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 79 State Forms found

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CERTIFICATE OF ACCRUED ARREARAGES OR CERTIFIED ACCOUNTING OF AWARD G.S. 97-87

 Form 87C 03/2020

CERTIFICATION OF PAYMENT OF PROCESSING FEE FOR COMPROMISE SETTLEMENT AGREEMENT

 No Form Number No Form/Rev Date

CLAIM BY EMPLOYEE, REPRESENTATIVE, OR DEPENDENT FOR BENEFITS FOR LUNG DISEASE

Form 18B 7/2024

CLAIM FOR BENEFITS UNDER THE PUBLIC SAFETY EMPLOYEES’ DEATH BENEFITS ACT

 No Form Number 9/2021

Claim For Damages Under Tort Claims Act

 FORM NCIC-T-1 03/2021

CLAIMANT'S PETITION FOR COMPENSATION

Form EC100 11/2019

CONSENT ORDER FOR MEDIATED SETTLEMENT CONFERENCE

 IC Form MSC1 (rev. 03/2022)

DENIAL OF WORKERS’ COMPENSATION CLAIM (G.S. 97-18(c) AND G.S. 97-18(d))

 FORM 61 03/2020

DESIGNATION OF MEDIATOR

 IC Form MSC4 (rev. 05/2024)

EMPLOYEE'S APPLICATION FOR ADDITIONAL MEDICAL COMPENSATION (G.S. 97-25.1)

 Form 18M 3/2020

EMPLOYEE'S REQUEST THAT COMPENSATION BE REINSTATED AFTER UNSUCCESSFUL TRIAL RETURN TO WORK (G.S. 97-32.1)

 Form 28U 03/2020

EMPLOYER’S ADMISSION OF EMPLOYEE’S RIGHT TO COMPENSATION (G.S.97-18(b))

 FORM 60 03/2020

EMPLOYER’S ADMISSION OF EMPLOYEE’S RIGHT TO PERMANENT PARTIAL DISABILITY (G.S. 97-31)

 FORM 26A 8/2023

EVALUATION FOR PERMANENT IMPAIRMENT

 FORM 25R 05/2017

Health Benefit Plans and Medical Costs Internal Checklist for the Review of Compromise Settlement Agreement

 No Form Number Updated May 5, 2014
Disclaimer: These forms may not be the most recent version. North Carolina may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on this site. Please check official sources.
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