North Carolina Form B-12 is the Notice of Voluntary Payment used by employers and insurance carriers to tell the North Carolina Industrial Commission that they are paying workers’ compensation benefits to an injured worker without admitting liability under the Workers’ Compensation Act. Filing it correctly tells the Commission, the employee, and any attorneys that wage-replacement checks have started, even though the carrier has not yet accepted the claim as compensable.
The form looks short, but the consequences of mistakes are large. Carriers that pay benefits without filing a B-12 (or its companion Form 63) can lose the right to later deny the claim, and employees who do not understand what a B-12 means may sign documents that change the value of their case. According to the N.C. Industrial Commission Annual Report, more than 60,000 workers’ compensation claims are filed each year in North Carolina, and a significant share involve voluntary payments made under Form B-12 or Form 63 before any final decision on compensability.
Here is what this guide covers, in plain English:
- 📋 What Form B-12 is, who files it, and the statute that requires it
- 🗂️ Every document and number you must gather before you open the PDF
- 🖊️ A line-by-line walkthrough of every box, with sample entries
- 👥 Three full filled-out examples using realistic injured-worker scenarios
- ⚠️ The most common mistakes, deadlines, fees, and post-filing steps that decide whether your filing is accepted or rejected
What Form B-12 Is and Who Must File It
Form B-12 is the Notice of Payment of Compensation Without Prejudice issued by the North Carolina Industrial Commission. It is filed by the employer or its workers’ compensation insurance carrier (or third-party administrator) to begin paying weekly indemnity benefits while the carrier still investigates whether the injury is compensable. The plain-English purpose is simple: it lets the carrier start checks quickly without locking itself into a permanent admission of liability.
The legal anchor is N.C. Gen. Stat. § 97-18(d), which lets a carrier pay compensation “without prejudice” for up to 90 days (extendable by another 30 days for good cause) before it must either accept the claim with a Form 60 or deny it with a Form 61. Form B-12 is the notice that tells the Commission this clock has started. Filers also rely on Industrial Commission Rule 11 NCAC 23A .0601, which sets the form-filing duties of carriers.
You must file Form B-12 if you are an employer, insurance carrier, or third-party administrator (TPA) paying disability compensation in a North Carolina workers’ compensation claim before formally admitting the claim. You should not file B-12 when you are paying medical-only benefits with no lost time, when you are accepting the claim outright (use Form 60), or when you are denying the claim (use Form 61). Self-insured employers fall under the same rule as carriers.
The consequence of skipping B-12 is steep. A carrier that pays indemnity benefits without filing a B-12 or Form 63 can be deemed to have accepted the claim by conduct, losing the right to deny it later under Higgins v. Michael Powell Builders. Filing B-12 protects the carrier’s right to later contest compensability. A common misconception is that B-12 is the only without-prejudice notice; in fact, Form 63 is the modern equivalent for many claims, and many practitioners now file Form 63 in place of B-12 because the statute references “payment without prejudice” through that vehicle.
Before You Start: Documents and Information You Need
Open the form only after you have gathered the items below. Missing any one of them is the most common reason B-12 filings get rejected at the Commission’s docket desk or kicked back through the Electronic Document Filing Portal.
- Industrial Commission (IC) File Number — the seven-digit number assigned after Form 19 is filed; without it, the Commission cannot route the B-12 to the correct claim file.
- Carrier File / Claim Number — the carrier’s internal claim ID; missing this number delays the carrier’s own audit trail and can cause duplicate payment errors.
- Employee’s full legal name, address, date of birth, and Social Security number — pulled from Form 18 or the employer’s HR file; mismatches with SSA records trigger correspondence holds.
- Employer’s exact legal name and FEIN — must match the name on the policy declarations page; a “doing business as” name alone will be rejected.
- Date of Injury (DOI) — the exact date of the accident or, for occupational disease, the date of last injurious exposure under G.S. § 97-57.
- Average Weekly Wage (AWW) — calculated under G.S. § 97-2(5); without it, the compensation rate cannot be verified.
- Compensation Rate — two-thirds of AWW, capped at the annual maximum weekly benefit for the year of injury.
- Date Disability Began — the first full day the employee was out of work beyond the seven-day waiting period under G.S. § 97-28.
- Carrier and adjuster contact information — name, phone, email, and NAIC number; required so the Commission and employee’s counsel can reach a live human.
- Signature authority — the adjuster, claims supervisor, or attorney who can legally bind the carrier; an unauthorized signature voids the filing.
