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Common mistakes

Filling out the North Carolina 90 form can seem straightforward, but many people make common mistakes that could jeopardize their workers' compensation benefits. Understanding these pitfalls can help ensure that your form is completed correctly and submitted on time.

One frequent mistake is failing to report all earnings. Some individuals think that if they earned money from a side job or self-employment, it doesn't need to be disclosed. However, the form requires you to report any earnings, regardless of the source. This includes cash, wages, commissions, and even non-cash benefits. Not reporting these earnings can lead to serious consequences, including the suspension of benefits.

Another error occurs when individuals do not sign the form. A signature is a crucial part of the process. Without it, the form is considered incomplete, and the insurance carrier may not process it. Ensure that you sign and date the form before submitting it. This small step can save you from unnecessary delays and complications.

People often overlook the deadline for submission. The form must be returned within 15 days of receipt, even if there are no earnings to report. Missing this deadline can result in the suspension of benefits. Setting a reminder can help you stay on track and ensure timely submission.

Additionally, some individuals fail to provide complete information about their employers or businesses. It's essential to include accurate names, addresses, and dates worked for each employer. Incomplete information can lead to confusion and delays in processing your benefits.

Another common mistake is misunderstanding the definition of "gross earnings." Some individuals only report their take-home pay, neglecting bonuses or commissions. Remember, gross earnings include all pre-tax income. Misreporting your earnings can lead to penalties or even criminal charges.

Many people also forget to read the instructions thoroughly. The form contains important information about what needs to be reported and how to fill it out correctly. Taking a few extra minutes to read through the guidelines can prevent errors that could cost you your benefits.

Finally, some individuals do not keep a copy of the submitted form. It's wise to retain a copy for your records. If any issues arise, having documentation can help clarify misunderstandings and protect your rights.

By avoiding these common mistakes, you can ensure that your North Carolina 90 form is completed accurately and submitted on time, helping you maintain your workers' compensation benefits without unnecessary complications.

Similar forms

The North Carolina Form 18 is similar to the Form 90 as it serves as a notice of injury to the employer. Both forms are essential in the workers' compensation process, ensuring that the employer is informed about an employee's injury. The Form 18 specifically details the circumstances of the injury, while the Form 90 focuses on the employee's earnings during their time off work. Both documents play a crucial role in determining the benefits an employee may receive following an injury.

The Form 19, known as the "Employer's Report of Injury," also parallels the Form 90. This form is completed by the employer to report the details of an employee's injury to the North Carolina Industrial Commission. Like the Form 90, the Form 19 is important for maintaining accurate records and helps in the assessment of workers' compensation claims. Both forms contribute to the overall understanding of the employee's situation and the employer's responsibilities.

The Form 20, or "Employee's Claim," is another document that shares similarities with the Form 90. This form is used by employees to formally file a claim for workers' compensation benefits. While the Form 90 focuses on earnings and reporting requirements, the Form 20 emphasizes the employee's injury and the need for compensation. Both forms are vital for processing claims and ensuring that employees receive the benefits they deserve.

The Form 21, "Agreement for Compensation," is also akin to the Form 90. This document is used when an employer and employee agree on the amount of compensation for an injury. Similar to the Form 90, the Form 21 requires accurate information to ensure that the employee receives the appropriate benefits. Both forms are crucial in the negotiation and settlement process of workers' compensation claims.

The Form 26, "Notice of Termination of Compensation," has a relationship with the Form 90 as it informs employees when their benefits will be terminated. While the Form 90 gathers information about ongoing earnings, the Form 26 is focused on the conclusion of benefits. Both forms highlight the importance of communication between the employer and employee regarding the status of workers' compensation benefits.

The Form 28, "Application for Review," is similar to the Form 90 in that it allows for the reevaluation of a workers' compensation claim. Employees can use this form to request a review of their case if they believe their benefits are insufficient. While the Form 90 is concerned with reporting earnings, the Form 28 focuses on the outcome of the claim process, emphasizing the need for ongoing assessment of benefits.

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The Form 30, "Request for Hearing," is another document that relates to the Form 90. This form is used by employees who wish to contest a decision made by the workers' compensation system. While the Form 90 is primarily about reporting earnings, the Form 30 addresses disputes and the need for a formal hearing. Both forms are integral to the workers' compensation process, ensuring that employees have avenues to address their concerns.

Lastly, the Form 31, "Final Settlement Agreement," shares similarities with the Form 90 as it concludes the workers' compensation claim process. This form is used to finalize the terms of compensation between the employer and employee. While the Form 90 is focused on current earnings, the Form 31 wraps up the financial aspects of the claim, highlighting the importance of clear documentation throughout the workers' compensation journey.

