The North Carolina 28 form is a crucial document used in the state's workers' compensation system. It serves as a Return to Work Report that employers must complete when an employee returns to work after a period of disability. This form ensures compliance with the Workers' Compensation Act and helps manage the employee's compensation status effectively.
The North Carolina 28 form, officially known as the Return to Work Report, plays a vital role in the workers' compensation process for employees who have been injured on the job. This form is essential for notifying the North Carolina Industrial Commission about an employee's return to work status after a period of disability. It captures important information such as the employee's name, contact details, and the specifics of their injury, including dates of injury and disability. The form also addresses situations where an employee has returned to work for reduced wages or with a different employer. It's crucial to note that this form should not be used if the employee is returning on a trial basis; in such cases, a different form, the Form 28T, is required. The employer or the insurance carrier must complete this form to ensure accurate reporting and compliance with the Workers' Compensation Act. Additionally, employees are informed about their rights regarding partial disability compensation during their return to work, especially if they are earning less than before their injury. Understanding the nuances of the North Carolina 28 form can help streamline the workers' compensation process, ensuring that both employees and employers are on the same page regarding compensation and work status.
Understanding the North Carolina 28 form can be challenging, and several misconceptions often arise. Here are six common misunderstandings about this important document:
By addressing these misconceptions, employees and employers can better navigate the complexities of the workers' compensation process in North Carolina.
The North Carolina 28 form is a critical document in the workers' compensation process. It serves to report an employee's return to work after a period of disability. Several other forms serve similar purposes in the realm of workers' compensation and employment reporting. Below is a list of nine documents that share similarities with the North Carolina 28 form:
Each of these forms plays a role in the workers' compensation system, ensuring that both employees and employers have a clear understanding of the status of claims, work capabilities, and compensation entitlements.
Completing the North Carolina 28 form is essential for reporting an employee's return to work after a disability. This process ensures that all relevant information is documented accurately. Follow the steps outlined below to fill out the form correctly.
NORTH CAROLINA INDUSTRIAL COMMISSION
IC File #
RETURN TO WORK REPORT
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
Address
City
State
Zip
(
)
Home Telephone
Work Telephone
M F
/
Social Security Number
Sex
Date of Birth
Employer's Name
Telephone Number
Employer’s Address
Insurance Carrier
Carrier's Address
Carrier's Telephone Number
Fax Number
Employer: The use of this form is not appropriate when an employee has returned to work on a trial return to work basis pursuant to N.C. Gen. Stat. § 97-32.1, in which case Form 28T must be used. By using this form you are stating that this case is not a trial return to work and that one of the exclusions contained in NCIC Rule 404A(7) applies.
Important Notice To Employee: Your disability compensation has been stopped because you have returned to work. You are entitled to a trial return to work for a period not to exceed nine months, unless you have been released by an authorized treating physician to unrestricted work, in which case your trial return to work may be limited to 45 days. During your trial return to work, you may be entitled to partial disability compensation if, because of your on-the-job injury, you earn less wages now than before your injury. If your trial return to work is unsuccessful, you should complete form 28U in order to request that your compensation be reinstated.
THE EMPLOYER OR CARRIER/ADMINISTRATOR MUST COMPLETE THE FOLLOWING
WHEN EMPLOYEE RETURNS TO WORK OTHER THAN ON A TRIAL RETURN TO WORK BASIS.
SECTION A. COMPLETE THE FOLLOWING:
1.Date of injury:
2.Date disability began:
3.Date returned to work:
SECTION B. COMPLETE IF EMPLOYEE RETURNED TO WORK FOR REDUCED WAGES:
Employee is being paid at the rate of $
weekly.
SECTION C. COMPLETE IF EMPLOYEE RETURNED TO WORK FOR A DIFFERENT EMPLOYER:
1.Name of that employer:
2.Address:
3.Telephone:
SIGNATURE OF EMPLOYER OR CARRIER/ADMINISTRATOR
TITLE
DATE
Employer: The original of this form shall be sent to the address below, and a copy sent to the employee and the employee's attorney of record, if any. A Form 28B must be filed to report the amount and last date compensation and/or medical compensation were paid.
MAIL TO: NCIC - CLAIMS SECTION
4335 MAIL SERVICE CENTER
FORM 28
RALEIGH, NC 27699-4335
2/01
MAIN TELEPHONE: (919) 807-2500
PAGE 1 OF 1
HELPLINE: (800) 688-8349
WEBSITE: HTTP://WWW.IC.NC.GOV/
North Carolina Non Resident Tax Return - The dosimetry evaluation discusses additional monitoring options for high-risk individuals.
When creating a loan agreement, it is important to utilize comprehensive resources that can guide you through the process. For example, the smarttemplates.net website offers fillable loan agreement templates that ensure all necessary details are captured accurately, helping to avoid any potential misunderstandings between the borrower and lender.
Workers Compensation North Carolina - If there are reasons for reinstatement, those must be clearly described in the appropriate section.
When dealing with workers' compensation in North Carolina, several forms accompany the North Carolina 28 form. Each document serves a specific purpose in the process, ensuring that both employees and employers fulfill their obligations under the law. Below is a list of related forms that may be necessary in various situations.
Understanding these forms can help streamline the workers' compensation process. Each document plays a vital role in protecting the rights of employees while also ensuring that employers comply with legal requirements. Always keep copies of any forms submitted for your records, and don't hesitate to seek assistance if needed.