North Carolina Administrative Code
Title 11 - INSURANCE
Chapter 23 - INDUSTRIAL COMMISSION
Subchapter A - WORKERS' COMPENSATION RULES
Section .0100 - ADMINISTRATION
Section 23A .0104 - EMPLOYER'S REQUIREMENT TO FILE FIRST REPORT OF INJURY
Current through Register Vol. 39, No. 6, September 16, 2024
(a) The form required to be provided by G.S. 97-92(a) is the Form 19 Employer's Report of Employee's Injury or Occupational Disease to the Industrial Commission. The Form 19 shall be used when the injury causes the employee to be absent from work for more than one day or when the charges for medical compensation exceed four thousand dollars ($4,000). The Form 19 shall be filed with the Commission in accordance with Rule .0108(d) of this Section.
(b) The employer, carrier, or administrator shall provide the employee with a copy of the completed Form 19 Employer's Report of Employee's Injury or Occupational Disease to the Industrial Commission, along with a blank Form 18 Notice of Accident to Employer and Claim of Employee, Representative, or Dependent for use by the employee in making a claim.
Authority
G.S.
97-80(a);
97-92;
Eff. March 15,
1995;
Amended Eff. November 1, 2014; January 1, 2011; August 1,
2006; March 1, 2001; June 1, 2000;
Recodified from
04 NCAC
10A .0104 Eff. June 1, 2018;
Amended Eff. December 1, 2020.
