North Carolina workers use Form 18M to ask the Industrial Commission for additional medical compensation under G.S. 97-25.1 after their claim has closed. The treating physician may be asked to complete the optional Section B statement, which certifies a substantial risk that further care or monitoring will be needed because of the original injury by accident or occupational disease.
The employee completes and signs Section A, giving the injury date and the reason more medical care is needed. The treating physician completes the optional Section B with area of practice, the date treatment began, the care expected, and a signature with printed name and address.
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Employee's Application for Additional Medical Compensation (G.S. 97-25.1)
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No. Section B, the Treating Physician's Statement, is marked optional. When completed, it certifies that the signer is the employee's treating physician and that there is a substantial risk the employee will need specified additional medical care or monitoring as a result of the injury or occupational disease described in Section A.
The physician gives an area of medical practice and the date treatment of the employee began, then describes the additional care expected, such as medical, surgical, hospital, nursing or rehabilitation services, medicines or supplies, and confirms the need results from the work injury. The statement ends with signature, printed name, date and office address.
The employee does. The form tells the employee to send the original and any supporting documentation to the Commission and a copy to the employer or carrier/administrator. Employees can file by email, fax or mail, while attorneys and carriers use the Commission's Electronic Document Filing Portal.