North Carolina N.C. Workers' Compensation Notice to Injured Workers and Employers Poster Required
The N.C. Workers' Compensation Notice to Injured Workers and Employers is a labor law posters poster by the North Carolina Department Of Labor. This is a mandatory posting for all employers in North Carolina, and businesses who fail to comply may be subject to fines or sanctions.
This poster must be posted in a conspicuous place where all employees will see it. This poster describes how employees can qualify for workers' compensation when injured on the job as well as steps employers should take to file a claim and what the employer should do when an employee is injured while working.
NC All-In-One Labor Poster: Instead of printing out dozens of posters, employers can also purchase an all-in-one poster that covers both North Carolina and Federal poster requirements by clicking here .
All employees of this business, except specifically excluded executive officers, suffering work - related injuries may be entitled to Workers’ Compensation benefits from the employer or its insurance carrier. FORM 17 Revised 12/2020 N.C. WORKERS’ COMPENSATION NOTICE TO INJURED WORKERS AND EMPLOYERS IF YOU HAVE A WORK - RELATED INJURY OR AN OCCUPATIONAL DISEASE The Employee Should: • Report the injury or occupational disease to the Employer immediately. • Give written notice to the Employer with in 30 days. • File a claim with the Industrial Commission on a Form 18 immediately, but no later than 2 years from injury date or occupatio nal disease. Give a copy to the Employer. • If medical treatment and wage loss compensation are not promptly provided, ca ll the insurance carrier/administrator or request a hearing before the Industrial Commission using a Form 33 Request for Hearing. Commission forms are available at website www.ic.nc.gov or by calling the Help Line. • Your employer’s workers’ compensation insurance carrier is___________________________________________________________ . • The insurance policy number is____________________________________________________________________________________ . • Your employer’s workers’ compensation insurance policy is valid from___________________ until___________________________ . For assistance: Call the Industrial Commission HELP LINE — (800) 688 - 8349. The Employer Should: • Provide all necessary medical services to the Employee. • Report the injury to the carrier/administrator and file a Form 19 Report of Injury within 5 days with the Industrial Commissi on, if the Employee misses more than 1 day from work or if cumulative medical costs exceed $4,000.00. • Give a copy of your completed Form 19 to the Employee along with a copy of a blank Form 18 Notice of Accident. Ensure that compensation is promptly paid as req uired under the Workers’ Compensation Act. NORTH CAROLINA INDUSTRIAL COMMISSION 1235 MAIL SERVICE CENTER RALEIGH, NORTH CAROLINA 27699 - 1235 Website: www.ic.nc.gov TO EMPLOYER: THIS FORM MUST BE PROMINENTLY POSTED IF YOU HAVE WORKERS’ COMPENSATION INSURANCE OR QUALIFY AS SELF - INSURED. (N.C. Gen. Stat. §97 - 93).
Other North Carolina Labor Law Posters 4 PDFS
There are an additional six optional and mandatory North Carolina labor law posters that may be relevant to your business. Be sure to also print all relevant state labor law posters, as well as all mandatory federal labor law posters.
- Original poster PDF http://www.ic.nc.gov/forms/form17.pdf , updated June 2023
- North Carolina Labor Law Posters at http://www.nclabor.com/posters/posters.htm
- North Carolina Department Of Labor
While we do our best to keep our list of North Carolina labor law posters up to date and complete, we cannot be held liable for errors or omissions. Is the poster on this page out-of-date or not working? Please let us know and we will fix it ASAP.