We help business owners navigate North Carolina workers' comp rules.

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 Workers' Comp Insurance Forms

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.

Workers' Comp Exemption

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.

Waiver of Subrogation

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.

Certificate of Insurance

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.

cashflow improves when the cost of workers' comp is calculated on actual payroll.

Pay As You Go Work Comp

Improve your business cash flow with our Agency Pay As You Go Workers' Comp plans. Available through most of our insurance companies.

Pay ASs You Go

State Resources for North Carolina

North Carolina Rate Bureau

2910 Summer Blvd
Raleigh, NC 27616

North Carolina Industrial Commission

430 N Salisbury Street
Raleigh, NC 27603-5926
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.

Why Quote Workers' Comp Insurance with Us?

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Easy payment plans for work comp insurance.

We offer Pay As You Go Workers' comp plans and easy monthly payment options for your business.

Get Pay As You Go workers' compensation insurance.

We've developed Target Programs with key insurance companies that provide bigger discounts and more credits.

Visit NCCI for more resources and information about workers' compensation class codes. Visit United States Department of Labor for more information about government agencies managing workers compensation insurance rates.

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