Important Disclaimer. These forms are provided here a courtesy. The forms are created by the North Carolina Industrial Commission. They may change between updates to this page. It is important that you verify that you are using the most up-to-date form.  By making these forms available Anderson & Anderson is offering no opinion about their use.

1. Notice Of Accident To Employer And Claim Of Employee, Representative, Or Dependent (Form 18)  This form  establishes a legal claim of injury on your behalf if filed within two years of the date of injury or occupational
   disease, and gives the required written notice to the employer if a copy is submitted to the employer within 30 days of the injury. The employer is required by law to file a Form 19 if the employee misses more than one day of work due to the injury or if the medical bills exceed $2,000.00. However, the employer’s filing of a Form 19 does not satisfy the employee’s obligation to file a claim. In order to ensure the employee’s rights are protected, the employee must file a Form 18 even though the employer may be paying compensation or the Industrial Commission may have opened a file for the injury.
2. Request That Claim Be Assigned for Hearing (Form 33) 
3. Itemized Statement of Charges for Drugs  (Form 25P)
4. Itemized Statement of Charges for Travel (Form 25T)
5. Workers’ Compensation Medical Status Questionnaire