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Workers' Compensation in North Carolina is administered by the North Carolina Rate Bureau and most related forms for NC employers, insurance carriers, and employees are available online at the North Carolina Industrial Commission Website.
We have compiled a complete list of the most common workers' compensation forms and guides for North Carolina. We make every effort to keep our state forms up to date with most recent forms issues by the North Carolina Department of Insurance, NCCI, and Acord.
Need help with a NC form? Give us a call at 888-611-7467 today.
North Carolina Acord 130 Workers' Compensation Application
The standard application form for workers' comp coverage in North Carolina. Form is required by insurance companies.
North Carolina Form 17- Notice to Injured Workers and Employers
Form 17 is known as the North Carolina Broken Arm Poster and is required to be posted in a conspicuous place at each worksite.
North Carolina First Report of Injury Form
NC First Report of Injury Form 19. Employers should complete this form and send to their insurance company each time an injury occurs.
Application for Exclusion of Officers and Stockholders
Owners and Officers of corporations should complete this form to exclude themselves from workers' compensation coverage.
North Carolina Election or Rejection of Coverage Form
This Form is used to elect or reject work comp coverage for Sole Proprietors, Partners, LLC Members, and Corporate Officers. Officers are covered on all
Certificate of Exemption From Coverage Under NC Law
Corporate Officer exemption form for North Carolina Retail Self Insurers Fund or Comp Carolina.
NC Notice of Accident Form 18
This form is required by the NC Industrial Commission and must be completed by the insurance company.
North Carolina Work Comp Dispute Procedures
This is a reference guide for employers who would like to dispute a workers' compensation insurance claim.
NC Assigned Risk Fact Sheet
Learn more about getting assigned risk coverage through the North Carolina State Fund.
NC Assigned Risk Carriers
A complete list of all current assigned risk carriers for the state of North Carolina.
NC Class Code Survey
Use this form in order to request a class code survey with the state of North Carolina to verify your business is properly classified for workers' compensation insurance.
Each state has its own laws and requirements regarding when and how employers are allowed to opt-out of coverage under their workers' compensation policy. Some states make it easier than others because they don't require anything to be filed. Other states require special inclusion or exclusion affidavit documentation. Failure to comply often causes employers to have to pay premium on themselves even when they wanted to be excluded form coverage.
A waiver of subrogation means that a business and their insurance company is foregoing all rights to file suit, or seek damages, from another business. This is common in the construction industry as builders attempt to protect their company from negligence. A workers' comp waiver of subrogation does not prevent an injured employee from filing a lawsuit for damages. This coverage typically add about $100 to the cost of a work comp policy.
A Certificate of Insurance is a document that serves as evidence of insurance or proof of coverage. Certificates indicate your current coverages and policy limits. Insurance Agencies issue on an insured's behalf and they often list a third party as a certificate holder. This means they should be notified if a policy cancels prior to expiration. Requests for any special wording should be carefully checked against the policy language before being added to a certificate as they can create legal issues with coverage.
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State Resources for North Carolina
North Carolina Rate Bureau
2910 Summer BlvdRaleigh, NC 27616919-582-1056 NRCB.org
North Carolina Industrial Commission
430 N Salisbury StreetRaleigh, NC 27603-5926919-807-2500 NC Industrial Commission
Workers' compensation insurance is required by law for North Carolina employers.
North Carolina forms and applications such as owners inclusion or exclusion forms are sometimes updated by the state. Contact us if you need help or can't find the workers' compensation form your need for North Carolina.
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