If you’re an injured worker in North Carolina assigned to a Rehabilitation Professional, you may be asked to sign Form 25C — an authorization allowing your assigned Rehabilitation Professional to access your medical records related to your work injury. This guide explains who to contact, what the form does, and your rights and obligations under the Workers’ Compensation Act.
How to Contact the N.C. Industrial Commission for Help
The North Carolina Industrial Commission (NCIC) oversees workers’ compensation claims, including rehabilitation services and disputes about Form 25C.
| Contact Method | Details |
|---|---|
| Main Telephone | (919) 807-2500 |
| Helpline (Toll-Free) | (800) 688-8349 |
| Website | ic.nc.gov |
| Address | N.C. Industrial Commission, 433 N. Salisbury Street, Raleigh, NC 27603 |
What the Industrial Commission Can Help With
- Questions about Form 25C and your obligation to sign
- Understanding your rights regarding medical record access
- Rehabilitation Professional assignments and disputes
- Concerns about noncompliance or benefit suspension
- Filing motions or requesting hearings
- General workers’ compensation claim questions
What Is Form 25C and Why Does It Matter?
Purpose of Form 25C
Form 25C is the Authorization for Rehabilitation Professional to Obtain Medical Records of Current Treatment. It allows the Rehabilitation Professional assigned to your workers’ compensation case to access your medical records related to your work-related injury or occupational disease.
| Detail | Information |
|---|---|
| Form Name | Authorization for Rehabilitation Professional to Obtain Medical Records |
| Form Number | Form 25C (revision 07/2026) |
| Required By | North Carolina Workers’ Compensation Act |
| What It Authorizes | Release of medical records of treatment resulting from your work-related injury or occupational disease |
| Who Receives Access | The Rehabilitation Professional assigned to your case |
⚠️ Important Warning
The refusal of the claimant to sign this form upon the request of the Rehabilitation Professional may be deemed by the Industrial Commission to be noncompliance with rehabilitation and may result in the SUSPENSION OF BENEFITS.
This means that if you refuse to sign Form 25C without a valid legal reason, the Industrial Commission may determine you are not cooperating with your rehabilitation — and your workers’ compensation benefits could be suspended.
Who Is a Rehabilitation Professional?
A Rehabilitation Professional is a person assigned to your workers’ compensation case to help you recover and return to work. They may be:
| Type | Role |
|---|---|
| Rehabilitation Nurse | Coordinates medical care and monitors your recovery progress |
| Vocational Rehabilitation Counselor | Helps you return to suitable employment |
| Case Manager | Oversees your overall rehabilitation plan |
What a Rehabilitation Professional Does
- Coordinates your medical treatment
- Communicates with your doctors
- Monitors your recovery and return-to-work progress
- Reviews your medical records related to the work injury
- Helps identify suitable employment opportunities
- Reports to the insurance carrier and the Industrial Commission
How to Contact Your Rehabilitation Professional
Your assigned Rehabilitation Professional’s contact information will appear on Form 25C:
| Field on Form 25C | Information |
|---|---|
| Name | Full name of the Rehabilitation Professional |
| Address | Mailing address |
| Telephone | Direct phone number |
What to Do
- Review the information on Form 25C carefully
- Confirm the Rehabilitation Professional’s identity — make sure the name matches the person assigned to your case
- Sign and date the form
- Mail the completed form to the Rehabilitation Professional at the address listed on the form
How to Contact Your Insurance Carrier
Your employer’s workers’ compensation insurance carrier is involved in the rehabilitation process and can answer questions about your claim and assigned Rehabilitation Professional.
