Notice To The Commission Of Assignment Of Rehabilitation Professional {25N}

FORM 25N - NOTICE TO THE COMMISSION OF ASSIGNMENT OF REHABILITATION PROFESSIONAL. This is a required form under the North Carolina Workers' Compensation Act, used to notify the North Carolina Industrial Commission when a qualified rehabilitation professional has been assigned to manage an injured worker’s case. This form is typically submitted by the insurance carrier, self-insured employer, or third-party administrator handling the workers’ compensation claim. It identifies the rehabilitation professional (RP) assigned to the case, verifies that the RP meets the qualifications outlined in Rule 11 NCAC 23C .0105, and states whether the case involves field/on-site case management or telephonic case management. The form also specifies the purpose of the assignment—such as medical case management or vocational rehabilitation—and includes details about the employee, employer, insurance carrier, injury type, and date of injury. By completing this form, the assigning party confirms the RP’s credentials and formally introduces them into the claim process. The RP’s involvement helps ensure coordinated medical treatment and may also assist the injured worker in returning to suitable employment. A copy of the form must be sent to the employee’s attorney, if represented, and filed with the Commission electronically. www.FormsWorkflow.com