Each of those items maps to a specific box on the form. If a box is blank, the Commission’s Claims Administration Section sends a deficiency letter, and the 90-day pay-without-prejudice clock keeps running while you scramble to fix it.
Where to Get the Form and How to Access It
The current revision of Form B-12 lives on the Industrial Commission’s Forms page. Always pull the PDF directly from that page rather than from a third-party site, because the Commission updates form revisions without warning, and an outdated revision can be rejected. Note the small revision date in the lower-left corner of the form (for example, “Rev. 7/14”) and confirm it matches what is currently posted before you file.
You can also reach the form through the NCIC Online Services Center, which links to both the fillable PDF and the Electronic Document Filing Portal (EDFP). EDFP is the exclusive filing channel for parties required to file electronically under 11 NCAC 23A .0108, which covers most carriers, TPAs, and attorneys. Pro se employers may still mail paper.
If you cannot access the website, you can request a paper copy by writing to the NC Industrial Commission, 1236 Mail Service Center, Raleigh, NC 27699-1236, Attention: Office of the Clerk, under 11 NCAC 23A .0102. Expect about a week for a mailed form. Spanish-speaking employees may use the bilingual version where available, but the carrier’s filed copy must be the English revision.
A common misconception is that any prior B-12 PDF saved on a desktop is fine to reuse. It is not. The Commission rejects forms that do not match the current revision, and the rejection does not stop the 90-day pay-without-prejudice clock under G.S. § 97-18(d).
Step-by-Step: How to Fill Out Form B-12 Line by Line
The form is a single page divided into a header (case identifiers), a body (compensation details), and a footer (signature and certification). Complete it top to bottom in the order printed. Use black ink if filing on paper, all caps where the form prompts, and MM/DD/YYYY for every date.
Caption: Employee, Employer, and Carrier Block
The top caption asks for the names of the Employee, Employer, and Carrier/Administrator. Print the employee’s full legal name exactly as it appears on the Form 18 (Notice of Accident to Employer and Claim of Employee). The employer line takes the legal entity name on the policy — not the trade name on the storefront. The carrier line takes the licensed carrier’s name and, where the form provides space, the NAIC number.
For example, Maria Lopez is the employee, Carolina Cabinet Works, Inc. is the employer, and Liberty Mutual Insurance Company (NAIC 23043) is the carrier. A nuance arises with TPAs: if Sedgwick administers the claim for Liberty Mutual, list the carrier on the carrier line and the TPA in the adjuster block below, never the other way around.
The most common mistake here is using a “doing business as” name like Carolina Cabinets instead of Carolina Cabinet Works, Inc.; the consequence is that the Commission cannot match the filing to the policy on file and may bounce the form. A misconception is that listing the parent company is enough — it is not, because workers’ comp coverage attaches to the named insured on the Form 19, not the parent.
IC File Number and Carrier File Number
These two numbers anchor the filing. The IC File Number is the Commission’s seven-digit identifier (often shown as 24-712345); the Carrier File Number is the adjuster’s internal claim ID. Type both exactly as printed in prior correspondence. If the IC File Number has not yet issued, write “PENDING” and attach the Form 19 cover sheet.
For example, adjuster Brian Hale writes 24-712345 in the IC File Number box and LMG-2024-008812 in the Carrier File Number box. A nuance is dual coverage: if the employee has two open claims, file a separate B-12 for each IC File Number; the Commission will not accept a combined filing.
The most common mistake is transposing digits in the IC File Number, which routes the B-12 to a stranger’s file and triggers a confidentiality breach inquiry. A misconception is that the carrier’s claim number alone is enough — it is not, because the Commission indexes everything by IC File Number, not by carrier ID.
Date of Injury (DOI)
The Date of Injury field captures the exact date of the accident under G.S. § 97-2(6), or, for occupational disease, the date of last injurious exposure under G.S. § 97-57. Use MM/DD/YYYY format with slashes, not dashes.
For example, if Maria slipped on a wet shop floor on March 14, 2026, write 03/14/2026. A nuance is the cumulative-trauma claim: when there is no single accident, use the date the employee first missed work due to the condition, not the date a doctor diagnosed it.
The most common mistake is writing the date of report instead of the date of injury, which can shift the AWW calculation period by months and change the compensation rate. A misconception is that a weekend or holiday cannot be a DOI; it can, if the employee was performing work at the employer’s request.
Average Weekly Wage (AWW)
The AWW field requires the figure calculated under G.S. § 97-2(5) — usually total earnings in the 52 weeks before the DOI divided by 52, with adjustments for time lost. Round to the nearest cent and include the dollar sign.
