Get the free nc industrial commission form 87s - ic nc

Signature Claimant Attorney Address Telephone FORM 87S 7/08 PAGE 1 OF 2 MAIL TO THE FULL COMMISSION NORTH CAROLINA INDUSTRIAL COMMISSION 4336 MAIL SERVICE CENTER RALEIGH NC 27699-4336 CERTIFICATE OF SERVICE This is to certify that I have this day served a copy of the foregoing Statement of Accrued Arrearages upon the below listed persons by depositing a copy of same in the United States mail postage prepaid addressed as follows This the day of 20...

How to fill out nc industrial commission form

How to fill out the NC Industrial Commission form:

1. Start by obtaining the form from the official website of the North Carolina Industrial Commission.
2. Carefully read and understand the instructions provided with the form to ensure accurate completion.
3. Gather all the necessary information and documents required to fill out the form, such as personal details, employment information, injury or incident details, medical records, and supporting evidence.
4. Begin by providing your personal information, including your full name, address, contact information, and social security number.
5. Proceed to fill out the employment details section, which may include your job title, employer's name and address, date of hire, and other relevant information.
6. Provide a detailed description of the injury or incident, including the date, time, and location of the occurrence.
7. If applicable, include information about any medical treatments received, healthcare providers consulted, and medications prescribed.
8. Carefully review the entire form to ensure accuracy and completeness before submitting it.
9. Sign and date the form in the designated areas.
10. Make a copy of the filled-out form for your records and submit the original to the North Carolina Industrial Commission according to their instructions.

Who needs the NC Industrial Commission form:

1. Individuals who have sustained a work-related injury in the state of North Carolina may need to fill out the NC Industrial Commission form.
2. Employers may also be required to fill out the form if they have received a claim for workers' compensation from an employee.
3. Healthcare providers or other parties involved in the diagnosis, treatment, or rehabilitation of the injured individual may need to complete sections of the form pertaining to their respective roles.

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What is nc industrial commission form?

The NC Industrial Commission form is a document used to report information related to workplace injuries and workers' compensation claims in North Carolina.

Who is required to file nc industrial commission form?

Employers in North Carolina are required to file the NC Industrial Commission form when there is a workplace injury or workers' compensation claim.

How to fill out nc industrial commission form?

To fill out the NC Industrial Commission form, employers must provide details about the injured employee, the injury that occurred, and any relevant medical treatment.

What is the purpose of nc industrial commission form?

The purpose of the NC Industrial Commission form is to report workplace injuries and workers' compensation claims in order to ensure that employees receive proper benefits and medical treatment.

What information must be reported on nc industrial commission form?

The NC Industrial Commission form requires information such as the injured employee's name, date of injury, description of the injury, and details about the medical treatment received.