Fill in Your North Carolina 60 Template

• Misconception 1: The North Carolina 60 form is only for serious injuries.

This form is used for any injury or occupational disease that the employer admits is compensable, regardless of severity. It is not limited to serious injuries.

• Misconception 2: Filing the North Carolina 60 form automatically guarantees compensation.

While the form indicates the employer's admission of liability, it does not guarantee that compensation will be paid. Verification of details and compliance with all relevant laws are necessary.

• Misconception 3: Employers can change their admission of liability after submitting the form.

Once the North Carolina 60 form is filed, the employer's admission of liability is generally binding unless new evidence arises that justifies a change.

• Misconception 4: Employees do not need to keep a copy of the North Carolina 60 form.

It is essential for employees to retain a copy of the form for their records. This documentation may be important for future reference or disputes.

• Misconception 5: The North Carolina 60 form is the only document needed for a workers' compensation claim.

Other forms, such as Form 28B for reporting compensation and medical payments, may also be required. The North Carolina 60 form is just one part of the overall claims process.

• Misconception 6: The North Carolina 60 form must be filed immediately after an injury occurs.

While timely filing is important, the North Carolina 60 form should be submitted after the employer has assessed the situation and admitted liability. There is no strict deadline for its submission, but it must be filed within the required timeframes for other related forms.

The North Carolina 60 form is an important document in the workers' compensation process. It serves as an admission of an employee’s right to compensation. Several other documents share similarities with the North Carolina 60 form in terms of purpose, structure, or content. Here are seven such documents:

• Form 28B - Report of Compensation and Medical Compensation Paid: Like the North Carolina 60 form, this document provides a record of compensation payments made to the employee. It details medical expenses and any payments for lost wages, ensuring transparency in the compensation process.
• Form 30 - Notice of Death: This form is used when a compensable injury results in death. Similar to the North Carolina 60, it establishes the employer's acknowledgment of liability and outlines the benefits payable to dependents.
• Form 18 - Notice of Accident to Employer: This document is filed by the employee to report an injury. It shares a common goal with the North Carolina 60 form in that it initiates the workers' compensation claim process, highlighting the nature of the injury.
• Form 19 - Employer’s Report of Employee’s Injury: This form is completed by the employer to report the details of an employee's injury. It complements the North Carolina 60 by providing the employer's perspective on the incident and confirming the injury's occurrence.
• Form 21 - Agreement for Compensation: This document outlines the agreement between the employer and employee regarding compensation. Like the North Carolina 60 form, it formalizes the recognition of the employee's right to benefits.
• Form 26 - Application for Approval of Settlement: This form is used to request approval for a settlement agreement. It is similar to the North Carolina 60 in that both documents require acknowledgment of the employee's rights and the employer's responsibilities.
• Form 22 - Wage Statement: This document provides details about the employee's wages, which are essential for calculating compensation rates. It aligns with the North Carolina 60 form by ensuring accurate financial records are available for compensation calculations.

Steps to Writing North Carolina 60

Filling out the North Carolina 60 form is an important step in the workers' compensation process. This form is used by employers to admit an employee's right to compensation for work-related injuries or occupational diseases. After completing the form, it must be submitted to the North Carolina Industrial Commission, and copies should be provided to the employee and their attorney, if applicable.

1. Obtain the Form: Start by downloading or printing the North Carolina 60 form from the North Carolina Industrial Commission website.
2. Fill in Basic Information: Enter the employer’s FEIN (Federal Employer Identification Number), employee’s name, employer’s name, and contact numbers.
3. Provide Addresses: Fill in the employer’s address, including city, state, and zip code. Also, provide the insurance carrier’s address.
4. Insurance Details: Write the insurance carrier policy number and the carrier’s telephone number.
5. Employee Information: Enter the employee’s Social Security number, sex, and date of birth.
6. Describe the Injury: Specify the date of the injury or occupational disease, and describe the body part(s) or condition(s) involved.
7. Provide Injury Details: Answer questions about the injury, including whether the employee was paid for the entire day of the injury and the employee's average weekly wage.
8. Compensation Information: Indicate the compensation rate and any temporary total or partial compensation amounts being paid.
9. Disability Dates: Fill in the dates when the disability began and when compensation commenced.
10. Sign the Form: The employer or their representative must sign and date the form to validate it.
11. Distribute Copies: Make sure to provide a copy of the completed form to the employee and their attorney, if applicable.
12. Submit the Original: Send the original form to the North Carolina Industrial Commission at the specified address.

The North Carolina 60 form serves as an Employer's Admission of Employee's Right to Compensation under the Workers' Compensation Act. Several other forms and documents are commonly used in conjunction with this form to ensure compliance and facilitate the claims process. Below is a list of these documents, each accompanied by a brief description.

• Form 28B: This form is a Report of Compensation and Medical Compensation Paid. It must be filed within 16 days after the last payment pursuant to an agreement or award. Failure to file can result in penalties.
• Form 30: This form is utilized for compensable injuries that result in death. It documents the claim for death benefits and is essential for the processing of such claims.
• Form 18: The Employee's Notice of Claim is submitted by the employee to notify the employer and the Industrial Commission of a work-related injury. This initiates the claims process.
• Form 19: This form serves as the Employer's Report of Injury to the Industrial Commission. It provides details about the incident and the nature of the injury.
• Form 21: This is the Agreement for Compensation form, which outlines the terms of compensation agreed upon by the employer and employee after a claim is accepted.
• Form 26: The Employee's Application for Hearing is used when an employee seeks a formal hearing regarding their claim, typically due to disputes over compensation or benefits.
• Form 27: This form is the Employer's Request for Hearing, which may be filed by the employer if there is a dispute regarding the claim or if they contest the employee's entitlement to benefits.
• Form 90: This is the Application for Approval of Settlement, which is used when parties reach a settlement agreement outside of a formal hearing. It must be approved by the Industrial Commission.

These documents play a critical role in the workers' compensation process in North Carolina, ensuring that both employees and employers fulfill their obligations and that claims are processed efficiently. Understanding these forms can help streamline the claims process and mitigate potential disputes.