For example, $842.31 is Maria’s AWW after adjusting for two unpaid weeks. A nuance is the short-tenure employee: if the worker has been on the job under 52 weeks, use a similarly situated employee’s wages or the Method 5 fairness test under the statute.
The most common mistake is including non-wage payments such as expense reimbursements, which inflates AWW and the compensation rate, exposing the carrier to overpayment recovery problems. A misconception is that overtime is excluded; it is not — overtime counts toward AWW.
Compensation Rate
The Compensation Rate is two-thirds of the AWW, capped at the annual maximum on the NCIC max benefits table for the year of injury. Show the math by listing AWW first, then the rate.
For example, Maria’s AWW of $842.31 yields a compensation rate of $561.54 per week. A nuance is the high-wage earner: for 2026 injuries, the maximum weekly benefit is set annually by the Commission, and any AWW above the cap rate gets ceiling-limited, not the math.
The most common mistake is using two-thirds of gross salary without first computing AWW per the statute, which produces a rate that ignores bonuses and overtime. A misconception is that the rate is fixed for life; cost-of-living adjustments under G.S. § 97-29.1 can apply to long-term TTD.
Date Disability Began
This box captures the first day the employee was unable to earn wages due to the injury, after the seven-day waiting period in G.S. § 97-28. Use MM/DD/YYYY.
For example, if Maria’s DOI was 03/14/2026 and her doctor took her out of work starting 03/17/2026, the date disability began is 03/17/2026. A nuance is light-duty: if the employer offered suitable light-duty work and the employee refused, the disability date may be disputed, and you should file Form 24 alongside.
The most common mistake is writing the DOI here instead of the actual first lost-wage day, which shortens the waiting period and inflates the indemnity owed. A misconception is that the waiting period is automatically waived; it is only waived once disability lasts more than 21 days under G.S. § 97-28.
Date of First Payment
Enter the mail date or direct-deposit date of the first indemnity check, not the date the check is cut internally. Use MM/DD/YYYY.
For example, if Maria’s first check leaves the carrier’s mailroom on 03/31/2026, write 03/31/2026. A nuance is the late first payment: if it is more than 14 days after the date disability began, a 10% late penalty under G.S. § 97-18(g) attaches automatically.
The most common mistake is back-dating to the disability date to avoid penalties, which is an Industrial Commission rule violation that can trigger sanctions. A misconception is that direct deposit dates do not count; they do, and the Commission treats them as the payment date.
Period of Payment / Weekly Amount
State the weekly amount being paid and the period it covers. List start date and either an end date or the word “ongoing”.
For example, $561.54 per week from 03/17/2026, ongoing. A nuance is partial disability: if the employee returned to lower-paying light duty, list the temporary partial disability (TPD) rate computed under G.S. § 97-30, not the TTD rate.
The most common mistake is writing the monthly equivalent instead of the weekly figure, which the Commission treats as facially defective. A misconception is that the form locks in the payment forever; it does not — the carrier can stop payments by filing Form 24 (with approval) or Form 28 (return to work).
Without-Prejudice Statement
The form contains a printed paragraph stating that payment is made without admission of liability under G.S. § 97-18(d). Do not strike, alter, or annotate this language.
For example, Brian Hale simply leaves the printed paragraph alone and signs below. A nuance is the 90-day clock: this paragraph triggers it, and a Form 60 (acceptance) or Form 61 (denial) must follow within that window unless the Commission grants a 30-day extension for good cause.
The most common mistake is striking through the without-prejudice language thinking it limits the carrier; striking it converts the filing into an effective acceptance and forfeits the right to deny later. A misconception is that the without-prejudice period is 180 days; it is not — it is 90 days, with one possible 30-day extension.
Signature, Title, and Date
The signature block requires the adjuster, supervisor, or attorney’s signature, printed name, title, phone, email, and signature date. Sign in blue or black ink on paper; in EDFP, type the name preceded by /s/ (for example, /s/ Brian Hale).
For example, Brian Hale, Senior Claims Adjuster, Sedgwick CMS, (704) 555-0142, brian.hale@sedgwick.com, 03/31/2026. A nuance is the attorney filer: defense counsel can sign, but should add the State Bar number to avoid Commission staff returning the form for signature authority confirmation.
The most common mistake is leaving the title blank, which makes it impossible for the Commission to confirm the signer can bind the carrier. A misconception is that an electronic signature image is required; in EDFP, the /s/ convention satisfies Rule 11 NCAC 23A .0108.
