NEED ASSISTANCE Clause Samples

NEED ASSISTANCE. If you have questions or need help and you do not have an attorney, you may contact the Industrial Commission at (▇▇▇) ▇▇▇-▇▇▇▇.

NEED ASSISTANCE. 16 If you have questions or need help and you do not have an attorney, you may contact the Industrial Commission at ▇▇ (▇▇▇) ▇▇▇-▇▇▇▇. 18 19 Form 26A 20 7/2015 6/2020[8/2020]3/2021 22 Self-Insured Employer or Carrier, File via Electronic Document Filing Portal (“EDFP”): Carrier Mail to: 24 4335 Mail Service Center 25 Raleigh, North Carolina ▇▇▇▇▇-▇▇▇▇ ▇▇ Main Telephone: (▇▇▇) ▇▇▇-▇▇▇▇ 27 Helpline: (▇▇▇) ▇▇▇-▇▇▇▇ 28 Website: ▇▇▇▇://▇▇▇.▇▇.▇▇.▇▇▇/ 29 ▇▇▇▇▇://▇▇▇.▇▇.▇▇.▇▇▇/docfiling.html 30 Contact Information: 31 NCIC- Claims Administration 32 Telephone: (▇▇▇) ▇▇▇-▇▇▇▇ 33 Helpline: (▇▇▇) ▇▇▇-▇▇▇▇ 34 Website: ▇▇▇▇▇://▇▇▇.▇▇.▇▇.▇▇▇ 35 36 (b) A copy of the form described in Paragraph (a) of this Rule can be accessed at 37 ▇▇▇▇://▇▇▇.▇▇.▇▇.▇▇▇/forms/form26a.pdf. ▇▇▇▇▇://▇▇▇.▇▇.▇▇.▇▇▇/forms/form26a.pdf. The form may be reproduced 38 only in the format available at ▇▇▇▇://▇▇▇.▇▇.▇▇.▇▇▇/forms/form26a.pdf ▇▇▇▇▇://▇▇▇.▇▇.▇▇.▇▇▇/forms/form26a.pdf and 39 may not be altered or amended in any way. 40

NEED ASSISTANCE. 31 If you have questions or need help and you do not have an attorney, you may contact the Industrial Commission at ▇▇ (▇▇▇) ▇▇▇-▇▇▇▇. 33 34 Form 26A 35 11/2014 36 37 Self-Insured Employer or Carrier Mail to: 38 NCIC - Claims Administration 39 4335 Mail Service Center 40 Raleigh, North Carolina ▇▇▇▇▇-▇▇▇▇ 41 Main Telephone: (▇▇▇) ▇▇▇-▇▇▇▇ 42 Helpline: (▇▇▇) ▇▇▇-▇▇▇▇ 43 Website: ▇▇▇▇://▇▇▇.▇▇.▇▇.▇▇▇/ 44 45 (a) (Effective July 1, 2015) The parties to a workers' compensation claim shall use the following Form 26A, 46 Employer's Admission of Employee's Right to Permanent Partial Disability, for agreements regarding the employee's 47 entitlement to and the employer's payment of compensation for permanent partial disability pursuant to G.S. 97-31. 48 Additional issues agreed upon by the parties, such as election of payment of temporary partial disability pursuant to 49 G.S. 97-30, may also be included on the form. This form is necessary to comply with Rule 11 NCAC 23A .0501, 50 where applicable. The Form 26A, Employer's Admission of Employee's Right to Permanent Partial Disability, shall 51 read as follows: