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North Carolina State Bar Board of Legal Specialization
Supplemental Materials for Workers’ Compensation Law Recertification Applicants Only
(Attach additional pages, if necessary)
Name: ________________________________________
IV. Substantial Involvement
Briefly summarize your experience, during the preceding five years, in the matters listed below.
Briefly summarize your experience as principal counsel of record, in cases tried to an opinion and award of the NC
Industrial Commission. Dependency and disfigurement cases should not be included unless a case involved
complicated factual and/or legal issues. An occupational disease case may be listed here if it is not also listed in
Section B. below. (Attach additional pages, if necessary)
A.
B. Occupational Disease Cases. Briefly summarize your experience with occupational disease cases that you
tried to opinion and award including a description of factual and legal issues. (Attach additional pages, if
necessary)
C. Mediations. Briefly summarize your experience in mediations of workers’ compensation cases in which you
participated either as a representative of a party or as a mediator. (Attach additional pages, if necessary)
D. Appeals. Briefly summarize your experience in handling appeals of workers’ compensation cases to the
North Carolina Court of Appeals of North Carolina Supreme Court. For each appeal discussed, indicate
whether you made the oral argument and/or wrote the brief. (Attach additional pages, if necessary)
E. Other Relevant Experience. Briefly summarize your other workers’ compensation experience including
teaching, training, advocacy and counseling, and public service. (Attach additional pages, if necessary)