Certificate of Service
At the bottom, a Certificate of Service confirms a copy was mailed or emailed to the employee and any known counsel. List the names, addresses, and date of service.
For example, I certify that on 03/31/2026 a copy of this Notice was served on Maria Lopez, 1408 Pine St., Hickory, NC 28601, by U.S. Mail, first class, postage prepaid. A nuance is represented employees: serve counsel of record at the law firm address listed on the Form 18, not the employee directly.
The most common mistake is forgetting to serve the employee at all, which violates Rule 11 NCAC 23A .0108 and can be raised at any later hearing as a due-process defect. A misconception is that filing in EDFP automatically serves the employee; it does not — service is the filer’s separate duty.
Three Filled-Out Examples Using Real Scenarios
The three scenarios below show how three different filers complete Form B-12 from caption to signature. Each scenario follows one named adjuster filing on behalf of a real-world employer and employee.
Scenario 1 — Maria Lopez, Cabinet Shop Slip-and-Fall
Maria slipped on a wet shop floor at Carolina Cabinet Works, Inc. on March 14, 2026 and was taken out of work three days later. Adjuster Brian Hale at Sedgwick CMS (TPA for Liberty Mutual) starts indemnity benefits while the carrier investigates whether the floor wetness was a compensable accident.
| Form Section | What Brian Enters |
|---|---|
| Employee | Maria Lopez |
| Employer | Carolina Cabinet Works, Inc. |
| Carrier / Administrator | Liberty Mutual Insurance Company / Sedgwick CMS |
| IC File Number | 24-712345 |
| Carrier File Number | LMG-2024-008812 |
| Date of Injury | 03/14/2026 |
| Average Weekly Wage | $842.31 |
| Compensation Rate | $561.54 |
| Date Disability Began | 03/17/2026 |
| Date of First Payment | 03/31/2026 |
| Period of Payment | $561.54 weekly from 03/17/2026, ongoing |
| Signature / Title / Date | /s/ Brian Hale, Senior Claims Adjuster, 03/31/2026 |
Scenario 2 — Marcus Bell, Warehouse Lifting Injury
Marcus injured his lower back lifting a 70-pound carton at Triangle Logistics, LLC on April 2, 2026. Adjuster Jenna Park at Travelers Indemnity files B-12 because the MRI is still pending and compensability turns on whether a prior back condition contributed.
| Form Section | What Jenna Enters |
|---|---|
| Employee | Marcus Bell |
| Employer | Triangle Logistics, LLC |
| Carrier / Administrator | Travelers Indemnity Company (NAIC 25658) |
| IC File Number | 24-803221 |
| Carrier File Number | TRV-26-44119 |
| Date of Injury | 04/02/2026 |
| Average Weekly Wage | $1,012.50 |
| Compensation Rate | $675.00 |
| Date Disability Began | 04/05/2026 |
| Date of First Payment | 04/18/2026 |
| Period of Payment | $675.00 weekly from 04/05/2026, ongoing |
| Signature / Title / Date | /s/ Jenna Park, Claims Specialist II, 04/18/2026 |
Scenario 3 — Aisha Coleman, Hospital Needle-Stick Exposure
Aisha, a registered nurse at Mercy Regional Hospital, suffered a needle-stick exposure on January 22, 2026 and was placed on prophylactic medication that caused side effects keeping her out of work. Adjuster Daniel Reyes at Hartford Underwriters files B-12 while infectious-disease testing continues.
| Form Section | What Daniel Enters |
|---|---|
| Employee | Aisha Coleman, RN |
| Employer | Mercy Regional Hospital |
| Carrier / Administrator | Hartford Underwriters Insurance Company |
| IC File Number | 24-559004 |
| Carrier File Number | HUI-2026-001774 |
| Date of Injury | 01/22/2026 |
| Average Weekly Wage | $1,488.46 |
| Compensation Rate | $992.31 |
| Date Disability Began | 01/26/2026 |
| Date of First Payment | 02/06/2026 |
| Period of Payment | $992.31 weekly from 01/26/2026, ongoing |
| Signature / Title / Date | /s/ Daniel Reyes, Lead Adjuster, 02/06/2026 |
How to File the Completed Form
Form B-12 can be filed three ways. Most carriers and TPAs are required to use EDFP under 11 NCAC 23A .0108, but pro se employers and out-of-state filers may still mail paper.
