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Common mistakes

Completing the North Carolina 60 form can be a straightforward process, but several common mistakes can lead to complications. One frequent error occurs when individuals fail to provide accurate information regarding the employee's name and Social Security number. These details are crucial for the identification of the employee and for processing the claim. A simple typo or omission can delay the claim significantly.

Another common mistake is neglecting to specify the body part or condition involved in the injury. The form requires a clear description of the injury or occupational disease, including the specific body parts affected. Failing to include this information can result in misunderstandings about the nature of the claim and may lead to denial of benefits.

Many people overlook the importance of providing the correct dates on the form. The date of the injury or the onset of the occupational disease must be clearly stated. Additionally, the date when compensation commenced is equally important. Inaccurate dates can create confusion and may hinder the timely processing of the claim.

Individuals often miscalculate the average weekly wage, which is a critical component of the compensation calculation. It is essential to include all relevant earnings, such as overtime and allowances, to ensure that the compensation rate is accurate. Misrepresentation of this figure can lead to either underpayment or overpayment, both of which can create legal issues.

Another mistake is failing to sign the form. The signature of the employer or carrier/administrator is required to validate the admission of liability. Without this signature, the form is incomplete and cannot be processed. It is important to double-check that all necessary signatures are present before submission.

Lastly, many individuals do not provide a copy of the completed form to the employee or their attorney, as required. This oversight can lead to a lack of communication and understanding regarding the claim. Ensuring that all parties receive the necessary documentation helps maintain transparency and can prevent disputes later on.

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Similar forms

The North Carolina Form 28B serves a similar purpose to the North Carolina Form 60 in the context of workers' compensation. This form is used by employers to report compensation and medical benefits that have been paid to an employee following a work-related injury. Like the Form 60, it requires detailed information about the employee, the nature of the injury, and the compensation provided. Both forms are essential for maintaining accurate records and ensuring compliance with state laws regarding workers' compensation.

The Form 30 is another document that parallels the North Carolina Form 60, particularly in cases involving fatal work-related injuries. This form is used to report a compensable injury that results in the death of an employee. It outlines the circumstances of the incident and the compensation due to the dependents of the deceased. Both forms highlight the employer's acknowledgment of liability and the need to provide necessary compensation, although the Form 30 focuses specifically on death claims.

Form 19, the Employer's Report of Injury to Employee, is also similar to the Form 60. This document is typically filed by the employer to report an injury that has occurred in the workplace. It includes information about the employee, the nature of the injury, and the circumstances surrounding it. While Form 60 admits liability and outlines compensation, Form 19 serves as an initial report that helps initiate the claims process.

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The Form 18, which is the Employee's Notice of Accident to Employer, shares similarities with the Form 60 as it is crucial for the claims process. This form is filled out by the employee to notify the employer about a work-related injury. It includes information about the employee, the injury, and the circumstances of the accident. Both forms are integral to ensuring that the claims process is initiated correctly and that all parties are informed of the situation.

Form 21, the Agreement for Compensation for Disability, is another document that aligns with the North Carolina Form 60. This form is used when the employer and employee agree on the compensation amount for a work-related injury. It formalizes the agreement and ensures that both parties understand the terms of compensation. While Form 60 admits liability, Form 21 solidifies the agreement on compensation, making both forms important in the claims process.

The Form 26, which is a Notice of Change of Compensation, is similar in that it is used to communicate changes in the compensation being paid to an employee. This form is crucial when there are adjustments to the benefits due to changes in the employee's condition or work status. Both the Form 60 and Form 26 serve as official documents that help maintain clarity and transparency in the compensation process.

Form 28, the Employer's Report of Compensation and Medical Compensation Paid, is comparable to the Form 60 as it provides a detailed account of the compensation and medical benefits paid to the employee. This form is essential for tracking the payments made and ensuring compliance with workers' compensation laws. Both forms aim to provide a clear record of what has been paid and what is owed to the employee.

The Form 30R, which is a Request for Hearing, is another document that shares a connection with the Form 60. While Form 60 admits liability, the Form 30R is used when there is a dispute regarding compensation or benefits. This form initiates a formal hearing process to resolve disagreements. Both forms play critical roles in the workers' compensation system, ensuring that employees receive the benefits they are entitled to while also providing a mechanism for dispute resolution.

Form 33, the Request for Hearing on Claim, is similar in function to the Form 30R. This form is filed when an employee seeks a hearing regarding their claim for benefits or compensation. It serves as a formal request to the Industrial Commission to review the case. Both Form 33 and Form 30R are essential for addressing disputes and ensuring that employees have a fair opportunity to present their claims.

Lastly, the Form 60 is akin to the Form 19B, which is the Employer's Report of Work-Related Injury for Occupational Diseases. This form is used to report cases of occupational diseases, similar to how Form 60 addresses injuries. Both documents require detailed information about the employee and the conditions related to the claim. They are vital for ensuring that employees receive appropriate compensation for their work-related health issues.

