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Form 31 North Carolina Industrial Commission

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North Carolina Industrial Commission
APPLICATION FOR LUMP SUM AWARD

IC File #:

Emp. Code #:

Carrier Code #:

Carrier File #:

The Use of This Form Is Required Under the Provisions of the Workers' Compensation Act Employer FEIN

Employee's Name

Employer's Name

Address

Telephone Number

City

State

Zip

Employer's Address

Home Telephone

( ) Work Telephone

Insurance Carrier

Last 4 Digits of SSN

M F Sex

Carrier's Address

Date of Birth

( ) Carrier's Telephone Number

Fax Number

APPLICATION MUST BE COMPLETED IN FULL BEFORE REQUEST WILL BE CONSIDERED.

The applicant represents that he or she has been granted an award of compensation by the North Carolina Industrial Commission, and that the award has been paid in periodical payments for not less than six weeks. The applicant hereby requests that he or she be allowed a lump-sum payment in an amount as requested below. (If the applicant desires to buy property of any kind with this lump sum settlement, three estimates of the value of the property must be submitted with the application to the Industrial Commission.)

Name:

Address:

Birth Date:

Phone Number:

Marital Status:

Present Employer:

How Long:

Job Title:

Average Wage/Wk:

Are you unemployed:

Other Income (Including Spouse's):

Dependents (Names & Ages):

Outstanding Bills (Creditor and Amount Owed):

Purpose of Lump Sum Request:

Applicant's Signature:

Date:

Amount Requested $:

Applicant must send a copy of this form to the carrier and a copy to the Industrial Commission at the address below.

TO BE COMPLETED BY CARRIER/ADMINISTRATOR

The , agrees to pay the requested amount of $ in a lump sum without commutation, or agrees to pay the following recommended amount of $ in a lump sum without commutation or refuses to pay the compensation in a lump sum without commutation.

Balance due applicant (pre-lump sum):

For Commission's Use Only

Approved By:

Amount:

Denied By:

Date:

Signature

Title

FORM 31

02/2017

PAGE 1 OF 1

FORM 31

FILE VIA ELECTRONIC DOCUMENT FILING PORTAL

HTTP://WWW.IC.NC.GOV/DOCFILING.HTML

CONTACT INFORMATION:

NCIC-CLAIMS ADMINISTRATION

TELEPHONE: (919) 807-2502

HELPLINE: (800) 688-8349

WEBSITE: HTTP://WWW.IC.NC.GOV

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What the Form 31 North Carolina Industrial Commission is and when it's used

The Form 31 North Carolina Industrial Commission is the standard filing used to initiate or respond to a workers' compensation matter before the North Carolina Industrial Commission. It captures claimant and employer details, dates, injury or exposure descriptions, and the type of relief requested. The form triggers case assignment and scheduling by the Commission and is commonly used by injured workers, employers, and attorneys to start a claim, request hearings, or notify the Commission of claims-related actions. Review local Commission filing rules before submission to avoid processing delays.

Why accurate completion of Form 31 matters

Completing Form 31 correctly ensures timely case intake, preserves statutory rights, and speeds scheduling. Accurate fields reduce administrative returns and potential deadlines missed under workers' compensation procedures.

Why accurate completion of Form 31 matters

Who typically completes and relies on Form 31

If you represent a party, confirm who will sign and file to avoid duplicate filings and to maintain accurate Commission records.

  • Injured employees or claimants filing an initial claim or requesting a hearing in a compensation matter.
  • Employers or insurers responding to claims, providing employer contact and insurance details for Commission records.
  • Attorneys or claims professionals submitting representative filings, attachments, or amended information on behalf of parties.

Primary signer roles and responsibilities

Claimant

A claimant completes personal and injury-related sections, provides the date and description of injury, and signs or authorizes counsel to sign. Accurate identity and injury details are essential to establish jurisdiction and applicable benefit entitlements.

Employer / Carrier

Employers or their insurers complete employer identification fields, confirm coverage status, and provide contact and claims adjuster information. Timely and accurate employer responses enable Commission scheduling and benefits determination.

Key data elements required on Form 31

Claimant name: Full legal name
Employer name: Business or employer legal name
Date of injury: MM/DD/YYYY
Injury description: Brief incident summary
Insurance carrier: Carrier name and contact
Signature block: Printed name and date

Potential consequences of incorrect or late Form 31 filings

Missed deadlines: May forfeit rights to timely hearings
Case delays: Clerical errors cause processing returns
Evidence gaps: Incomplete facts weaken claim or response
Sanctions: Commission may impose procedural sanctions
Duplicative filings: Create administrative confusion and delay
Incorrect party info: Can affect jurisdiction or service

Common preparation pitfalls to avoid

  • Using abbreviations or nicknames for legal names that do not match government ID increases the risk of administrative returns and confusion.
  • Entering an approximate date of injury instead of the precise date may create disputes about compensability or lapse statutory timelines.
  • Failing to list the insurer or claims contact prevents the Commission from routing notices correctly and can delay scheduling.
  • Attaching unsigned or incomplete supporting documents often results in rejection or requests for correction from the Commission.

