Blank Commission 18 Template

1. What does a Form 18 do?

A Form 18 establishes your legal claim for injury or occupational disease. It's crucial that this form is filed within two years of the injury date. By filing, you also provide the required notice to your employer, ensuring they are aware of the situation. If your employer has to file a Form 19, it doesn’t replace your need to file a Form 18. Even if your employer pays compensation, filing the Form 18 is essential to protect your rights.

2. To whom should the Form 18 be sent?

The original Form 18 must be submitted to the Industrial Commission. You should keep one copy for your records. Additionally, provide one signed copy to your employer at the time of the incident. This ensures that all parties are informed about the injury.

3. What numbers do I write in the upper right corner?

You don’t need to fill in the spaces in the upper right corner of the Form 18 unless you have an existing I.C. File Number. If you know your I.C. File Number or that your employer has filed a Form 19, you can include it. The other two spaces are for internal purposes and should remain blank.

4. What if I do not know who my employer’s insurance carrier is?

If you’re unsure of your employer’s insurance carrier, you can ask your employer directly. Alternatively, call the Industrial Commission’s Claims Administration Section at (800) 688-8349 and follow the prompts for assistance. If you still can’t find the information, it’s acceptable to leave the line blank.

5. When listing the number of days out of work, do I count partial days?

Yes, you should include both partial and whole calendar days not worked. This count does not need to consist of consecutive days, so even intermittent absences count towards the total.

6. What happens after I file the Form 18?

Once you submit the Form 18, the Industrial Commission will send you an acknowledgment letter. The processing time can vary based on their current workload. They will also send a copy of this acknowledgment to your employer or their insurance carrier to ensure they are aware of your claim and can inform you about any compensation decisions.

7. Can someone else sign the Form 18 for me?

If you are unable to sign the Form 18 yourself, someone else can sign on your behalf. Ensure that the person signing is authorized to do so, as this preserves the validity of the claim submission.

8. What should I do if I miss the filing deadline?

If you miss the filing deadline of two years from your injury or occupational disease, your claim might be barred. It’s important to act quickly and seek legal advice if you suspect you won’t meet the deadline.

9. Is there any assistance available if I have questions about the Form 18?

If you have questions or need assistance with the Form 18, you can reach out to the Industrial Commission directly at their main telephone number, (919) 807-2500 or the helpline at (800) 688-8349. They can provide guidance on filing and any related processes you should be aware of.

Filling out the Commission 18 form correctly is crucial for anyone reporting an injury or occupational disease in North Carolina. However, many people make common mistakes that can lead to delays in processing their claims. Here are five significant errors to avoid:

1. Failure to Submit on Time:

   One of the most critical mistakes is not filing the form within the specified time frame. The form must be submitted within two years from the date of the injury or occupational disease. Remember, timely submission protects your rights!

2. Inaccurate Personal Information:

   Providing incorrect personal details such as your name, address, or social security number can cause significant issues. Ensure that all information matches your official documents to avoid future complications.

3. Neglecting to Describe the Incident:

   A complete description of how the injury occurred is vital. Many people forget to detail what happened, which is necessary for assessing the claim. Provide specific facts about the event, including the location and time.

4. Not Reporting to Employer:

   It’s essential to give notice to your employer immediately after the accident or as soon as practicable. This should be done within 30 days. Failing to do so might jeopardize your claim.

5. Leaving Required Sections Blank:

   Some individuals fail to fill in all required fields, especially about the injury specifics and work details. Every section of the form needs to be completed accurately for it to be processed effectively.

Avoiding these common pitfalls when completing the Commission 18 form can make a significant difference in the success of your claim. Take your time, review your entries, and ensure everything is accurate.

The Commission 18 form is essential for initiating a workers' compensation claim in North Carolina. Along with this form, several other documents are commonly used to ensure that both employees and employers fulfill their legal obligations. Each of these forms serves a specific purpose in managing claims effectively. Below is a list of these related forms and documents.