Key takeaways

Here are key takeaways about filling out and using the North Carolina 60 form:

  1. Purpose: The North Carolina 60 form is used by employers to admit an employee's right to compensation under the Workers' Compensation Act.
  2. Employer Information: Include the employer's name, address, and Federal Employer Identification Number (FEIN) on the form.
  3. Employee Details: Provide the employee's name, Social Security Number, and contact information.
  4. Injury Description: Clearly describe the body part(s) or condition(s) for which compensation is being admitted.
  5. Compensation Dates: Indicate the date of the injury or occupational disease and when compensation began.
  6. Average Weekly Wage: Report the employee's average weekly wage, including overtime and allowances, to determine the compensation rate.
  7. Payment Information: Specify if temporary total or partial compensation is being paid, along with relevant amounts.
  8. Filing Requirements: Submit the form to the Industrial Commission and provide copies to the employee and their attorney, if applicable.
  9. Penalties: Failure to file Form 28B within 16 days after the last payment may result in penalties for the employer or carrier.
  10. Contact Information: For questions, contact the North Carolina Industrial Commission at (919) 807-2500 or visit their website.

Frequently Asked Questions

What is the North Carolina 60 form?

The North Carolina 60 form, also known as the Employer’s Admission of Employee’s Right to Compensation, is a document required under the Workers' Compensation Act. It is used by employers to formally acknowledge an employee's entitlement to compensation for work-related injuries or occupational diseases.

Who needs to fill out the North Carolina 60 form?

The employer or their insurance carrier must complete the North Carolina 60 form when an employee sustains an injury or develops an occupational disease that is compensable under the Workers' Compensation Act.

What information is required on the form?

The form requires several key pieces of information, including:

  • Employer's name and contact information
  • Employee's name, Social Security number, and date of birth
  • Details of the injury or occupational disease, including dates and body parts involved
  • Average weekly wage and compensation rates
  • Dates when disability began and when compensation commenced

What happens if the employer does not file the form?

If the employer fails to file the North Carolina 60 form, they may be subject to penalties as outlined in N.C. Gen. Stat. §97-18(h). This can include financial penalties and complications in the claims process.

When should the North Carolina 60 form be submitted?

The form should be submitted promptly after the employer admits liability for the employee's injury or occupational disease. It is important to provide this form to the Industrial Commission and the employee in a timely manner.

Can the employee dispute the information on the form?

Yes, the employee has the right to dispute any information provided on the North Carolina 60 form. If there are discrepancies regarding the injury, compensation, or any other details, the employee can address these issues through the appropriate channels.

Is there a deadline for filing the form?

While the North Carolina 60 form itself does not have a specific deadline, it is crucial for employers to act quickly. Additionally, employers must file Form 28B, Report of Compensation and Medical Compensation Paid, within 16 days after the last payment to avoid penalties.

What should be done with the completed form?

Once completed, the original North Carolina 60 form must be submitted to the Industrial Commission. A copy should also be provided to the employee and their attorney, if applicable.

Where can I find more information about the North Carolina 60 form?

Additional information about the North Carolina 60 form and the Workers' Compensation process can be found on the North Carolina Industrial Commission's website at http://www.ic.nc.gov/ .

What if the employer is self-insured?

If the employer is self-insured, they must still complete the North Carolina 60 form and submit it to the Industrial Commission. The process remains the same as with an insured employer.

Instructions on How to Fill Out North Carolina 60

Once you have gathered the necessary information, you can begin filling out the North Carolina 60 form. This form is essential for documenting the employer's admission of an employee's right to compensation under the Workers' Compensation Act. Follow these steps carefully to ensure accurate completion.

  1. Begin by entering the IC File # and Emp. Code # at the top of the form.
  2. Fill in the Carrier Code # and Carrier File # as applicable.
  3. Provide the Employer FEIN (Federal Employer Identification Number).
  4. Enter the Employee’s Name and Employer’s Name.
  5. List the Employer’s Telephone Number and Address, including City, State, and Zip.
  6. Fill in the Insurance Carrier Policy Number and the Carrier’s Address with City, State, and Zip.
  7. Provide the Home Telephone and Work Telephone numbers.
  8. Enter the Carrier’s Telephone Number and Fax Number.
  9. Input the Employee’s Social Security Number, Sex, and Date of Birth.
  10. In the section for defendants, describe the body part(s) or condition(s) for which you are admitting liability and compensability.
  11. Indicate the date of the injury by accident or occupational disease and specify the body part(s) or condition(s) involved.
  12. For informational purposes, complete items 1 through 4 regarding the injury or occupational disease description, payment status, average weekly wage, and compensation details.
  13. Sign and date the form in the designated area for the Employer or Carrier/Administrator.

After completing the form, ensure that a copy is provided to the employee and their attorney, if applicable. The original form should be submitted to the Industrial Commission at the specified address. Following these steps will help ensure compliance with the necessary requirements.

Form Attributes

Fact Name Details
Purpose of Form The North Carolina 60 form is used by employers to admit an employee's right to compensation for work-related injuries or occupational diseases.
Governing Law This form is governed by the North Carolina Workers' Compensation Act, specifically G.S. §97-18(B).
Submission Requirements A copy of the completed Form 60 must be provided to the employee and their attorney, if applicable, while the original is sent to the North Carolina Industrial Commission.
Filing Penalties Failure to file Form 28B within 16 days after the last payment can result in penalties as outlined in N.C. Gen. Stat. §97-18(h).
Contact Information The form must be mailed to the North Carolina Industrial Commission at 4335 Mail Service Center, Raleigh, North Carolina 27699-4335. Contact can be made via main telephone at (919) 807-2500 or helpline at (800) 688-8349.
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