Fillable North Carolina 60 Template

What is the North Carolina Form 60?

The North Carolina Form 60 is a document that plays a crucial role in the workers' compensation claims process. Formally known as the "Employer’s Admission of Employee’s Right to Compensation," it is utilized by employers or their insurance carriers to officially acknowledge an employee's entitlement to workers' compensation benefits. This admission covers injuries by accident or occupational diseases that occur in the course of employment, specifying the body parts or conditions for which the employer admits liability and compensability. It's a mandatory form required under the provisions of The Workers' Compensation Act (G.S. §97-18(B)) in North Carolina.

When should Form 60 be filed?

Form 60 should be filed promptly after the employer or insurance carrier has made a determination to accept the employee's claim for workers' compensation benefits as compensable. This form plays a critical part in the process, as it not only acknowledges the employee's right to compensation but also starts the benefits. It is important for employers to file this form without undue delay to comply with state regulations and to ensure that the injured worker begins receiving benefits in a timely manner.

Who is responsible for filing Form 60?

Typically, the responsibility for filing Form 60 falls on the employer or their insurance carrier/administrator. It's their duty to complete the form with accurate details regarding the compensation and benefits owed to the employee due to the workplace injury or occupational disease. Once filled out, the form should be provided to the employee and, if applicable, their attorney. The original copy must then be sent to the North Carolina Industrial Commission (NCIC) for processing.

What information is required on Form 60?

The form calls for detailed information about the employer, the employee, and the injury or disease, including:

• Employer's and employee's names and contact information
• Details of the insurance carrier
• A description of the injury/disease, including the body parts or conditions involved
• Information regarding the employee's average weekly wage, compensation rate, and type of compensation being paid
• Dates marking the beginning of the disability and the commencement of compensation

What are the consequences of not filing Form 60?

Failing to file Form 60 correctly and on time can have significant consequences. Employers or carriers/administrators may face penalties as stipulated by N.C. Gen. Stat. §97-18(h) for not complying with the regulations set out by the North Carolina Industrial Commission. Beyond monetary penalties, delayed filing can also result in delayed compensation for the injured worker, potentially causing financial difficulties and dissatisfaction. Thus, timely and proper filing is essential for compliance and maintaining a positive relationship between employers and their employees.

Where can I find Form 60 or get assistance with it?

Form 60 can be obtained from the North Carolina Industrial Commission's website at http://www.ic.nc.gov/. For individuals seeking assistance with the form, or if there are any questions regarding its completion or the filing process, the NCIC offers resources and guidance. One can contact the NCIC's main telephone number at (919) 807-2500 or use their helpline at (800) 688-8349 for further support.

Filling out the North Carolina 60 form, otherwise recognized as the Employer’s Admission of Employee’s Right to Compensation, mandates scrupulous attention to specificity and accuracy. However, individuals commonly encounter pitfalls that could compromise the process, leading to delays or discrepancies in compensation claims. Enumerated below are prevalent mistakes made during this critical documentation exercise:

1. Incomplete Information: Often, entries on the form are left blank. It's crucial that every section is filled out comprehensively to avoid unnecessary processing delays.
2. Incorrect Employer FEIN: The Employer's Federal Employer Identification Number (FEIN) must be correctly noted. Mismatch or inaccuracies here can confuse the identity of the employing entity.
3. Employee Details Errors: Mistakes in the employee’s name, Social Security Number, or contact information not only lead to difficulties in claim processing but also potential identity discrepancies.
4. Incorrect Dates: Frequently, the date of the injury or occupational disease onset is incorrectly reported or vaguely defined. Precision with these dates ensures the timely and appropriate adjudication of the claim.
5. Vague Description of Injury or Disease: A common oversight is providing a broad or unclear description of the injury or occupational disease. Precise details including the body part(s) affected are imperative for clear understanding and assessment.
6. Misreported Compensation Rate: Listing an incorrect weekly compensation rate, or failing to include overtime and allowances, can significantly affect the benefits owed to the employee.
7. Inaccurate Disability Information: Misstating the commencement date of disability or the nature of compensation paid can lead to incorrect payment amounts and scheduling.
8. Failure to Sign and Date: Overlooked by some, the omission of a signature and date at the bottom of the form renders it incomplete and unofficial.
9. Not Distributing Copies Appropriately: A final but often neglected step is ensuring that a copy of the completed form is provided to the employee, any attorney of record, and the original to the Industrial Commission. Ignoring this can lead to communication breakdowns and procedural delays.

Falling into these common errors can impede the swift and orderly processing of compensation claims. Hence, a thorough review and double-checking of details entered in the North Carolina 60 form are advised to secure an efficient and successful outcome for all parties involved.

The North Carolina Form 60 is a crucial document in the realm of workers' compensation, indicating an employer's admission of an employee’s right to compensation following an injury or occupational disease. This admission is a pivotal moment in the claims process, setting the stage for the employee's entitlement to benefits. Alongside Form 60, various other documents play integral roles within the context of North Carolina's Workers' Compensation Act. These forms facilitate communication, ensure compliance, and help administer the benefits properly. Below is an outline and brief description of some of these additional forms and documents.

