North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter L - INDUSTRIAL COMMISSION FORMS › Section .0100 - WORKERS' COMPENSATION FORMS › Section 23L .0105 - FORM T-42 - APPLICATION FOR APPOINTMENT OF GUARDIAN AD LITEM

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Persons seeking to appear on behalf of an
				  infant or incompetent shall apply on a Form T-42, Application for Appointment
				  of Guardian Ad Litem, in accordance with Rule
				  11 NCAC
				  23B .0203. The Form T-42, Application for
				  Appointment of Guardian Ad Litem, shall read as follows:
North Carolina Industrial Commission
IC File # T
A
- __________
Application for Appointment of Guardian Ad Litem
The use of this Form is required under Rule
					 11 NCAC
					 23B .0203
___________ Plaintiff(s) v. _________Defendant(s)
To the North Carolina Industrial Commission:
The undersigned __________ respectfully shows unto the
					 North Carolina Industrial Commission that __________ is an __ infant or __
					 incompetent without general or testamentary guardian in this State, and that by
					 reason thereof can bring an action only by a guardian ad litem; that the infant
					 or incompetent has a cause of action against the defendants on account of the
					 following matter and things:
_____________________________________________________________________________________________
The undersigned is a reputable person closely connected
					 with the infant or incompetent having the relationship with the infant or
					 incompetent as follows:
					 _______________________________________________________________
Wherefore, the undersigned prays the Commission that a fit
					 and proper person be appointed Guardian Ad Litem for the infant or incompetent
					 for the purpose of bringing on his or her behalf an action as above set
					 out.
Signature of Applicant
					 __________________________________________________
					 Date____________________
(Please complete page 2 of form)
Order Appointing Guardian Ad Litem
It appearing to the North Carolina Industrial Commission
					 from the above application that ____________________ is an __ infant or __
					 incompetent having no general or testamentary guardian within this State and
					 that said infant or incompetent appears to have a good cause of action against
					 the defendant(s); and it further appearing to the Commission after due inquiry
					 that ____________________ is a fit and proper person to be appointed guardian
					 ad litem for the infant or incompetent for the purpose of bringing this action
					 on his or her behalf;
It is therefore ordered that ____________________ be and is
					 hereby appointed guardian ad litem of ____________________ to bring action on
					 his or her behalf.
This __________ day of ____________________.
Commissioner, Deputy Commissioner, or Executive
					 Secretary______________________________________________________________________
Please type or print:
Full name and address of minor or incompetent:
_____________________________________________________________________________________________
Birth date of minor: ____________________
Full name and address of proposed guardian ad litem:
_____________________________________________________________________________________________
Important Information for Parties
Parties should take notice of the provisions set forth in
					 Rule 11
					 NCAC 23B .0203.
11 NCAC 23B .0203 Infants and
					 Incompetents
(a) Persons seeking to
				  appear on behalf of an infant or incompetent, in accordance with
				  G.S.
				  1A-1, Rule 17, shall apply on a Form T-42
				  Application for Appointment of Guardian ad Litem. The Commission shall appoint
				  a fit and proper person as guardian ad litem, if the Commission determines it
				  to be in the best interest of the minor or incompetent. The Commission shall
				  appoint the guardian ad litem only after due inquiry as to the fitness of the
				  person to be appointed.
(b) The
				  Commission may assess a fee to be paid to an attorney who serves as a guardian
				  ad litem for actual services rendered upon receipt of an affidavit of actual
				  time spent in representation of the minor or incompetent as part of the costs.
ATTORNEYS
: File via Electronic Document Filing
					 Portal ("EDFP")
https://www.ic.nc.gov/docfiling.html
UNREPRESENTED PLAINTIFFS
: File via EDFP,
https://www.ic.nc.gov/docfiling.html
OR
Mail to: Industrial Commission Clerk-s Office, 1236 Mail
					 Service Center, Raleigh NC 27699-1236 OR
File via hand delivery: Business days from 8 a.m. - 5 p.m.,
					 Dobbs Building, 6th floor, 430 N. Salisbury
					 Street,
Raleigh NC 27603 OR Fax to (919) 715-0282 OR Email to
					 dockets@ic.nc.gov.
FORM T-42
(b) A
				  copy of the form described in Paragraph (a) of this Rule can be accessed at
https://www.ic.nc.gov/forms/formt-42.pdf
. The form shall be reproduced only in the format available at
https://www.ic.nc.gov/forms/formt-42.pdf
and shall not be altered or amended in any way.
Authority
					 G.S.
					 143-291;
					 143-295;
					 143-300;
Eff. March
					 1, 2019;
Amended Eff. March 1,
					 2021.