Online via EDFP — Log in to the Electronic Document Filing Portal using your registered carrier or attorney credentials, select the matching IC File Number, upload the PDF, and click Submit. There is no filing fee. The portal returns a date-stamped confirmation page; save it as your proof of filing. Processing time is typically same-day. For help, email support@ic.nc.gov or call 919-807-2695.
By mail — Send the original signed form to NC Industrial Commission, 1236 Mail Service Center, Raleigh, NC 27699-1236. There is no filing fee, but use certified mail with return receipt as your proof of filing because the Commission does not return file-stamped copies by default. Processing time is 5–10 business days.
In person — Hand-deliver to the Commission’s offices at 430 N. Salisbury Street, Raleigh, NC. Ask the clerk to stamp a copy and hand it back; that stamped copy is your proof of filing. There is no fee. This channel is rarely used outside Wake County.
A misconception is that fax filing is acceptable; it is not. The Commission stopped accepting fax filings of indemnity forms once EDFP became the exclusive electronic channel under Rule 11 NCAC 23A .0108.
What Happens After You File
Once the Commission accepts your B-12, it dockets the filing under the IC File Number and sends an acknowledgment (often a letter or an EDFP receipt). The without-prejudice clock under G.S. § 97-18(d) begins on the date of first payment and runs for 90 days, with one possible 30-day extension on motion for good cause.
During that period, the carrier must complete its compensability investigation and either accept the claim with Form 60 or deny it with Form 61. If neither form is filed by day 90 (or day 120 with extension), the carrier is deemed to have accepted the claim by operation of law, and any later denial is procedurally barred.
The employee should expect to receive weekly checks at the stated compensation rate, plus an explanation letter from the carrier. The employee can confirm the filing through the NCIC Online Services Center using the IC File Number. If checks stop without a Form 24 approval, the employee can file Form 33 to request a hearing.
A common misconception is that filing B-12 settles the case; it does not. B-12 only opens the temporary payment window — final resolution requires a Form 60 admission, a Form 61 denial, an Industrial Commission Award, or a Form 21 / Form 26 settlement agreement under G.S. § 97-17.
Mistakes to Avoid When Filling Out the Form
Each mistake below has caused real claim files to derail. Avoid all of them.
- Using the trade name instead of the legal employer name. The Commission cannot match the policy and may bounce the form.
- Leaving the IC File Number blank. The filing has nowhere to land and disappears into the deficiency queue.
- Writing the date of report instead of the date of injury. Every downstream calculation breaks.
- Skipping overtime in the Average Weekly Wage. The compensation rate ends up too low and the employee is shorted.
- Using two-thirds of gross pay rather than statutory AWW. Producing a rate that violates G.S. § 97-2(5).
- Writing the monthly compensation amount instead of weekly. The form is treated as facially defective.
- Striking the without-prejudice language. Converts the filing into a deemed acceptance and forfeits the carrier’s denial right.
- Back-dating the date of first payment. Triggers a sanctionable rule violation and can void the late-payment penalty waiver.
- Missing the certificate of service to the employee. Creates a due-process defect raised at any later hearing.
- Filing past the 14th day after disability began without explanation. Triggers an automatic 10% late penalty under G.S. § 97-18(g).
- Mailing instead of EDFP for a regulated carrier. Violates 11 NCAC 23A .0108 and risks rejection.
- Forgetting to follow up with Form 60 or Form 61 within 90 days. Results in deemed acceptance by operation of law.
Do’s and Don’ts
Do’s
- Do pull the latest revision directly from the Industrial Commission Forms page, because saved copies go stale fast.
- Do double-check the IC File Number against the Form 19, because a single transposed digit ruins service.
- Do calculate AWW under G.S. § 97-2(5), because shortcut math creates overpayment problems.
- Do mail the first check by the 14th day after disability began, because day 15 triggers a 10% penalty.
- Do docket the 90-day deadline the moment you file, because missing it costs the carrier its denial rights.
- Do serve the employee and any counsel separately from the EDFP filing, because EDFP does not serve them for you.
Don’ts
- Don’t strike or annotate the without-prejudice paragraph, because it converts the form into a deemed acceptance.
- Don’t use the parent company’s name on the carrier line, because coverage attaches to the named insured.
- Don’t include reimbursements in AWW, because they are not “wages” under the statute.
- Don’t fax the form, because the Commission no longer accepts faxed indemnity filings.
- Don’t rely on B-12 as a substitute for Form 60 or 61, because it only opens the temporary window.
- Don’t ignore deficiency letters, because the 90-day clock keeps running while you fix errors.
