If you have been injured on the job, you may have received a Form 18 and Form 19 in the mail. Understandably, you may wonder what these forms are and how they impact your workers’ compensation claim.
All injured workers–with a few exceptions–must complete a Form 18 Notice of Accident to Employer and Claim of Employee, Representative, or Dependant within two years of the date of your work-related injury or illness and return the form to the North Carolina Industrial Commission; otherwise, your claim could be time barred. You must also send a copy of the form to your employer.
There are other forms you will need to fill out during the claims process, but the Form 18 is one of the most important. If you fill it out incorrectly, your otherwise “compensable” workers’ compensation claim could be denied.
Note that if you have been injured by asbestosis, silicosis, or byssinosis you should complete the Form 18B Claim by Employee, Representative, or Dependent for Benefits for Lung Disease.
While you can complete this form and return it to the Industrial Commission, it is often recommend that you have an experienced workers’ compensation attorney do this for you. Your attorney will include the information required by the Industrial Commission and provide you with the best chance of having your claim “accepted.” If you would rather proceed without an attorney, below is general information on how to complete the form, but keep in mind that every case is different.
You will need a few bits of information apart from the injury description to complete this form. To begin with, you will need to fill out your name, social security number, gender, date of birth, and current contact information. You must also provide your employer’s name and contact information as well as your employer’s insurance carrier’s name, contact information and policy number. If you do not know this information, you can find it out by contacting the North Carolina Industrial Commission’s Claims Administration Section.
After you complete the first section, you can move on to the most important part: filling out all pertinent information regarding your on-the-job injury or illness; this information includes the time of day your injury occurred, the date on which it occurred, and where it occurred (in which city and county). You then need to share explicit details about your injury. You need to identify the body part injured and describe in as many details as possible how it happened. If you do not share enough details, your claim can be denied. It is vital that you fill out this portion of the Form 18 correctly as not doing so will affect the outcome of your claim.
The Form 18 also requires that you share whether you have received medical treatment for your injury, how many days of work you have missed because of the injury (including partial days) and lastly, what your hourly wage is. This will help the parties determine how much, and what type of, compensation you are entitled to.
After your Form 18 is complete, you can sign it personally or have your attorney sign it for you. You will then need three copies, one for yourself, one to send to the North Carolina Industrial Commission and one to give to your employer.
The Form 19 is not actually a form you have to fill out.
It is the form your employer files with the North Carolina Industrial Commission anytime someone is injured at work. This form notifies the North Carolina Industrial Commission that a work-related injury did occur.
Often, the Form 19 is filed after an injured worker submits a Form 18 to their employer. However, your employer is supposed to file this form whether you file a Form 18 or not.
The Form 19 does not initiate a claim on your behalf. You must file Form 18 to start your claim for workers’ compensation.
Attempting to manage a workers’ compensation claim on your own can be overwhelming. If you have questions regarding how to protect your right to workers’ compensation benefits, contact us today for a FREE initial consultation.