Key takeaways

Filling out and using the North Carolina 90 form is a crucial part of the workers' compensation process. Here are some key takeaways to keep in mind:

  • Timeliness is Essential: Employees must complete and return the form within 15 days of receipt. Failure to do so may lead to a suspension of benefits.
  • Report All Earnings: Any earnings from work, including self-employment, must be reported. This includes cash, wages, commissions, and bonuses, regardless of whether they were earned before the injury.
  • Honesty is Crucial: Making false statements or concealing material facts can result in serious penalties, both civil and criminal. Transparency is vital for maintaining benefits.
  • Signature Affirmation: By signing the form, employees affirm that they have not made any false claims regarding their entitlement to benefits. This signature is a legal commitment to accuracy.
  • Reinstatement of Benefits: If benefits are suspended due to a failure to return the form, they must be reinstated with back payment once the form is submitted. Employees can request an order for reinstatement if necessary.

Frequently Asked Questions

What is the North Carolina 90 form?

The North Carolina 90 form, officially known as the Report of Earnings, is a document required under the Workers' Compensation Act. It is used by employers and insurance carriers to verify an employee's ongoing eligibility for workers' compensation benefits. The form collects information about any earnings the employee may have received during a specified time period. It is essential for maintaining accurate records and ensuring that benefits are provided in compliance with the law.

Who is required to complete the North Carolina 90 form?

Employees who are receiving workers' compensation benefits must complete the North Carolina 90 form. This requirement applies even if the employee has no earnings to report. The form must be filled out and returned to the employer or insurance carrier within 15 days of receipt. Failure to do so can result in the suspension of benefits, making it crucial for employees to adhere to this timeline.

What types of earnings need to be reported on the form?

When completing the North Carolina 90 form, employees must report any earnings they have received during the specified time period. This includes:

  • Wages or salary from any employment outside of the job where the injury occurred.
  • Self-employment income.
  • Commissions and bonuses.
  • Any cash value received in forms other than cash, such as benefits or housing allowances.

It is important to note that earnings earned before the disability does not need to be reported. However, all work, regardless of profit or loss, must be disclosed.

What happens if I fail to report my earnings?

Not reporting earnings as required can lead to serious consequences. If an employee fails to complete and return the North Carolina 90 form in a timely manner, their workers' compensation benefits may be suspended. Additionally, making false statements on the form can result in civil and criminal penalties. Employees are encouraged to report all earnings truthfully to avoid any legal repercussions.

What should I do if my benefits are suspended?

If an employee's benefits are suspended due to the failure to submit the North Carolina 90 form, they can have their benefits reinstated by promptly submitting the completed form. If benefits are not reinstated immediately after submission, the employee should write to the North Carolina Industrial Commission requesting an order to reinstate benefits. This request should be addressed to the Office of the Executive Secretary, ensuring that the employee's rights are protected.

Instructions on How to Fill Out North Carolina 90

Filling out the North Carolina 90 form is essential for maintaining your workers' compensation benefits. After completing the form, it must be returned to your employer or insurance carrier promptly to ensure there are no interruptions in your benefits.

  1. Begin by entering the IC File #, Employer Code #, Carrier Code #, and Carrier File # at the top of the form.
  2. Provide the Employer FEIN in the designated section.
  3. Fill in your name, address, city, state, and zip code.
  4. Enter your home telephone and work telephone numbers.
  5. Indicate your gender by checking the appropriate box (M or F).
  6. Provide your social security number and date of birth.
  7. Next, fill in your employer's name, telephone number, and address details.
  8. Complete the insurance carrier and their address information.
  9. In the section labeled "To Employees," read the instructions carefully.
  10. Identify the time period covered by this report by entering the start and end dates.
  11. Answer questions (1) and (2) regarding your earnings during the specified time period by checking YES or NO.
  12. If you answered NO to both questions, sign and return the form as instructed.
  13. If you answered YES to either question, proceed to complete item (5).
  14. List your earnings for each employer or business you worked for during the time period, including location, dates worked, and gross earnings.
  15. Sign and date the form at the bottom.
  16. Return the completed form to the insurance carrier or employer as specified.

Form Attributes

Fact Name Description
Purpose of Form The North Carolina Form 90 is used to report an employee's earnings while receiving workers' compensation benefits.
Governing Law This form is governed by the North Carolina Workers' Compensation Act.
Submission Deadline Employees must complete and return the form within 15 days of receipt, even if they have no earnings.
Consequences of Non-Compliance Failure to submit the form on time may result in the suspension of workers' compensation benefits.
Definition of Earnings Earnings include all cash, wages, bonuses, commissions, and non-cash benefits received from any employment.
Self-Employment Reporting Employees must report earnings from self-employment, regardless of whether the business was profitable.
False Statements Making false claims on this form can lead to civil and criminal penalties.
Employer Responsibilities Employers or insurance carriers must provide the form to employees and include a self-addressed stamped envelope for its return.
Reinstatement of Benefits If benefits are suspended, they must be reinstated with back pay upon submission of the completed form.
Contact Information The form includes contact details for the North Carolina Industrial Commission for assistance.