Workers' Compensation Program Filing Procedures and Forms

All University employees are covered under the North Carolina Workers' Compensation Act, including full-time faculty, staff (EHRA and SHRA), part-time employees, temporary employees, and student employees. Any employee who suffers an accidental injury or contracts an occupational disease within the meaning of the Workers' Compensation Act may be entitled to benefits provided by the Act.

Compensable Injury, Illness

An injury is compensable under the NC Workers' Compensation Act if it meets the following criteria:

  • The injury was caused by an accident. Note: In the case of a hernia or injury to the back, the injury is compensable only if it is the result of a specific traumatic incident of the work assigned.
  • The injury arose out of employment (e.g. during the period of employment; an employer-employee relationship existed).
  • The injury was sustained in the course of employment (e.g. occurred while employee was doing his/her job).

In order to be compensable, the accident must be accidental in nature (i.e. an unplanned event which may result in injury and/or property damage or loss) and arise from a specific traumatic event which generally involves the interruption of the employee's work routine. Occupational diseases recognized under the Workers' Compensation Act which can be associated with the employees' work routine may also be compensable. As stated above, specific traumatic incidents (e.g. hernia or an injury to the back) may also be compensable.

Workers' Compensation Program Filing Procedures

Read these procedures before clicking on the link to the form you need. Links to the Workers' Compensation Forms are given below the following information.

Employees Responsibility in the Event of a Job-related Injury or Illness

  • Report all injuries or illness to your supervisor immediately.
  • Seek appropriate medical attention from the following authorized primary care physicians:
  • Note: In case of a life-threatening emergency, go to the nearest medical facility.
  • Contact Watauga Medics at 9-911 for emergency transportation to Watauga Medical Center Emergency Room. For non-emergency transportation to Fast-Med Urgent Care or Watauga Medical Center Emergency Room, contact University Police at ext. 8000 or 2150.
  • Return to work after your medical treatment unless your authorized physician provides you with a written authorization prohibiting your return to work.
  • All medical notes given to you at medical treatment should be given to your supervisor for submittal to the Workers' Compensation Administrator.
  • Provide a doctor's note, to your supervisor, returning you to work with no restrictions or stating any medical restrictions placed upon you as a result of the work-related injury.
  • Follow all medical restrictions; your recovery is a major concern to the University.
  • Provide the completed Employee's Accident Report Form with details of the accident to your supervisor.
  • NOTE: Be sure to contact the Office of Human Resources with questions regarding payment and/or continuation of employee benefits. Refer to the "Continuation of Benefits" section in the State of North Carolina Workers' Compensation Employee Handbook for additional information.
  • Adhere to any transitional duty assigned to you as a part of the University's Return to Work Program.
  • Keep supervisor notified of any changes in medical condition or any concerns in reference in your case.
  • Follow safe work practices!

Supervisor's Responsibility in the Event of a Job-related Injury or Illness of an Employee

  • Ensure that the injured employee receives immediate and appropriate medical attention.
  • Direct the employee to one of the authorized primary care facilities listed above, unless it is a life threatening injury.
  • If able to do so safely, employees should transport themselves for treatment. If they are not able to do so, contact Watauga Medics at 9-911 for emergency transportation to Watauga Medical Center Emergency Room. For non-emergency transport to Fast-Med Urgent Care or Watauga Medical Center ER, contact University Police at ext. 8000 or 2150.
  • Report the injury immediately to the Workers' Compensation Administrator, Carolyn Bosley, 262-6488.
  • Investigate all injuries as soon as possible after the incident occurs.
  • Complete the required documentation (Employee's Accident Report Form, Supervisor's Accident/Illness Investigation Form, Medical Records Release Form, and Witness Statement) and forward to the Office of Human Resources - Workers' Compensation within 24 hours of the incident or as soon as possible.
  • Correct unsafe conditions immediately.
  • Maintain weekly contact with injured employee to ensure their needs are met. Keep employee notified of any departmental changes while employee is out of work.
  • NOTE: Refer employees to the Office of Human Resources if they have questions regarding payment and/or continuation of employee benefits. Refer to the "Continuation of Benefits" section in the State of North Carolina Workers' Compensation Employee Handbook for additional information.
  • Identify and notify the Workers' Compensation Administrator of modified, transitional duty available in your department. Assign transitional duty work as soon as the employee is medically able to return to work.
  • Notify the Workers' Compensation Administrator if employee indicates a change in medical status or condition, or employee indicates absence is related to the injury.
  • Encourage safe work practices!

If you have questions about your claim call Carolyn Bosley at Human Resource Services, ext 6488.

Workers' Compensation Forms