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Common mistakes

Filling out the North Carolina 28 form can be straightforward, but many people make common mistakes that can delay the process or lead to complications. One frequent error is not providing complete information in the required fields. Each section is crucial, and missing details can result in the form being returned or rejected.

Another mistake is using the wrong form altogether. This form is specifically for reporting when an employee returns to work, but if the return is on a trial basis, Form 28T should be used instead. Failing to use the correct form can lead to misunderstandings regarding the employee's status.

People often overlook the importance of signatures. The form must be signed by the employer or the carrier/administrator. An unsigned form will not be processed, so it’s essential to double-check this before submission.

Incorrect dates are another common issue. The form requires specific dates: the date of injury, the date disability began, and the date the employee returned to work. If any of these dates are wrong or unclear, it can create confusion and delay the claims process.

Many individuals also fail to update the employee's information, such as their address or phone number. This can lead to communication issues and delays in receiving important information or payments.

Another mistake is not indicating whether the employee returned to work for reduced wages. If this applies, it’s vital to fill out the relevant section accurately. This information affects the employee's compensation and should be clearly stated.

Some people forget to include the employer's details, such as the name and address. This information is necessary for processing the claim and ensuring that all parties are properly informed.

Additionally, not providing the correct insurance carrier information can complicate matters. It’s essential to include the insurance carrier’s name, address, and contact number to avoid delays in the claims process.

Another common error is neglecting to send copies of the form to the employee and their attorney, if applicable. This step is crucial for keeping all parties informed about the status of the claim.

Lastly, failing to mail the original form to the correct address can lead to significant delays. The form should be sent to the NCIC Claims Section at the specified address. Double-checking the mailing address can prevent unnecessary complications.

Similar forms

The North Carolina Form 28 is similar to the Form 28T, which is specifically designed for cases involving a trial return to work. While the Form 28 serves to report an employee's return to work under standard circumstances, the Form 28T is used when an employee has returned to work on a trial basis after a workplace injury. This distinction is crucial because the trial return to work period allows for the possibility of partial disability compensation if the employee earns less than before the injury. Therefore, the two forms address different scenarios under the Workers' Compensation Act, but both aim to document the employee's work status and related compensation issues.

Another document that shares similarities with the Form 28 is the Form 28U. This form is utilized when an employee who has returned to work on a trial basis finds that their return is unsuccessful. In such cases, the employee can request reinstatement of their compensation by submitting the Form 28U. While the Form 28 indicates that the employee has returned to work, the Form 28U serves as a follow-up mechanism for those who may need to re-establish their benefits due to complications arising from their injury. Both forms are essential in managing the ongoing relationship between the employee, employer, and insurance carrier.

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The Form 19 is another related document, as it is used to report an employee's injury to the North Carolina Industrial Commission. This form is typically submitted shortly after an injury occurs and serves to initiate the claims process. While the Form 28 focuses on the employee's return to work and its implications for compensation, the Form 19 lays the groundwork for the entire claim by providing details about the injury. Both forms are integral to the workers' compensation process, ensuring that all necessary information is communicated to the relevant parties.

Lastly, the Form 26 is comparable to the Form 28 in that it is used to report changes in the employee's disability status. The Form 26 is specifically for reporting a change in the employee's compensation rate due to changes in their work status or medical condition. While the Form 28 confirms that an employee has returned to work, the Form 26 addresses the financial implications of that return. Both forms are essential for maintaining accurate records and ensuring that employees receive the appropriate benefits throughout their recovery process.

Key takeaways

Filling out the North Carolina 28 form is an important process for both employers and employees involved in workers' compensation cases. Here are key takeaways to consider:

  • Purpose of the Form: The North Carolina 28 form is used to report an employee's return to work after a period of disability. It is essential to ensure that this form is completed accurately to avoid complications with compensation claims.
  • Trial Return to Work Exclusion: This form should not be used if an employee is returning to work on a trial basis. In such cases, Form 28T is required. Ensure you understand the distinction to avoid incorrect submissions.
  • Compensation Status: When filling out the form, note that an employee's disability compensation will cease upon returning to work. If the return is unsuccessful, employees should complete Form 28U to request reinstatement of their compensation.
  • Submission Requirements: After completing the form, the original must be sent to the NC Industrial Commission, while copies should be provided to the employee and their attorney, if applicable. Ensure timely and accurate submission to maintain compliance.

