North Carolina Workers Comp Forms

Find North Carolina workers compensation forms and coverage guides.

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.

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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 know 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.

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.

Find Affordable Workers Comp Programs in Your State


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We work with over 35 workers comp insurance companies across the U.S to shop your insurance coverage for the best price.

Easy payment plans for work comp insurance.

With dozens of Pay As You Go and easy installment plans to choose from, you get more flexible options for your business.

Get Pay As You Go workers' compensation insurance.

We've developed Target Programs with our insurance companies to help find you the right insurance product with lower rates.

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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