When you are involved in an accident that occurs on the job, there are a number of necessary worker’s compensation forms that need to be completed and then submitted to the appropriate office. One of these forms is called Form 30D.
A Form 42 is an application for Appointment of Guardian Ad Litem, a person the court appoints to represent the best interests of a child or someone who is incompetent in a case. This form is used when a plaintiff in a case is an infant or an incompetent person that has no general or testamentary guardian (A person named in a will to serve as a guardian).
In the state of North Carolina, the average weekly wage is controlled by North Carolina General Statute 97-2(5). There are several methods used to determine the average weekly wages. The most common method to calculate the wages are to use your wages earned for the prior year divided by the number of weeks that you have worked. Wages earned will include overtime, tips, bonuses, per diem income and housing income.
When you are involved in an accident that occurs on the job, there are a number of necessary Worker’s Compensation forms that need to be completed and then submitted to the appropriate office. One of these forms is called a 25P. Form 25P is also referred to as an “Itemized Statement of Charges for Drugs.”
This form is needed to obtain reimbursement for prescription or medical supply expenses related to the on the job injury and is also required under the Provisions of the Workers’ Compensation Act.
The form must be completed in its entirety and prescription and/or medical supply receipts must be attached. The completed form and the receipts should then be sent to the workers’ compensation adjuster or your workers’ compensation attorney who can provide them to the adjuster. The adjuster will then issue you a reimbursement check.
Form MSC7 is the report of the Evaluator in a workers compensation case in North Carolina. An Evaluator is usually a neutral person who meets with the plaintiffs and defendants in a workers compensation case in a neutral evaluation conference.
The Evaluator will usually conducts an informal presentation of facts from both parties about the case and evaluate the weaknesses and strengths of each party in the case and provide an assessment of the settlement value and possible liabilities of the parties in the case.
Unlike a mediator, whose duties are to bring the parties to a resolution of the case, the Evaluator states the strengths and weaknesses of each party so the parties may get an unbiased opinion of the possible outcome of a case if the case proceeded to the North Carolina Industrial Commission.
At the completion of the neutral evaluation conference, the Evaluator will file form MSC7 with the Industrial Commission reporting the results of this conference and the Evaluator’s fees earned. This form will report, among other things, when and where the conference was held, names of the parties and attorneys at the conference, whether or not the parties reached an agreement. If not all issues reached an agreement, the issues in which an agreement was not agreed upon. This report must be mailed to the Industrial Commission within seven days of the conclusion of the neutral evaluation conference.
North Carolina Industrial Commission Form MSC8 is a mediated or compromised settlement agreement. This mediated settlement agreement sets forth the terms of the settlement agreement in a workers’ compensation case in North Carolina. The agreement stipulates certain agreed upon facts of the case which may include, but is not limited to, the following topics:
1) Whether the Defendants admit or deny compensability of Plaintiff’s claim.
2) Employment status of the worker. For example, has the worker returned to work, or is the worker still out of work due to the injuries?
3) Compromise settlement agreement states the total sum in dollars paid to the worker for the injuries. In other words, the dollar amount settled in this case.
4) The fourth section talks about the injured worker’s ability to receive disability benefits until this settlement agreement is approved by the North Carolina Industrial Commission.
5) This section deals with medical payments. Is the injured worker aware if there is a settlement agreement, he or she may be responsible for all future medical expenses pertaining to this case? When signing a compromised settlement agreement the Plaintiff acknowledges they will no longer have their medical expenses covered by the Defendants.
6) The sixth section discusses potential liens. It explains the Plaintiff has not put the Defendants on notice of any liens against the settlement proceeds and explains the Defendants will not be responsible for any liens.
7) This section deals with other interest. Basically the parties agree that this is a fair settlement.
8) The eighth section pertains to third-party claims. For example, health insurance claims.
9) This section deals with the mediator’s fees. Most of the mediator fees are paid by the Defendants if a settlement is reached at mediation.
10) This section pertains to the fact that only written promises in this agreement will be relied upon by the Plaintiff, or injured worker. No oral or verbal promises will be relied upon by the Plaintiff. In other words, unless it is in writing, no promises have been made.
11) The final section explains that all parties are bound by the language in the settlement agreement.
Eventually, the Plaintiff / Worker’s attorneys, the Plaintiff / Worker, the Defendants’ attorneys, and the mediator signs this agreement binding all parties to the terms of the agreement. It is important that you carefully go over Form MSC8 or Mediated Settlement Agreement because it contains the final language of your settlement agreement with the Defendants.