• Form 18: Notice of Accident to Employer and Claim of Employee, Representative, or Dependent for Workers' Compensation - This form is filed by the employee, representative, or dependent to notify the employer of an accident or occupational disease and to formally claim workers' compensation benefits.
• Form 19: Report of Employee's Injury or Occupational Disease to the Industrial Commission - Employers use this form to report an employee's injury or occupational disease to the North Carolina Industrial Commission.
• Form 28B: Report of Compensation and Medical Compensation Paid - This document is submitted by the employer or insurance carrier to report compensation and medical bills paid, as mentioned in the overview of the Form 60, and is necessary to avoid potential penalties.
• Form 25T: Itemized Statement of Charges for Travel - Employees use this form to request reimbursement for travel expenses related to medical treatment for their injury or disease.
• Form 22: Statement of Days Worked and Earnings of Employee - This form provides a detailed account of the days worked and earnings of an injured employee, aiding in the calculation of compensation rates.
• Form 26: Agreement for Compensation for Disability - Employers and employees use this form to agree upon compensation for an employee's temporary total disability or permanent partial disability resulting from a work-related injury or disease.
• Form 33: Request that Claim be Assigned for Hearing - When there's a dispute about a claim that cannot be resolved through negotiation, this form is used to request a hearing before the Industrial Commission.
• Form 30: Agreement for Compensation for Death - This form is an agreement for compensation payable to the dependents of an employee whose death results from a compensable injury or occupational disease.
• Form 24: Application for Approval of a Lump Sum Award - This application is used when an employer or employee wishes to settle a part or all of a compensation claim in a lump sum, subject to the approval of the Industrial Commission.

Understanding these forms, in conjunction with the North Carolina Form 60, offers a comprehensive view of the paperwork involved in the workers' compensation process. Each form serves a distinct purpose, contributing to the efficient handling of claims, from the initial notice of an injury to the final settlement of compensation. Adequately managing and submitting these forms ensures that the rights and obligations of both employers and employees are properly addressed within the framework of North Carolina’s Workers' Compensation Act.

The North Carolina Form 18, also known as the "Notice of Accident to Employer and Claim of Employee, Representative, or Dependent" is similar to Form 60 in its fundamental purpose of dealing with worker's compensation claims. While Form 60 is an employer's acknowledgment of an employee's entitlement to worker's compensation benefits, Form 18 serves as the initial notice that an employee or their representative must provide to both the employer and the North Carolina Industrial Commission to officially start the claim process. Both forms are crucial steps within the North Carolina Workers' Compensation Act process, intended to ensure that employees receive appropriate benefits for workplace injuries or illnesses.

Form 19, titled "Report of Employee's Injury or Occupational Disease to the North Carolina Industrial Commission", mirrors the function of Form 60 by facilitating communication regarding an employee's injury or illness. However, Form 19 is specifically designed for employers to report an injury or occupational disease to the Industrial Commission, making it a necessary preceding step before the employer can submit Form 60. This reporting form collects detailed information about the incident, similar to the detailed admission of liability required on Form 60, and ensures that the injury or disease is officially documented from the employer's perspective.

The Agreement for Compensation for Disability, known as Form 21, is related to Form 60 in its role within the compensation process but focuses on the agreement between the employer (or insurance carrier) and the employee regarding compensation for a disability resulting from a work-related injury. It similarly requires detailed information about the injury and compensation to be provided. While Form 60 signifies an employer's initial admission of liability, Form 21 is used when there's an agreement on the degree of disability and amount of compensation, marking a step towards the resolution of the claim.

The North Carolina Industrial Commission's Form 28B, or "Report of Compensation and Medical Compensation Paid," also ties closely to the process initiated by Form 60. After acknowledging an employee's right to compensation through Form 60, employers or carriers must eventually complete Form 28B to report the compensation and medical bills paid under the claim. This form serves as a means to document the financial aspects of the claim outcome and ensure compliance with the Workers' Compensation Act's requirements, following the liability admission made on Form 60.

Lastly, Form 30, the "Agreement for Compensation for Death", parallels Form 60 in its purpose within the realm of workers' compensation but is specifically tailored to cases resulting in the death of the employee. Similar to how Form 60 is used to admit liability for an injury, Form 30 is utilized to agree on compensation for the dependents of a deceased employee. It highlights the importance of documenting agreements and rights to compensation not just for injuries but also for the gravest of outcomes under the Workers' Compensation Act.

When filling out the North Carolina Form 60, it is essential to be aware of the actions that can aid in the accurate and effective completion of the form, as well as those that may hinder the process. Here are seven crucial dos and don'ts to consider:

• Ensure accuracy in the description of the injury or occupational disease. Specify the body parts involved or the nature of the disease accurately, as this is critical for the employee’s claim.
• Verify the employee's average weekly wage carefully, including overtime and all allowances. This calculation is essential for determining the correct compensation rate.
• Provide clear communication to the employee regarding their rights and the details of the compensation admitted through the completion of Form 60.
• Sign and date the form to confirm the authenticity of the information provided and the acknowledgment of the employer’s admission of the employee’s right to compensation.
• Provide copies of the completed Form 60 to the employee and their attorney of record, ensuring that all parties are informed.
• Submit the original Form 60 to the Industrial Commission promptly to avoid any delays in the employee’s compensation process.
• Consult with legal guidance if there are uncertainties or complex issues relating to the compensation admission process to ensure compliance with the Workers' Compensation Act.

