Lewis & Keller is dedicated to helping injured workers across North Carolina get the compensation they truly deserve.
Every on-the-job accident is unique, and your needs as an individual aren’t the same as every other injured employee. That’s why we approach each client with personal attention, and build a robust case on your behalf in order to get the most out of your claim.
Download Center: North Carolina Workers’ Compensation Forms
We’re here to simplify your workers’ compensation claim. Whether you’re just getting started or are looking to apply for additional compensation, appoint a guardian ad litem, or need to itemize statements, we have all of the NC workers’ compensation forms for claimants available for download.
Click on a form below to download:
Notice of Accident to Employer and Claim of Employee
This is your initial claim form, including instructions.
Itemized Statement of Travel Charges
Itemize the costs of your travel expenses for medical treatment using this form.
Claim for Lung Disease, Including Asbestosis, Silicosis and Byssinosis
Use this form for lung disease workers’ compensation claims
Application for Lump Sum Award
Use this form to apply to receive your workers’ comp benefits in one lump sum.
Employee’s Application for Additional Medical Compensation
Apply for more medical compensation using this form.
Request that Claim be assigned for Hearing
If there is a dispute with your claim and you wish to request a hearing, use this form.
Itemized Statement of charges for Drugs
Itemize the costs of your prescription drugs for your claim using this form.
Application for Appointment of Guardian Ad Litem
Use this form to apply to appoint a guardian ad litem for an infant or incompetent person.
Strengthen Your Workers’ Comp Claim with Lewis & Keller
You shouldn’t suffer the financial burden of medical bills and lost wages when your injury wasn’t your fault.
We’re here to help you. Find out about your legal options, learn about filing a claim, and get answers to your questions about hiring a workers’ comp lawyer, all for free during your case evaluation.