
(indigentsue) Petition to Sue as an Indigent Person N/D
(nurseref) Workers' Compensation Nurses Section Referral Form 2/16
(deathben) CLAIM FOR BENEFITS UNDER THE PUBLIC SAFETY EMPLOYEES’ DEATH BENEFITS ACT, G.S. § 143-166, ET SEQ. N/D
(wcmsques) Workers' Compensation Medical Status Questionnaire N/D
(EFT authorization) Manage AR EFT Payment Account Set-Up Form (added 4/11) N/D

SubChapter A - Workers Compensation Rules (11 NCAC 23A .0101 - 11 NCAC 23A .1001)

SubChapter B - Tort Claims Rules (11 NCAC 23B .0101 - 11 NCAC 23B .0503)

SubChapter C- North Carolina Industrial Commission Rules for Utilization of Rehabilitation Professionals in Workers' Compensation Claims (11 NCAC 23C .0101 - 11 NCAC 23C .0201)

SubChapter D - Workers' Compensation Rules for Managed Care Organization (11 NCAC 23D .0101 - 11 NCAC 23D .0110)

SubChapter E - Administrative Rules of the Industrial Commission (11 NCAC 23E .0101 - 11 NCAC 23E .0302)

SubChapter F Electronic Billing Rules (11 NCAC 23F .0101 - 11 NCAC 23F .01018)

SubChapter G - North Carolina Industrial Commission Rules for Mediated Settlement and Neutral Evaluation Conferences (11 NCAC 23G.0101 - 11 NCAC 23G .0112

SubChapter H Rules of the Industrial Commission Relating to thePublic Safety Employees' Death Benefits Act (11NCAC 23H.0101 - 11NCAC 23H.0206)

SubChapter I - Childhood Vaccine-Related Injury Rules of the North Carolina Industrial Commission ( 11 NCAC 23I .0101 - 11 NCAC 23I .0204)

SubChapter J - Fees for Medical Compensation (11 NCAC 23J.0101 - 11 NCAC 23J.0103)

SubChapter K - Rules for the Eugenics Asexualization and Sterilization Compensation Program (11 NCAC 23K .0101 - 11 NCAC 23K .0501)

SubChapter L - Industrial Commission Forms (11 NCAC 23L .0101 -11 NCAC 23L .0104)

SubChapter M - Rules for the Utilization of Opioids, Related Prescriptions, and Pain Management in Workers' Compensation Claims (11-NCAC 23M.0101 - 11 NCAC 23M.0501)

Chapter 97 Workers' Compensation Act

Misc. Related Statutes