Frequently Asked Questions

What is the purpose of the North Carolina 28 form?

The North Carolina 28 form, also known as the Return to Work Report, serves to notify the North Carolina Industrial Commission about an employee's return to work following a workplace injury. This form is essential for documenting that the employee has resumed their job duties, which impacts their eligibility for disability compensation. By completing this form, the employer or carrier confirms that the return to work is not on a trial basis, thereby ensuring compliance with the Workers' Compensation Act.

Who is required to complete the North Carolina 28 form?

The responsibility for completing the North Carolina 28 form lies with the employer or the insurance carrier/administrator. This requirement arises when an employee returns to work after a workplace injury, but not on a trial basis. If the employee is returning under a trial return to work arrangement, a different form, known as the Form 28T, must be utilized instead. It is crucial for the employer to accurately fill out the form to avoid any complications with the employee's compensation status.

What information must be provided on the North Carolina 28 form?

Several key pieces of information are required on the North Carolina 28 form, including:

  1. Date of injury
  2. Date disability began
  3. Date returned to work
  4. If applicable, the employee's new wage rate if they have returned to work for reduced wages
  5. If applicable, details about a different employer, including name, address, and telephone number

Additionally, the form must include the signatures of the employer or carrier/administrator, along with their title and the date of completion. This information ensures that all parties are informed and that the employee's return to work is properly documented.

What should an employee do if their trial return to work is unsuccessful?

If an employee finds that their trial return to work is unsuccessful, they should complete the Form 28U. This form is used to request the reinstatement of their compensation. It is important for the employee to take this step promptly to ensure they receive the benefits they are entitled to due to their on-the-job injury. The process is designed to support employees as they navigate their recovery and return to work.

Where should the North Carolina 28 form be submitted?

The original North Carolina 28 form must be mailed to the following address:

NCIC - Claims Section
4335 Mail Service Center
Form 28
Raleigh, NC 27699-4335

Additionally, a copy of the form should be provided to the employee and their attorney of record, if applicable. This ensures that all relevant parties are informed of the employee's return to work status and any changes to their compensation.

Instructions on How to Fill Out North Carolina 28

Filling out the North Carolina 28 form is an important step after an employee returns to work following a workers' compensation claim. Ensure you have all necessary information ready before you start. Follow these steps to complete the form accurately.

  1. Enter the IC File #, Emp. Code #, Carrier Code #, and Carrier File # at the top of the form.
  2. Fill in the Employer FEIN.
  3. Provide the Employee’s Name, Address, City, State, and Zip.
  4. Include the Home Telephone and Work Telephone numbers.
  5. Mark the employee’s Sex (M or F) and enter the Date of Birth.
  6. Fill in the Employer's Name, Telephone Number, and Employer’s Address, including City, State, and Zip.
  7. Provide the Insurance Carrier name and their Address, City, State, and Zip.
  8. Enter the Carrier's Telephone Number and Fax Number.
  9. In Section A, fill in the Date of Injury, Date Disability Began, and Date Returned to Work.
  10. If the employee returned to work for Reduced Wages, complete Section B with the weekly pay rate.
  11. If the employee returned to work for a Different Employer, complete Section C with the new employer's Name, Address, and Telephone.
  12. Have the Employer or Carrier/Administrator sign the form, and include their Title and Date.

After completing the form, send the original to the specified address and provide copies to the employee and their attorney, if applicable. Ensure all information is accurate to avoid delays in processing.

Form Attributes

Fact Name Description
Form Purpose The North Carolina 28 form is used to report an employee's return to work after a workers' compensation claim.
Governing Law This form is governed by the North Carolina Workers' Compensation Act, specifically N.C. Gen. Stat. § 97-32.1.
Trial Return to Work If an employee returns to work on a trial basis, Form 28T must be used instead of the 28 form.
Compensation Notice Employees must be informed that their disability compensation will stop upon returning to work.
Partial Disability Compensation Employees returning to work for reduced wages may be eligible for partial disability compensation.
Submission Requirements The employer or carrier must complete specific sections of the form when the employee returns to work.
Mailing Address The completed form should be mailed to the NC Industrial Commission at 4335 Mail Service Center, Raleigh, NC 27699-4335.
Employee Rights Employees have the right to request reinstatement of compensation if their trial return to work is unsuccessful.
Contact Information The form includes contact details for the NC Industrial Commission, including a helpline and website.
Form Version This version of the form was last updated in February 2001.