• Delay the filing of Form 60. Timeliness in submitting this form is crucial for the commencement of benefits to the injured employee.
• Omit relevant details about the injury or disease, including specific body parts affected. Incomplete descriptions may lead to unnecessary complications or disputes.
• Miscalculate the average weekly wage. Incorrect calculations can adversely affect the compensation rate and, therefore, the employee’s benefits.
• Forget to provide the form to all relevant parties. The employee, their attorney, and the Industrial Commission must all receive the appropriate copies of Form 60.
• Overlook the signature and date, as an unsigned or undated form may be considered invalid, delaying the compensation process.
• Ignore the need for legal advice when faced with complex situations during the admission process. Professional advice can help avoid mistakes and ensure compliance.
• Assume the form's completion is the end of the employer’s responsibility. Follow-up may be necessary, including additional documentation and compliance with any subsequent requests from the Industrial Commission.

The North Carolina Form 60 plays a critical role in the workers' compensation claims process, yet it is often surrounded by misconceptions. Understanding these misconceptions is essential for both employers and employees to navigate their rights and responsibilities effectively under the Workers' Compensation Act. Here are six common misconceptions about the North Carolina Form 60:

• Form 60 automatically grants benefits to the employee. While Form 60 is an admission of an employee's right to compensation, it is not an automatic guarantee of benefits. The form is a step in the process, requiring further actions and approvals before compensation is finalized.
• Any injury or condition can be listed on Form 60. The use of Form 60 is specific to injuries by accident or occupational diseases that are considered compensable under the North Carolina Workers' Compensation Act. It requires detailing the body part(s) or condition(s) for which liability and compensability are admitted.
• Employers can delay filing Form 60 without consequence. Timeliness is crucial in the workers' compensation claims process. Employers or carriers/administrators have specific filing deadlines to adhere to. Failure to timely file Form 60, and subsequent forms like Form 28B, can result in penalties under N.C. General Statute §97-18(h).
• Form 60 covers injuries resulting in death. For compensable injuries resulting in an employee's death, Form 30 must be used instead of Form 60. This distinction ensures that claims involving fatalities are processed with the appropriate considerations and documentation.
• Form 60 is solely for the employer's or insurance carrier's benefit. While it is the responsibility of the employer or insurance carrier to complete and file Form 60, it is equally beneficial to employees. It officially recognizes their right to compensation for a workplace injury or disease, setting the stage for receiving benefits.
• The information provided in Form 60 is final and cannot be disputed. While Form 60 includes admissions by the employer regarding the employee’s injury and compensation rights, the particulars of the injury, compensation rates, and other details are subject to verification and potentially, dispute. Both employers and employees can seek clarification or challenge aspects of the claim as it progresses through the workers' compensation system.

Understanding these misconceptions is pivotal for all parties involved in the workers' compensation process in North Carolina. Accurate knowledge guides proper action, ensuring that rights are protected, responsibilities are fulfilled, and the process proceeds as smoothly as possible.

Filling out and using the North Carolina Form 60 is a crucial step in handling workers' compensation claims. This document, required by the Workers' Compensation Act, facilitates the process for both employers and employees. Here are the key takeaways about this important form:

• The purpose of Form 60 is for an employer to officially acknowledge an employee's right to workers' compensation due to an injury or occupational disease.
• Form 60 is mandatory under North Carolina law, specifically referenced under G.S. §97-18(B), ensuring that workers' compensation claims proceed under the provisions of the Act.
• Details such as the employer and employee's name, contact information, and the insurance carrier's details must be accurately filled in to avoid processing delays.
• The form requires a precise description of the injury or occupational disease, including the specific body parts affected, to clarify the scope of the employer's admission of liability.
• It also provides a section to note whether the employee was paid for the full day of the injury and details regarding the employee’s average weekly wage, which affects the calculation of compensation rates.
• Employers or their carrier/administrator must sign the form to validate the admission of the employee’s right to compensation and include the date of the signature.
• Failure to submit a completed Form 28B, Report of Compensation and Medical Compensation Paid, within 16 days after the last payment as per an agreement or award can result in penalties for the employer or carrier/administrator as outlined in N.C. Gen. Stat. §97-18(h).
• A copy of Form 60 must be provided to the employee and, if applicable, the employee's attorney of record. The original form should be sent to the Industrial Commission using the provided address, ensuring full compliance with the Act’s requirements.

Proper completion and timely submission of Form 60 are vital steps in ensuring that the rights and obligations of both parties under North Carolina's Workers' Compensation Act are recognized and adhered to.