North Carolina Workers Compensation Forms and Procedures

We are happy to provide links to download these forms on the left with the following explanation of when and how to use them. All forms are also available in TriSure Online. Call our office if you haven't activated your account.

Form 17

The N.C. Industrial Commission (NCIC) has revised Form 17, which is now titled the N.C. Workers’ Compensation Notice to Injured Workers and Employers and is dated 2/2009.

This form must be prominently posted if you have workers’ compensation insurance or qualify as self–insured. The NCIC requires that it is printed in the same colors and format that appears in this PDF (printed in color on white paper).

Please note that Form 17 also provides requirements for completing Forms 18 and 19.

Form 18 and Form 19

Form 18 and Form 19 are used for filing medical claims.

A blank Form 18 must be provided to each employee along with a completed copy of Form 19.

When you have a chance, please review the wording and instructions on these forms.

What You Should Do

Each qualifying employer is responsible for providing these forms to employees. We suggest that business owners identify a manager that is responsible for handling this essential portion of the reporting process.

If you have any questions about the multitude of workers’ compensation forms and procedures, contact your account manager or TriSure’s Claims Manager, Jay Baas at 919.469.2473.