• Form 19: This form, also known as the Employer's Report of Injury to the Industrial Commission, must be filed by the employer when an employee is unable to work for more than a day due to their injury. It documents the injury and essential details related to the claim.
• Form 18B: For specific occupational diseases such as asbestosis, silicosis, or byssinosis, this form replaces the Commission 18. It provides the necessary information to file a claim related to these types of diseases.
• Form 30: This form is a request for hearing. An employee can file it if there are disputes regarding compensation or if the insurer has denied the claim, allowing the matter to be addressed by the Industrial Commission.
• Form 25T: This Request for Modification of Benefits allows an employee to ask for changes to their benefits based on a change in medical condition or ability to work. It is crucial for ongoing compensation management.
• Form 28: The Employee's Report of Injury form provides further details about the injury, including its impact on the employee's ability to perform work. This can supplement the Commission 18 form’s information.
• Form 22: This form applies to wage loss claims. It provides information about the employee's wages and employment history, helping to determine the appropriate compensation rate.
• Form W-4: Employees may need to fill out a W-4 for tax withholding purposes when receiving compensation through workers' compensation benefits. It determines how much tax will be withheld from benefits received.
• Form 15: This is the Employer's Notice of Compensation Paid, which provides a record of payments made to the employee. It is critical for transparency and tracking compensation over time.
• Medical Reports: Any medical documentation related to the injury is crucial. These reports help establish the nature and extent of the injury, supporting the claim made in the Commission 18 form.
• Claim Form: If an employee decides to pursue their claim through additional channels, a comprehensive claim form may be required, detailing all aspects of the claim and the reasons for pursuing it further.

Understanding the relationship between these various forms and the Commission 18 is essential for navigating the workers' compensation process effectively. Proper documentation not only supports the claim but also safeguards the rights of all parties involved.

The Form 19 is another essential document related to workers' compensation claims. This form is completed by the employer when an employee misses more than one day of work due to a work-related injury. Unlike Form 18, which is filed by the employee, the Form 19 ensures that the employer informs the Industrial Commission of the injury's details. It captures data such as the employee's name, date of accident, and circumstances of the injury, thus helping to streamline compensation processes.

Form 18B is specifically designed for certain occupational diseases, such as asbestosis, silicosis, and byssinosis. It serves a similar purpose as Form 18 but is tailored for these specific conditions. Employees must use Form 18B to ensure proper filing for these particular diseases, which often require distinct documentation and evidence of exposure. This form must also be submitted within the same periods to protect the employee's rights.

The Form 30 is used when an employee wishes to appeal a decision made by the Industrial Commission regarding compensation claims. This form allows workers to contest a decision that they believe is incorrect or unfair. The process requires a detailed explanation of the reasons for the appeal, demonstrating that certain aspects of the initial decision should be reevaluated.

The Form 21 is utilized for initiating a payment agreement between the employee and the employer. An employee can file this form when they receive compensation for a work-related injury and both parties agree on the terms. It formalizes the understanding of payment rates and schedules, ensuring that both parties are clear on the compensation structures following an injury.

The Form 26 is related to the request for changes in the compensation rates or benefits. This form is essential for individuals who may experience changes in their condition, requiring adjustments in their compensation amounts. By filing this form, employees can seek an increase or decrease in their benefit payments due to changing circumstances related to their injury.

The Form 28 is a medical report that documents progress in treatment for injured employees. This form is typically completed by a healthcare provider, detailing an employee's recovery status and ongoing treatment plans. Both the employee and employer may refer to this form during the claims process to assess how an injury impacts work capabilities.

The Form 30R serves as a request for a hearing concerning a disputed claim or compensation issue. An employee can use this form when disputes arise about benefits that have been denied or delayed. Filing the Form 30R advances the process of resolving disputes and usually leads to a formal hearing where both sides can present their cases.

The Form 72 is a notification that must be filed whenever an injured employee returns to work, either full-time or part-time. This form informs the Industrial Commission and employer of the changes in the employee's work status, which can impact claims for ongoing benefits. Properly filing this form is crucial to ensure that compensation is adjusted or stopped as needed.

