Workers Compensation Forms

To get started with your case fill out the form below:
Workers Compensation Intake Form (PDF Download)

Once you have talked to Jeffrey, download, print and fax in the 2 forms below:
Workers Comp Contract (PDF Download)
Medical Release HIPAA (PDF Download)

A crucial aspect of any worker’s compensation claim in North Carolina is proper notification to your employer.  The most thorough document to use is a Form 18.

You can submit one electronically this way: Electronic Form 18 Notice of Accident to Employer

Or you can print a standard Form 18 for submission the old-fashioned way.

Just remember, it may behoove you to speak to an attorney before you act, but don’t wait too long!

For reimbursement from the worker’s compensation insurance carrier for travel expenses related to your treatment, use the Form 25T.