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Worker's Compensation

Billing information:
Sedgwick CMS
PO Box 241125
Charlotte, NC 28224

Phone: 800-822-4469                               

Please call 877-622-2276 for EMERGENCY AFTER HOURS claims

Please be sure to complete and supply a copy of all forms to the employee and Risk Manager.

Worker's Compensation Packets should be completed immediately after an employee sustains injuries or as soon as possible!

“Incident Only” claims need only a form 19 completed and submitted to Risk Manager unless employee seeks medical attention at a later date. In that instance, the other forms must be completed at that time.   

Worker's Compensation Supervisor Packets

Procedures
Supervisor please read the Worker's Compensation Procedures before printing forms.

Forms to Print

Welcome to Worker's Compensation Letter
Detailed information outlining Currituck County's Worker's Compensation program. 

Worker's Compensation Rx Program

How to get an Temporary Pharmacy Card and use it.
  
Direction Of Medical Care
Information on how to receive medical care after the initial treatment. 

Form 18 - Notice of Accident to Employer and Claim of Employee, Representative, or Dependent
The use of this form is required under The Provisions of The Worker's Compensation Act.

Non-Emergency Providers List
A list of approved non-emergency providers.

Form 19 - Employer's Report of Employee's Injury or Occupational Disease to the Industrial Commission
The use of this form is required under The Provisions of The Worker's Compensation Act.

Form 22 - Missed Days Reporting
The use of this form is required under The Provisions of The Worker's Compensation Act.  

Contact Information

Derinda Leary, Risk Manager
Phone: 252-232-7746
Fax: 252-232-0015