Step-by-step: filling out Form 31

Follow these sequential steps to complete Form 31 accurately and reduce processing time at the Commission.

  • 01
    1. Gather documents: Collect ID, medical reports, employer details
  • 02
    2. Complete claimant fields: Enter full legal name, address, and SSN last four
  • 03
    3. Describe the injury: Use clear factual language, include date and location
  • 04
    4. Sign and date: Sign using authorized signature method and date

How Form 31 moves through the Commission

Understand the typical routing so you can anticipate notices and next steps after filing.

  • Filing intake: Commission receives and logs the submission
  • Review for completeness: Clerical screening may trigger return for corrections
  • Case assignment: A deputy commissioner assigns a file number
  • Scheduling and notices: Parties receive hearing dates and instructions

Essential parts of a professional Form 31 filing package

A complete filing package pairs the Form 31 with supporting documents and clear contact details so the Commission can process matters without follow-up requests.

Cover letter

One-page cover summarizing purpose of filing, the parties involved, and attachments to help Commission staff triage and docket accurately.

Signed Form 31

Completed and signed form using the claimant's legal name and signature method accepted by the Commission; include dates and printed names where required.

Supporting medical records

Current medical reports, treatment notes, and disability assessments that substantiate dates, nature, and extent of injury or exposure.

Employer/insurer information

Name, address, adjuster contact, and policy number to ensure proper service and notice routing for case management and benefit determinations.

Service proof

Certificate of service or affidavit showing the date and method used to serve opposing parties and insurers as required by Commission rules.

Exhibits index

A numbered list of attachments with short descriptions to keep the record organized for hearings and any discovery disputes.

Practical tips to minimize processing delays

Use these practical measures to avoid returns and accelerate scheduling with the Commission.

Verify names and identifiers
Confirm claimant and employer names match government IDs and insurance records. Mismatches are a frequent cause of administrative returns and contested jurisdiction.
Use clear chronology
Provide a concise timeline of events and treatment to reduce follow-up requests and to present a coherent narrative for case intake and early mediation.
Include contact details
List phone, email, and mailing addresses for claimant, counsel, and carrier so the Commission can send notices and expedite communications without additional discovery.
Label attachments
Number and label each supporting document and reference those exhibit numbers directly on the Form 31 to streamline review and hearing preparation.

Timing considerations and common deadline triggers

Certain time limits affect filing and response obligations; verify statute and Commission rules for deadline specifics in each case.

Statute of limitations:

Varies by claim; filing delays can bar relief

Employer notice:

Provide carrier contact promptly to avoid notice defects

Medical evidence timing:

Attach current records to support causal connection

Response period:

Carrier responses follow Commission scheduling rules

Hearing scheduling:

Allow time for Commission docketing and notice delivery

Real-world examples of Form 31 usage

These short examples show how different parties package Form 31 filings for effective Commission processing.

Claimant filing

A claimant files Form 31 with a one-page cover explaining the injury and attaches medical records

  • Attaches current treatment notes and employer contact
  • The Commission accepted the filing and scheduled a pre-hearing within six weeks with no return for corrections.

Employer response

An employer submits Form 31 with insurer contact and an exhibit list

  • Includes adjuster phone and claim number
  • The insurer received Commission notices immediately and arranged early mediation, reducing litigation costs.

Recommended digital workflow settings for online Form 31 completion

Configure your electronic workflow to capture required fields, authentication, and retention for auditability.

Field Configuration
Claimant name field Mandatory text field; autofill validation
Date of injury field Date picker MM/DD/YYYY
Signature field eSign with date and audit trail
Attachment handling Allow PDF upload; force filename convention

Digital submission and platform considerations

Ensure the platform you use supports document retention, export, and the level of signer authentication required for legal admissibility.

  • File formats: PDF | Word DOCX supported
  • Integrations: Works with Google Workspace, Microsoft 365, NetSuite
  • Security: TLS in transit, AES-256 at rest

eSignature vendor pricing and capability comparison for Form 31 workflows

Compare per-user pricing and essential features relevant to completing and storing Form 31 documents electronically. No datestamps are included in this summary.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day free trial No No No No
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No

Frequently asked questions and troubleshooting for Form 31

Answers to common procedural and technical questions about completing and filing the Form 31 with the North Carolina Industrial Commission.


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