The Form 45 is used to report a settlement agreement between the injured employee and their employer. This agreement outlines the terms for resolving the worker's compensation claim. It includes details such as the amount of settlement and any conditions included in the agreement. Filing Form 45 ensures the settlement is legally recognized and can help prevent future disputes regarding the claim.

Lastly, the Form 1 is a general information request form that can be utilized by employees to seek clarification or details about their workers' compensation claims. This document provides a structured format for inquiries, which helps ensure that individuals receive accurate and relevant information regarding their claims and responsibilities.

When filling out the Commission 18 form, attention to detail is key to ensure your claim is processed smoothly. Here are ten important guidelines to follow and avoid:

• Do file the form within two years of your injury or occupational disease.
• Do provide notice to your employer immediately after the accident or as soon as you can, ideally within 30 days.
• Do keep copies of the signed form for yourself, your employer, and the Industrial Commission.
• Do make sure to describe your injury or disease clearly, including specific details like the date, time, and location.
• Do use black ink or typed text for better clarity on the form.

• Don't neglect to mention any medical treatment you have received; it’s important for your claim.
• Don't forget to include your employer’s insurance carrier information, if known.
• Don't exclude partial days when counting the number of days you’ve missed from work.
• Don't leave the form incomplete; each section must be filled out accurately.
• Don't assume your employer's filing of Form 19 fulfills your obligation to file Form 18.

By carefully following these dos and don'ts, you can help ensure that your Commission 18 form is completed correctly and that your claim is processed in a timely manner.

1. The Commission 18 form is optional. This is not true. The Commission 18 form is a required document. It must be filed with the Industrial Commission within two years of the incident to protect your claim.

2. Only the employer needs to file the form. This misconception overlooks the fact that the injured employee must also complete and submit the form. The employee needs to file the Form 18 even if the employer is handling compensation.

3. The form can be filed at any time. Incorrect. The form must be filed within two years of the injury or occupational disease. Delaying beyond this period can result in losing the right to claim.

4. I can leave out details about my injury. This is false. It is essential to provide a complete description of the injury, including specific body parts affected and how the injury occurred.

5. Partial days out of work don’t count. This is a misunderstanding. Both full and partial days out of work should be included in the information provided on the form.

6. The I.C. File Number must be known when filing the form. This is not necessary. If you do not have an I.C. File Number, one will be assigned by the Industrial Commission after the form is submitted.

7. Any signed copy of the form can be submitted. This is misleading. You must file the original form with the Industrial Commission. Keep a signed copy for your records and provide another to your employer.

8. Filing the form guarantees compensation. Filing a Form 18 is important for initiating a claim, but it does not guarantee that benefits will be received. Compensation is determined after a review of the claim.

9. It’s fine to wait to notify my employer. This is incorrect. You should notify your employer immediately after the injury or as soon as you can. This should happen within 30 days to comply with legal requirements.

10. The form can be submitted in any color ink. This is not accurate. The form should ideally be completed using black ink for better readability and clarity.

• The Form 18 serves as a legal claim for injury and must be filed within two years of the incident.
• Submit a copy of the Form 18 to your employer within 30 days of the injury to fulfill notification requirements.
• Include detailed information about the injury, including the specific body part affected and a description of how the injury occurred.
• Even if your employer files a Form 19, you still need to file a Form 18 to ensure your rights are protected.
• Keep one signed copy of the Form 18 for your records after filing.
• If you don’t know your employer’s insurance carrier, you can leave that section blank or ask your employer directly.
• The Industrial Commission will assign an IC File Number upon receipt of your Form 18 if you do not already have one.
• Include all days you were out of work, counting partial days and not just consecutive full days.
• After submitting your Form 18, the Industrial Commission will send you an acknowledgment letter to confirm processing.
• Remember that the processing time for the Form 18 can vary depending on the volume of submissions the Industrial Commission is handling.