| Contact | Where to Find It |
|---|---|
| Carrier Name | Listed on Form 25C |
| Carrier Address | Listed on Form 25C |
| Carrier Telephone | Listed on Form 25C |
| Adjuster’s Name | Listed on Form 25C |
| Adjuster’s Email | Listed on Form 25C |
| Carrier Code # | Listed on Form 25C |
| Carrier File # | Listed on Form 25C |
What Your Insurance Carrier Can Help With
- Questions about your assigned Rehabilitation Professional
- Concerns about the rehabilitation process
- Status of your workers’ compensation claim
- Information about your benefits
- How to change or dispute a Rehabilitation Professional assignment
How to Contact Your Employer
Your employer is also listed on Form 25C and may be able to help with questions:
| Field on Form 25C | Information |
|---|---|
| Employer’s Name | Your employer’s legal name |
| Employer’s Address | Mailing address |
| Employer Code # | Employer identification code |
What Information Form 25C Requires You to Provide
When completing Form 25C, you’ll need to fill in or verify the following:
| Field | What to Enter |
|---|---|
| IC File # | Your Industrial Commission file number |
| Employee’s Name | Your full legal name |
| Address | Your home address (city, state, zip) |
| Home Telephone | Your home phone number |
| Work Telephone | Your work phone number |
| Last 4 Digits of SSN | Last four digits of your Social Security Number |
| Sex | M or F |
| Date of Birth | Your date of birth |
| Date of Injury/Disease | The date your work-related injury occurred or occupational disease was contracted |
| Employee’s Signature | Your handwritten signature |
| Date | The date you sign the form |
What Medical Records Are Released Under Form 25C
Form 25C authorizes the release of all medical records of treatment resulting from your work-related injury or occupational disease. This includes:
| Type of Records | Examples |
|---|---|
| Doctor’s notes | Office visit notes, progress reports |
| Diagnostic results | X-rays, MRIs, CT scans, lab work |
| Treatment records | Surgery notes, physical therapy records |
| Prescriptions | Medication records related to the injury |
| Specialist reports | Reports from orthopedists, neurologists, etc. |
| Hospital records | Admission notes, discharge summaries |
Important: Form 25C only covers records related to your work-related injury or occupational disease. It does not authorize access to unrelated medical records.
Your Rights Regarding Form 25C
| Right | Details |
|---|---|
| Know who is accessing your records | The Rehabilitation Professional must be identified by name, address, and phone on the form |
| Records limited to work injury | Only records related to your work-related injury or disease are released |
| Ask questions before signing | You can contact the NCIC Helpline at (800) 688-8349 before signing if you have concerns |
| Request a different Rehabilitation Professional | If you have concerns about the assigned professional, contact your carrier or the NCIC |
| Seek legal advice | You have the right to consult with a workers’ compensation attorney before signing |
What Happens If You Refuse to Sign Form 25C
| Consequence | Details |
|---|---|
| Noncompliance determination | The Industrial Commission may determine you are not complying with rehabilitation |
| Suspension of benefits | Your workers’ compensation benefits may be suspended |
| Hearing may be required | You may need to appear before the Commission to explain your refusal |
If You Have Concerns About Signing
Before refusing to sign, consider:
- Call the NCIC Helpline at (800) 688-8349 to understand your obligations
- Contact a workers’ compensation attorney for legal advice
- Speak with your Rehabilitation Professional about your specific concerns
- Contact your insurance carrier to discuss alternatives
How to Resolve Disputes About Form 25C or Your Rehabilitation Professional
If you disagree with your Rehabilitation Professional or have concerns about the process:
| Step | Action |
|---|---|
| 1. Talk to Your Rehabilitation Professional | Discuss your concerns directly — many issues can be resolved through communication |
| 2. Contact Your Insurance Carrier | The adjuster handling your claim may be able to address your concerns |
| 3. Call the NCIC Helpline | (800) 688-8349 — get guidance on your rights and options |
| 4. File a Motion | If the dispute cannot be resolved, you may need to file a motion with the Industrial Commission |
| 5. Consult an Attorney | A workers’ compensation attorney can represent your interests |
How to Request a Change of Rehabilitation Professional
If you believe your current Rehabilitation Professional is not acting in your best interest, you may request a change:
| Step | Action |
|---|---|
| 1. Document Your Concerns | Write down specific issues with your current Rehabilitation Professional |
| 2. Contact Your Insurance Carrier | Request a different professional and explain why |
| 3. Call the NCIC Helpline | (800) 688-8349 for guidance on your rights |
| 4. File a Motion with the Commission | If the carrier refuses, you may need to request a hearing |
| 5. Consult an Attorney | Legal representation may be necessary for complex disputes |
Where to Send Completed Form 25C
Mail the completed and signed Form 25C directly to the Rehabilitation Professional named on the form — not to the Industrial Commission.
