Fill in Your Commission 18 Template

1. What does a Form 18 do?

A Form 18 establishes a legal claim of injury on your behalf if it is filed within two years of the date of injury or occupational disease. It also provides the required written notice to the employer when a copy is submitted within 30 days of the injury. If an employee misses more than one day of work due to the injury, or if medical bills exceed $4,000, the employer is required to file a Form 19. However, the employer's filing does not satisfy the employee's obligation to file a claim. To protect your rights, it is essential to file a Form 18, even if the employer is paying compensation or the Industrial Commission has opened a file for the injury.

2. To whom should the Form 18 be sent?

The original Form 18 should be submitted to the Industrial Commission. It is important for the injured worker to keep one copy for personal records. Additionally, one copy should be provided to the employer at the time of the injury.

3. What numbers do I write in the upper right corner?

You do not need to fill in the spaces in the upper right corner of the Form 18. If you know your employer has already filed a report of injury (Form 19) and you have the I.C. (Industrial Commission) File Number, you may write that number in the “I.C. File No.” space. If you do not have an I.C. File Number, the Industrial Commission will assign one upon receipt of the Form 18. The “Emp. Code No.” and “Carrier Code No.” spaces are for internal use only.

4. What if I do not know who my employer’s insurance carrier is?

If you are unsure of your employer's insurance carrier, you can ask your employer directly for the information. Alternatively, you can call the Industrial Commission’s Claims Administration Section at (800) 688-8349 and press “1” after the prompt. If you prefer, you may also leave the line blank on the form.

5. When listing the number of days out of work, do I count partial days?

Yes, you should include both partial and whole calendar days that were not worked. It is not necessary for these days to be consecutive.

6. What happens after I file the Form 18?

After filing the Form 18, the Industrial Commission will send you an acknowledgment letter once your form is processed. The time it takes to process varies based on the current workload. Additionally, the Commission will mail a copy of the acknowledgment letter to your employer or its workers’ compensation insurance carrier, requesting them to contact you regarding whether compensation will be paid voluntarily.

1. Not filing within the required time frame: One of the most critical mistakes is failing to submit the Commission 18 form within two years of the injury or occupational disease. Delays can bar your claim entirely.

2. Inaccurate personal information: Providing incorrect details, such as your name, address, or Social Security Number, can lead to processing delays or complications in your claim.

3. Omitting the description of the injury: Failing to clearly describe the injury or occupational disease can hinder your claim. Be specific about the body part affected and how the injury occurred.

4. Not notifying the employer: It’s essential to inform your employer about the injury immediately or as soon as practicable. Not doing so can jeopardize your claim.

5. Forgetting to include medical treatment details: If you received medical treatment, be sure to indicate this on the form. Missing this information can create confusion about your claim.

6. Neglecting to sign the form: Ensure that the form is signed by you or an authorized representative. An unsigned form will not be accepted.

7. Failing to keep copies: Always retain a signed copy of the form for your records. This can serve as proof of your submission and help track your claim.

8. Ignoring the submission process: Make sure to send the form to the correct address. If unsure, consult the guidelines provided on the form or contact the Industrial Commission.

When navigating the workers' compensation process in North Carolina, several forms and documents accompany the Commission 18 form. Understanding these additional documents is essential for ensuring that all necessary information is submitted correctly and timely. Here’s a brief overview of five important forms often used alongside the Commission 18.

• Form 19: Employer's Report of Injury to the Industrial Commission - This form is filed by the employer when an employee is injured at work. It documents the details of the injury and is required if the employee misses more than one day of work or if medical expenses exceed $4,000. The employer must submit this form within five days of the injury.
• Form 18B: Notice of Accident to Employer and Claim of Employee for Asbestosis, Silicosis, or Byssinosis - This specialized form is used specifically for claims related to certain occupational diseases such as asbestosis, silicosis, or byssinosis. It serves a similar purpose to the Commission 18 but is tailored for these particular conditions.
• Form 30: Application for Hearing - If there are disputes regarding the workers' compensation claim, the injured worker can file this form to request a hearing before the Industrial Commission. It is a critical step in resolving disagreements about compensation or benefits.
• Form 25R: Employee’s Request for Payment of Medical Bills - This form allows employees to request payment for medical expenses related to their injury. It is essential for ensuring that medical costs are covered under the workers' compensation policy.
• Form 26: Agreement for Compensation - This document is used when both the employee and employer agree on the terms of compensation for the injury. It outlines the agreed-upon benefits and is submitted to the Industrial Commission for approval.

Each of these forms plays a crucial role in the workers' compensation process. It is vital to complete and submit them accurately to avoid delays or complications in receiving benefits. Ensure that all forms are filled out completely and submitted within the required timeframes to protect your rights and streamline the claims process.

The Commission 18 form bears similarities to the First Report of Injury form, often used in various states. Both documents serve as initial notifications to employers and insurance carriers about workplace injuries. They require essential details such as the employee’s information, the nature of the injury, and the circumstances surrounding it. The First Report of Injury typically must be filed promptly after an incident, similar to the Commission 18, ensuring that the employer is aware of the situation and can take appropriate action.

