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North Carolina Industrial Commission IC File # AUTHORIZATION FOR REHABILITATION PROFESSIONAL TO OBTAIN MEDICAL RECORDS OF CURRENT TREATMENT EMP. Code # Carrier Code # Carrier File # The Use Of This
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How to fill out the North Carolina Industrial Commission:

01
Obtain the necessary forms: Start by acquiring the appropriate forms from the North Carolina Industrial Commission (NCIC) website or visiting their office. The forms can typically be downloaded and printed for convenience.
02
Provide personal information: Begin by filling out your personal information, such as your full name, address, contact details, and social security number. Ensure that all the information provided is accurate and up-to-date.
03
Specify the type of claim: Indicate the specific type of claim you are filing, whether it's related to workers' compensation, employment security, tort claims, or other matters. Each section may require different information, so be sure to review the instructions specific to your claim type.
04
Provide detailed incident information: Clearly describe the incident or circumstances that led to the claim. Include the date, time, and location of the incident, as well as any individuals involved or witnesses present. Be thorough yet concise when explaining the events.
05
Include medical information: If your claim is related to an injury or illness, provide relevant medical information. This may involve attaching medical reports, invoices, and receipts for treatments or examinations received. Ensure that all medical documents are legible and organized.
06
Include supporting documents: If you have any additional documents that support your claim, such as photographs, videos, or witness statements, include them with your submission. These can provide further evidence and support the validity of your claim.
07
Review and sign the form: Before submitting the form, carefully review all the information entered to ensure accuracy and completeness. Once you have reviewed the form, sign and date it accordingly.

Who needs the North Carolina Industrial Commission:

01
Employees: Workers who have suffered work-related injuries, illnesses, or disabilities can benefit from the services provided by the North Carolina Industrial Commission. They can file for workers' compensation claims or seek assistance in resolving workplace disputes.
02
Employers: Employers also need the Industrial Commission to ensure compliance with workers' compensation laws, manage workplace disputes, and understand their rights and responsibilities regarding employee injury claims.
03
Healthcare providers: Healthcare professionals involved in treating work-related injuries or illnesses may need to communicate with the Industrial Commission to provide medical records, treatment reports, and invoices for their patients.
04
Attorneys: Attorneys specializing in workers' compensation or employment law often work closely with the Industrial Commission to represent clients and navigate legal processes.
05
Other parties involved: Various parties, such as insurance companies, third-party administrators, and vocational rehabilitation providers, may also interact with the Industrial Commission in matters related to workers' compensation claims.
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The North Carolina Industrial Commission is a state agency responsible for enforcing state laws regarding workers' compensation and workplace safety.
All employers in North Carolina who have three or more employees are required to file with the Industrial Commission.
Employers can fill out the North Carolina Industrial Commission form online or submit a paper form by mail.
The purpose of the North Carolina Industrial Commission is to ensure that employees are provided with proper compensation and protection in case of workplace injuries.
Employers must report information about their employees, workplace safety measures, and any previous workers' compensation claims.
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2004 North_Carolina 25C claimant FEIN IC OMBUDSMAN NONCOMPLIANCE Emp Employers REFUSAL DEEMED occupational resulting REHABILITATION Provisions contracted

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