| Action | Where to Send |
|---|---|
| Completed Form 25C | Mail to the Rehabilitation Professional’s address listed on the form |
| Keep a copy | Retain a signed copy for your own records |
| Do NOT send to NCIC | The Industrial Commission does not need a copy of this form |
Quick Reference: Contact Information
| Who to Contact | How | When |
|---|---|---|
| NCIC Helpline | (800) 688-8349 | Questions about Form 25C, your rights, rehabilitation disputes |
| NCIC Main Office | (919) 807-2500 | Claim information, hearings, legal questions |
| NCIC Website | ic.nc.gov | Forms, rules, resources |
| Your Rehabilitation Professional | Name/phone/address on Form 25C | Questions about your rehabilitation plan |
| Your Insurance Carrier/Adjuster | Name/phone/email on Form 25C | Claim status, benefit questions, concerns about rehab |
| Your Employer | Name/address on Form 25C | Work status, return-to-work questions |
| Workers’ Compensation Attorney | Search online or through NC Bar Association | Legal advice, disputes, representation |
Frequently Asked Questions
Q: Do I have to sign Form 25C?
A: Refusing to sign may be deemed noncompliance with rehabilitation and could result in suspension of your benefits. If you have concerns, call the NCIC Helpline at (800) 688-8349 or consult an attorney before refusing.
Q: Can the Rehabilitation Professional access all of my medical records?
A: No. Form 25C only authorizes access to medical records related to your work-related injury or occupational disease — not your entire medical history.
Q: What if I don’t know who my Rehabilitation Professional is?
A: Contact your insurance carrier or the NCIC Helpline at (800) 688-8349 to find out who has been assigned to your case.
Q: Can I choose my own Rehabilitation Professional?
A: Generally, the insurance carrier assigns the Rehabilitation Professional. However, you may request a change if you have valid concerns. Contact the NCIC for guidance.
Q: What if the information on Form 25C is incorrect?
A: Contact your insurance carrier or the NCIC Helpline to correct any errors before signing.
Q: Does signing Form 25C waive any of my rights?
A: No. Form 25C only authorizes the release of medical records related to your work injury. It does not waive your right to benefits, treatment, or legal representation.
Q: Can I get a copy of my medical records too?
A: Yes. You have the right to request copies of your own medical records from your healthcare providers at any time.
Q: What if I’m unhappy with my Rehabilitation Professional?
A: First, try to resolve the issue directly. If that fails, contact your insurance carrier, call the NCIC Helpline at (800) 688-8349, or consult a workers’ compensation attorney.
Important Reminders
- Form 25C is required under the Workers’ Compensation Act — it’s not optional.
- Refusing to sign may result in benefit suspension — contact the NCIC Helpline at (800) 688-8349 if you have concerns before refusing.
- Only work-injury records are released — the Rehabilitation Professional cannot access unrelated medical records.
- Mail the form to your Rehabilitation Professional — not to the Industrial Commission.
- Keep a signed copy for your own records.
- Verify the Rehabilitation Professional’s identity — make sure the name matches the person assigned to your case.
- You have the right to ask questions — call the NCIC, your carrier, or an attorney before signing.
- You can request a different Rehabilitation Professional if you have valid concerns.
- Your benefits depend on cooperation — noncompliance with rehabilitation can jeopardize your claim.
- Help is available — the NCIC Helpline at (800) 688-8349 is there to answer your questions.
This guide is based on N.C. Industrial Commission Form 25C (revision 07/2026). For the most current forms, rules, and information, visit ic.nc.gov or call the NCIC Helpline at (800) 688-8349.
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