Pros and Cons of Filing on Your Own vs. With Help
Most carriers file B-12 in-house, but small employers and self-insureds sometimes consider whether to use defense counsel.
Pros of filing in-house
- Fastest turnaround, because the adjuster already has the AWW worksheet on file.
- Lower cost, because there is no attorney billable.
- Direct knowledge of the claim facts, which produces fewer transcription errors.
- Immediate access to the carrier’s EDFP credentials, which speeds up portal upload.
- Tight integration with diary systems, which keeps the 90-day clock in view.
Cons of filing in-house
- Adjusters who are unfamiliar with NC law can miscalculate AWW or strike the without-prejudice language.
- Without legal review, the carrier may miss a viable Form 61 denial path before the 90 days expire.
- DIY filers sometimes forget the certificate of service requirement under Rule 11 NCAC 23A .0108.
- A wrongly filed B-12 can cause a deemed acceptance worth tens of thousands of dollars in lifetime exposure.
- Out-of-state TPAs may not realize that NC’s 14-day first-payment rule is stricter than other states.
How B-12 Compares to Form 63 and Form 60
| Feature | What It Means |
|---|---|
| Form B-12 | Notice that compensation is being paid without prejudice under G.S. § 97-18(d). |
| Form 63 | Modern Notice to Employee of Payment of Compensation Without Prejudice; many practitioners now use Form 63 instead of B-12. |
| Form 60 | Admission of Employee’s Right to Compensation; locks the carrier into liability for the accepted body parts. |
| Form 61 | Denial of Workers’ Compensation Claim; ends payments and triggers the employee’s right to file Form 33 for a hearing. |
| Form 21 | Agreement for Compensation requiring Industrial Commission approval under G.S. § 97-17. |
FAQs
Is Form B-12 the same as Form 63?
No. They serve nearly identical purposes — payment without prejudice — but Form 63 is the modern vehicle most carriers now file under G.S. § 97-18(d). Many practitioners file Form 63 in place of B-12.
Does filing Form B-12 admit liability?
No. The printed without-prejudice paragraph keeps the carrier’s right to later deny the claim with Form 61, as long as denial happens within the 90-day window.
How long does the without-prejudice period last?
No more than 90 days from the date of first payment, with one possible 30-day extension for good cause shown to the Commission.
Who signs Form B-12?
Yes, the carrier’s adjuster, claims supervisor, or defense attorney signs. The signer’s title must appear so the Commission can confirm signature authority.
Do I write the date of injury or the date disability began in the AWW box?
No — the AWW box wants a dollar amount, not a date. The DOI sets the 52-week lookback period; the date disability began starts the indemnity clock.
Should I list the parent company or the named insured on the carrier line?
No, never the parent. Always list the licensed carrier whose name appears on the policy declarations page filed with the NC Department of Insurance.
Do I need to serve the employee separately if I file in EDFP?
Yes. EDFP filing does not serve parties. You must mail or email the employee (or counsel) and complete the certificate of service.
Is there a filing fee for Form B-12?
No. The Industrial Commission charges no fee to file Form B-12 by EDFP, mail, or in person.
What happens if I miss the 14-day first-payment deadline?
Yes, a 10% late penalty under G.S. § 97-18(g) attaches automatically to the late check, payable to the employee.
Can I correct a B-12 after filing?
Yes, by filing an amended B-12 in EDFP and serving the corrected copy on the employee, with a brief cover note explaining the correction.
Do I include overtime in the Average Weekly Wage?
Yes. Overtime, bonuses, and shift differentials are wages under G.S. § 97-2(5). Reimbursements and per-diems are not.
Can a pro se employer file B-12 by mail?
Yes. Small uninsured or self-insured employers without EDFP credentials may mail to 1236 Mail Service Center, Raleigh, NC 27699-1236 using certified mail.
What if the IC File Number has not issued yet?
No problem — write “PENDING” in the IC File Number box and attach a copy of the Form 19 so the Commission can match the filing once the number assigns.
Does Form B-12 cover medical-only claims?
No. B-12 is for indemnity (lost wage) payments. Medical-only claims do not need a B-12; they are reported on Form 19.
Related reading
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- How to Fill Out North Carolina Industrial Commission Form 21 + FAQs
- How to Fill Out North Carolina Industrial Commission Form 33 + FAQs
- How to Fill Out North Carolina Industrial Commission Form 60 + FAQs
- How to Fill Out North Carolina Industrial Commission Form 61 + FAQs
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