Workers’ Compensation Claim Kit – North Carolina

Who will handle your claims?
The Orlando Claim Office will handle your North Carolina claims, located at:

PO Box 14139
Lexington, KY 40512

Phone: 800-423-3060
Rose Powell, Manager
Mike Rumberger, Manager

How to report Workers’ Compensation claims?

To report via the Internet: Log on to the Crum & Forster website at Use your assigned User ID and Password. If you do not have a current User ID, please contact your local Crum & Forster Claims or Marketing resource.

To report e-mail:
To report via fax: 1-877-622-6218
To report claims via telephone: 1-800-690-5520

(7 day/24 hour toll free reporting line for all states)

  • In the event of a serious or fatal injury, notify the local claim office immediately by telephone.

What are the Reporting Requirements? What forms does the employer need to be aware of?

Form 17- Workers Compensation Notice
Prominently display the notice where each employee is likely to see the notice on a regular basis. The North Carolina posting notices are available on the Crum & Forster website. Notices should be displayed in English and Spanish.

Form 18 – Notice of Accident to Employer and Claim of Employee, Representative, or Dependent
The injured worker is required to report the injury to the employer, in writing, immediately and in any event within 30 days. The original of Form 18 should be mailed to the N.C. Industrial Commission and the first copy of Form 18 mailed certified, return receipt requested to the employer.

NC-Form 18a-10.17

Form 19 – Employer’s Report of Employee’s Injury or Occupational Disease to the Industrial Commission: If you report the claim via the Internet or Telephone, this form does not need to be completed. If you report the claim via Fax, complete the form, and Fax it to C&F at the Fax number provided above.

NC-Form 19-10.17

Form 22 – Statement of Days Worked and Earnings of Injured Employee

NC-Form 22-2.17

Form 25 PR – Preauthorization for Surgical and Inpatient Treatment
The following procedures require pre-authorization, as allowed by the North Carolina Workers Compensation Act:

  • Any inpatient or outpatient surgical procedure
  • Any inpatient hospitalization or inpatient admission to a treatment center

NC-Form 25PR

What is the Waiting Period for Lost Wages in North Carolina?
The waiting period for lost wages in North Carolina is 7 days. If the injured worker is off for more than 21 days, the first 7 days are paid retroactively.

What is the Choice of Physician Rules in North Carolina?
Choice of physician belongs to the carrier except that the Commission may, at any time upon the request of an employee, order a change of treatment and designate other treatment suggested by the injured employee subject to the approval of the Commission.

Preferred Provider Organization Network (PPO):
Crum & Forster has a PPO network available. Follow the instructions below to access the PPO Network:

Logon to the website at:

  • Search by Provider Address, Name or Region
  • Select the Distance, Provider Type and Specialty
  • Results can then be exported to a directory or excel.
  • You can obtain a Map List or text message by selecting a specific provider

Where should all medical bills be sent?

Crum & Forster
PO Box 14801
Lexington, KY 40512

Important Websites
North Carolina Industrial Commission

Multi-State Information-