Another document akin to the Commission 18 is the Employee's Claim for Compensation form. This form is used by employees to formally claim benefits following a workplace injury. Like the Commission 18, it requires detailed information about the injury, including dates and circumstances. Both forms emphasize the importance of timely submission to protect the employee's rights and ensure that claims are processed efficiently.

The Notice of Injury form is also comparable to the Commission 18. This document is designed to inform employers about an employee's injury and initiate the claims process. It typically includes similar fields for employee and employer information, as well as specifics regarding the incident. Both forms aim to provide necessary details to facilitate communication between the employee and employer, ensuring compliance with legal requirements.

The Workers' Compensation Claim form shares a close relationship with the Commission 18. This form is often used to initiate a claim for benefits after an injury occurs. It requires comprehensive information about the incident and the injured party, paralleling the information requested on the Commission 18. Both documents are critical in establishing the basis for compensation and ensuring that the injured worker receives the necessary support.

Similar to the Commission 18, the Occupational Disease Claim form is used to report illnesses resulting from workplace conditions. This form captures the specifics of the disease, the work environment, and the employee’s medical history. Both documents are essential for establishing a claim, ensuring that employees can seek compensation for health issues related to their employment.

The Form 19, or Employer’s Report of Injury, is another document that aligns with the Commission 18. This form is submitted by employers to report an injury to the Industrial Commission. While the Commission 18 focuses on the employee's perspective, the Form 19 provides the employer's account of the incident. Both forms are necessary for a comprehensive understanding of the injury and facilitate communication between all parties involved.

The Claim for Benefits form is also similar to the Commission 18. This form is used by employees to request specific benefits after a workplace injury. It requires the same type of information regarding the injury and the employee’s work situation. Both documents are crucial for ensuring that injured workers can access the benefits they need to recover and return to work.

The Medical Report form is relevant in the context of the Commission 18 as well. This document provides detailed medical information regarding the employee’s injury or illness. While the Commission 18 serves as a notification and claim initiation, the Medical Report complements it by offering the necessary medical evidence to support the claim. Both documents work together to establish the legitimacy of the injury and the need for compensation.

Lastly, the Release of Information form can be compared to the Commission 18. This form allows healthcare providers to share medical records with the employer or insurance carrier. While the Commission 18 initiates the claim process, the Release of Information form ensures that all relevant medical information is accessible to facilitate the claims process. Both documents are essential in maintaining transparency and ensuring that injured employees receive appropriate care and compensation.

When filling out the Commission 18 form, consider the following do's and don'ts:

• Do file the form within two years of the injury or occupational disease.
• Do provide notice to your employer immediately after the accident or as soon as practicable.
• Do retain one signed copy of the form for your records.
• Do ensure the form is typed or printed clearly in black ink.

• Don't leave the "I.C. File No." section blank if you have already received it.
• Don't forget to include the specific details about your injury or occupational disease.
• Don't assume your employer's filing of a Form 19 satisfies your obligation to file a Form 18.
• Don't neglect to provide accurate contact information for yourself and your employer.

There are several misconceptions about the Commission 18 form that can lead to confusion for employees filing claims. Here are six common misunderstandings:

• The Form 18 is optional. Many people believe that filing the Form 18 is not necessary if the employer is already handling the claim. This is incorrect. The Form 18 must be filed by the employee to protect their rights, even if the employer is paying compensation.
• All claims must be filed immediately. Some think they need to file the Form 18 the moment an injury occurs. While prompt filing is encouraged, the form must be submitted within two years of the injury or occupational disease.
• It’s fine to leave the upper right corner blank. Some individuals mistakenly believe that they should fill in the upper right corner of the form. In fact, if you do not have an I.C. File Number, you should leave those spaces blank, as they are for internal use only.
• Days out of work must be consecutive. There is a belief that only consecutive days out of work count when filling out the form. However, both partial and non-consecutive days should be included in the count.
• You can’t ask for help with the insurance carrier information. Some employees think they must figure out their employer’s insurance carrier on their own. In reality, they can ask their employer, call the Industrial Commission, or leave the line blank if necessary.
• Filing the Form 18 guarantees immediate compensation. Many people assume that once they file the Form 18, they will receive compensation right away. However, the processing time can vary, and the Industrial Commission will send an acknowledgment letter after processing the form.

Understanding these misconceptions can help employees navigate the workers' compensation process more effectively.

Key Takeaways for Filling Out and Using the Commission 18 Form:

• The Commission 18 form must be filed within two years of the injury or occupational disease.
• Notify your employer immediately after the accident, or as soon as possible, and within 30 days.
• This form is also applicable for occupational disease claims, except for specific conditions like asbestosis, which require a different form.
• Keep a signed copy of the form for your records, and send copies to both the Industrial Commission and your employer.
• Do not fill in the upper right corner unless you have an I.C. File Number; it will be assigned upon receipt of your form.
• If you’re unsure about your employer’s insurance carrier, ask your employer or contact the Industrial Commission for assistance.
• When reporting days out of work, include both whole and partial days, even if they are not consecutive.
• After filing, expect an acknowledgment letter from the Industrial Commission confirming receipt of your form.