North Carolina Industrial Commission Form 23 is the Application to Reinstate Payment of Disability Compensation. The NCIC requires this form to be used when payment from the employer to the employee in a workers’ compensation case has stopped, and the employee wants to reestablish a payment schedule with their employer. The form has two sections; one must be completed by the employee, and the other must be completed by the employer.
In the section to be filled out by the employee, you must record the nature of your original injury and the history of the case so far. This includes payments already received and which forms have been filed to establish original compensation. You must also state the reason you are seeking further payments from your employer.
The section that is to be completed by the employer can be filled out in one of two ways—If the request to reinstate payments is not being contested, then the employer must record the amount of the new payments and the date on which they will resume. If the employer does choose to contest the employee’s request for new payments then they must state their reason on this form. The employer must also provide a contact phone number so that the North Carolina Industrial Commission may conduct and informal phone interview to discuss why they have declined to reinstate payment.