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Form 18m 2017-2026

Create, verify, and track a Form 18m 2017 online using a ready-made template.

Number City State Zip City State Zip Insurance Carrier ) Work Telephone M F XXX-XX- Zip ) / / Date of Birth Carrier's Address ( ) ( ) Carrier's Telephone Number Fax Number SECTION A. TO BE COMPLETED BY EMPLOYEE: 1. 2. The above-named employee claims additional medical compensation as a result of an injury by accident or an occupational disease which occurred on or by (Date) because (Reason for Additional Medical Compensation) Additional medical and/or other...

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What is the Form 18m

The Form 18m is a crucial document used in the North Carolina workers' compensation system. It serves as a notice of claim for compensation benefits, specifically related to injuries sustained in the workplace. This form is essential for employees seeking to initiate a claim for benefits under the North Carolina Industrial Commission. It outlines the details of the injury, the circumstances surrounding it, and the type of compensation being sought.

Steps to complete the Form 18m

Completing the Form 18m requires careful attention to detail to ensure all necessary information is accurately provided. Here are the steps to follow:

  • Gather relevant information about the injury, including dates, locations, and witnesses.
  • Fill in personal details, such as your name, address, and contact information.
  • Provide a detailed account of the incident, including how the injury occurred.
  • Specify the nature of the injury and any medical treatment received.
  • Sign and date the form to certify that the information provided is true and correct.

Legal use of the Form 18m

The Form 18m must be used in compliance with North Carolina laws governing workers' compensation claims. It is important to submit the form within the designated time frame to ensure eligibility for benefits. Failure to do so may result in denial of the claim. Additionally, the information provided must be accurate and truthful, as any discrepancies could lead to legal repercussions.

Key elements of the Form 18m

Several key elements must be included in the Form 18m to ensure it is complete and valid. These include:

  • Claimant's personal information, including social security number.
  • Details of the employer and insurance carrier.
  • A comprehensive description of the injury and circumstances.
  • Medical treatment details and any ongoing care required.
  • Signature of the claimant or authorized representative.

How to obtain the Form 18m

The Form 18m can be obtained through the North Carolina Industrial Commission's official website or by contacting their office directly. It is essential to use the most current version of the form to ensure compliance with any updates in the law. Additionally, many legal and workers' compensation resources may provide access to this form for convenience.

Form Submission Methods

Once the Form 18m is completed, it can be submitted through various methods. Options include:

  • Online submission via the North Carolina Industrial Commission's e-filing system.
  • Mailing the completed form to the appropriate office address.
  • In-person submission at designated Industrial Commission locations.

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VersionsForm popularityFillable & printable
NC Form 18M 20174.8 Satisfied (8035 Votes)
NC Form 18M 20014.7 Satisfied (145 Votes)
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Related links to Form 18m
Form 18M - Industrial Commission - NC.gov

EMPLOYEE FILING OPTIONS: E-MAIL TO EXECSEC@IC.NC.GOV. FAX TO (919) 715-0282. MAIL TO NCIC-EXECUTIVE SECRETARY. 1236 MAIL SERVICE CENTER.Read more

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