nc workers comp form 19 is the official Employer’s Report of Employee’s Injury or Occupational Disease. The employer files it with the North Carolina Industrial Commission, not the injured worker. If you were hurt at work, this form is often the first official record of your injury. It tells the state and the insurance carrier what happened, when, and to whom. Knowing how it works can help you protect your claim while you focus on healing.
What the Nc Workers Comp Form 19 Is For
The nc workers comp form 19 creates an official record of a workplace injury or illness. It covers sudden accidents, like a fall or a cut. It also covers occupational diseases that build up over time, like hearing loss or repetitive strain. The report lists your name, your job, the date, and a short description of what happened. As a result, the Commission and the insurer can open a file and start looking at your case.
It helps to know what this form is not. In most cases, the employer’s report does not start a formal claim for you. North Carolina has a separate form the injured worker files. Many workers assume the employer’s report is enough. Typically, it is not. Learn more in our guide on how to file a North Carolina workers comp claim.
| Item | Details |
|---|---|
| Form number | Form 19 |
| Form title | Employer’s Report of Employee’s Injury or Occupational Disease |
| Who files | The employer |
| Where filed | North Carolina Industrial Commission |
| Fee | Not listed in our verified sources. Confirm with the Commission. |
| Official PDF | Download the official Form 19 PDF |
Who Files the Nc Workers Comp Form 19 and When
The employer files the nc workers comp form 19. In practice, a supervisor, HR staff member, or the insurance carrier may help fill it out. Still, the legal duty rests with the employer. You do not sign it as the person filing. However, you can ask for a copy. That way, you can check that the facts are right.
Your part comes first. You need to tell your employer about the injury as soon as you can. Written notice is best. For example, a short email or letter that says what happened, where, and when. Keep a copy for yourself. Prompt notice helps your employer meet its own deadline. It also helps protect your right to benefits.
What if your employer does not file? Typically, that does not end your claim. You can still file your own claim with the Commission. You can also contact the Commission directly. Our page on North Carolina workers comp requirements explains which employers must carry coverage.
How to Fill It Out and Where to Send It
The nc workers comp form 19 asks for a few main groups of facts. First, it covers the employer and the insurance carrier. Next, it covers the employee, such as name, address, job title, and wages. Then it covers the injury itself. That includes the date, the place, the body part, and how it happened. Finally, it asks about time lost from work and medical care.
Small mistakes can cause big delays. Common problems include a wrong date of injury, a missing body part, or a vague description. Missing wage details are another common issue. Wages matter because they help set your weekly benefit. For example, if overtime is left out, your benefit could be figured too low. As a result, it is worth asking your employer to show you the completed report.
You can get the official form from the Commission. Use the North Carolina Industrial Commission forms page to find the current version. You can also go straight to the official nc workers comp form 19 PDF. In most cases, employers and insurers send the report to the Commission through its filing systems. The forms page explains the current filing options. Always use the latest version, because older copies may be rejected.
What Happens After You File
Once the Commission receives the nc workers comp form 19, it opens a record for the injury. The insurer then reviews the case. Typically, the insurer will either accept the claim, deny it, or take more time to look into it. You should get written notice of that decision. If the claim is accepted, weekly wage benefits and medical care may begin. If it is denied, you have the right to challenge that decision.
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Keep copies of everything. That includes your injury notice, medical records, and any letters from the insurer. If you have questions, contact the North Carolina Industrial Commission. Our guide to the North Carolina workers comp board explains how the Commission works and how to reach it. Remember, every case is different. Confirm any deadline with the Commission and a licensed attorney.
Frequently Asked Questions
Do I need to fill out the nc workers comp form 19 myself?
No. The employer files the nc workers comp form 19. However, you should still report your injury in writing and file your own claim with the Commission. The employer’s report does not take the place of your claim.
What if my employer refuses to file the nc workers comp form 19?
You still have options. You can file your own claim with the North Carolina Industrial Commission. You can also contact the Commission to report that your employer has not filed. Confirm your next steps with the Commission and a licensed attorney.
Can I get a copy of the nc workers comp form 19 my employer filed?
In most cases, yes. Ask your employer or the insurer for a copy. Check that the date, body part, description, and wages are correct. If something is wrong, tell them in writing right away.
Nc workers comp form 19: Quick Recap
If you remember one thing about nc workers comp form 19, make it this: the rule is set by the state (or the federal program), not by the insurer, and the official source is linked above. Every figure on this page about nc workers comp form 19 should be confirmed with the agency before you act on it.
Questions about nc workers comp form 19 that this page does not answer are usually answered for free by the state workers’ comp agency’s information line — and, for a disputed claim, by a licensed attorney in a first consultation.
See your state’s exact numbers
What you are owed depends on your state’s benefit caps and deadlines. Start with your state’s settlement and claim guides for the exact figures.
Sources & How to Verify
The figures on this page come from official government and industry sources. Workers’ comp benefit caps, deadlines, and rules change, so always confirm the exact figure with your state’s workers’ comp board or a licensed attorney before acting. Settlement estimates are illustrative, and every case is different.
- Your state workers’ comp board, division, or commission: the official source for your state’s exact caps, deadlines, and forms — search “[your state] workers compensation board”
- U.S. Department of Labor (OWCP): dol.gov — federal workers’ compensation overview
- NCCI: ncci.com — workers’ comp rating and benefit data
- Social Security Administration: ssa.gov — benefit-cap and SSDI offset data
- Insurance Information Institute: iii.org — neutral workers’ comp background
Content last reviewed October 2026. If you notice an outdated figure, please contact us.
Related Guides
- North Carolina Workers Comp Board
- How to File a North Carolina Workers Comp Claim
- North Carolina Workers Comp Requirements
- Workers Comp Settlements by State (All 50)
- Workers Comp Claims by State (All 50)
- More in This Category
- Settlements by Injury
- Benefits Explained
- Workers Comp Glossary
Informational only — not legal, medical, or financial advice. Workers Comp Explained is an independent educational resource, not a law firm, insurer, or medical or financial advisor, and this page does not provide legal, medical, or financial advice. Workers’ compensation benefits, deadlines, and rules vary by state and change over time, and settlement estimates are illustrative only. Always confirm the exact figure and any deadline with your state’s workers’ compensation board and a licensed attorney before you act.