Employers Report Of Employees Injury Or Occupational Disease To The Industrial Commission {19}

FORM 19 - EMPLOYER’S REPORT OF EMPLOYEE’S INJURY OR OCCUPATIONAL DISEASE TO THE INDUSTRIAL COMMISSION. This form is used by employers in North Carolina to report a work-related injury or occupational disease to the North Carolina Industrial Commission. Form 19 is required under the Workers’ Compensation Act and must be filed by the employer through its insurance carrier or claims administrator within five days of learning of the injury or disease. The form captures detailed information about the employer, employee, insurance coverage, wages, and how the injury or occupational disease occurred. It also includes return-to-work details, medical treatment information, and special sections for fatal cases and OSHA-related data. A completed copy must be provided to the employee along with a blank Form 18, which the employee must file separately to make a workers’ compensation claim. www.FormsWorkflow..