Claims Kit

Physician Selection 97-25

The employer or its insurance company, subject to any Commission orders, provides and directs medical treatment. The Commission may permit the employee to change physicians or approve a physician of employee's selection when good grounds are shown. However, payment by the employer or carrier is not guaranteed unless written permission to change physicians is obtained from the employer, carrier, or Commission before the treatment is rendered.

Reporting of Claim by Employer Statute 97-92, Rule 11 NCAC 23A. 0104

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 5 days of learning of the injury or allegation.

In addition to providing the Form 19 to the employee, the employer or carrier/administrator must also provide a blank Form 18 for use by the employee.

Posting Requirements Rule11 NCAC 23A .0201  Statute 97-93

All employers subject to the provisions of the Workers' Compensation Act must post in a conspicuous location  a Form 17, Workers' Compensation Notice, to give notice to the employees that they are in an employment subject to the provisions of the Workers' Compensation Act and that their employer has obtained workers' compensation coverage or has qualified as self-insured for workers' compensation purposes.

Should the employer allow its workers' compensation coverage to lapse or cease to qualify as a self-insured, the employer shall remove within five working days any Form 17 and any other notice indicating otherwise.

Form 17

Form 17 (spanish)

Penalties for Late Reporting 97-92(e)

Any employer who refuses or neglects to make a report of injury is liable for a penalty of $5.00-$25.00 for each refusal or neglect.