Fillable North Carolina 28 Template

1. Failing to use Form 28T for trial return to work: Some individuals mistakenly use Form 28 for situations where an employee returns to work on a trial basis under N.C. Gen. Stat. § 97-32.1. However, in such cases, Form 28T is the correct form to use, as stated in the document's guidance.

2. Incorrect employer FEIN information: The Employer's Federal Employer Identification Number (FEIN) is often filled in incorrectly. This unique number is crucial for properly identifying the employer within the system and ensuring that the form is processed accurately.

3. Leaving the employee's work status details incomplete: The section of the form that requires information on whether the employee has returned to work for reduced wages or with a different employer is often not fully completed. This incomplete information can impact the employee's benefits and delay the processing of the form.

4. Not including the correct date of injury, disability begin date, and return to work date in SECTION A: These dates are vital for the North Carolina Industrial Commission to understand the timeline of the employee’s injury and recovery. Failure to accurately report these dates can result in delays or inaccuracies in benefit adjustments.

5. Forgetting to send copies to all required parties: The original form must be mailed to the NCIC - CLAIMS SECTION, and copies must be sent to the employee and the employee's attorney of record, if any. This step ensures all involved parties are informed of the employee’s return to work status. It’s a commonly missed step, leading to communication issues and potential legal complications.

• Ensure that all sections of the form are completed fully and accurately to avoid delays in processing and potential errors in benefit adjustments.

• Double-check the form for the correct FEIN and ensure that employee details, especially contact information and social security number, are filled out correctly.

• Communicate with the employee or their attorney (if applicable) to confirm receipt of the form and any updates on the status of their workers' compensation claim.

In the context of handling workers' compensation claims within North Carolina, the process involves several forms and documents beyond just the Form 28, Return to Work Report. Each of these forms serves a specific purpose in the intricate process of managing an employee's injury claim, ensuring both employee's rights and employer's responsibilities are clearly documented and communicated. Here's a look at some of the crucial forms and documents typically associated with or used in conjunction with the Form 28.

• Form 18: Notice of Accident to Employer and Claim of Employee, Representative, or Dependent - This form is the initial step in filing a workers' compensation claim, where the injured worker notifies the employer of the injury or occupational disease.
• Form 19: Report of Employee's Injury or Occupational Disease to the Employer - Employers use this form to report a worker's injury or occupational disease to the North Carolina Industrial Commission (NCIC).
• Form 22: Statement of Days Worked and Earnings of Employee - This form helps in calculating the wage replacement benefits by documenting the injured worker's earnings before and after the injury.
• Form 24: Application for Approval of Compromise Settlement Agreement - If there's a proposed settlement between the employer and the injured worker, this form outlines the terms of that agreement for NCIC's approval.
• Form 28B: Report of Compensation and Medical Compensation Paid - Following the Form 28, this document details the amount and the last date compensation and/or medical compensation were paid to the employee.
• Form 28C: Order Approving Career Rehabilitation Plan and Agreement - When a rehabilitation plan is part of the recovery process, this form records the agreement's approval by the NCIC.
• Form 28T: Trial Return to Work Agreement - As mentioned in Form 28, if the return to work is on a trial basis, this form outlines the agreement specifics between the employer and employee.
• Form 28U: Application for Reinstatement of Disability Compensation - If the trial return to work is unsuccessful, the employee uses this form to request the reinstatement of their disability compensation.
• Form 60: Employer’s Admission of Employee’s Right to Compensation - By submitting this form, an employer formally acknowledges an employee's injury or disease is compensable and agrees to pay benefits as required.

Together, these forms create a comprehensive framework for addressing workers' compensation claims, facilitating communication between all parties, and ensuring compliance with North Carolina's workers' compensation laws. The complexity of the process underscores the importance of understanding each form's role and the precise details that must be provided to successfully navigate a claim through the North Carolina Industrial Commission. Proper completion and timely submission of these documents help ensure that workers receive the support and compensation they're entitled to, while also safeguarding employers against potential legal issues.

The Form 28B mentioned in the North Carolina 28 form serves a complementary role in the overarching workers' compensation process. Similar to the purpose of the Form 28, which is utilized when an employee returns to work, the 28B focuses on documenting the cessation of compensation and/or medical benefits. This is crucial because it provides a structured means for reporting the end of benefits due to the employee’s return to work, highlighting the continuity and end-points of compensation, which supports accurate record-keeping and ensures lawful adherence to workers' compensation protocols.

The Form 28T, as directly referenced in the North Carolina 28 form, caters to employees undertaking a trial return to work. This distinct form underscores differences in the individuals’ return-to-work conditions compared to the standard outlined in Form 28, focusing on trial periods instead of permanent or long-term return scenarios. It is designed to accommodate the flexibility needed for employees to test their capacity to work in their pre-injury role or in a modified position, acknowledging the intricate nature of workplace injuries and the recovery process, while still within the framework of workers' compensation law.

Form 28U provides a mechanism for employees whose trial return to work, as outlined in Form 28T, was unsuccessful. This document is essential for employees seeking to have their disability compensation reinstated after an unsuccessful attempt to return to work. It embodies the principle of support and fairness within the workers' compensation system, ensuring that employees who are not yet ready to return to work due to their injuries have a clear path to request the continuation of their benefits, closely tying into the broader scope of workers' compensation by prioritizing employee health and recovery.

The Form 18 is another foundational document within North Carolina's workers' compensation system, initiating the process by requiring employees to formally notify their employer (and the Industrial Commission) of an injury or occupational illness. This form sets the stage for all subsequent actions and documents, including Form 28, by officially recording the incident, which is crucial for establishing the validity of the claim and the employee’s eligibility for benefits. Its importance cannot be understated, as it activates the protective measures afforded by the Workers' Compensation Act.

Similarly, the Form 19, completed by the employer, reports the injury to the North Carolina Industrial Commission. This document parallels the intent behind the employee-submitted Form 18, from another perspective, ensuring that there is a mutual acknowledgment between the employer and the employee about the occurrence of a workplace injury or illness. The dual reporting mechanism established by Forms 18 and 19 ensures transparency and compliance with regulatory requirements, facilitating a smooth transition into the administrative and compensatory phases of workers' compensation proceedings.

Form 60 is used by employers or their insurance carriers to admit liability for an employee's claim of a work-related injury without prejudice and to begin payment of temporary total disability benefits. This acknowledgment is a critical step that enables the injured worker to receive the benefits they are entitled to under the Workers' Compensation Act. The issuance of Form 60 signifies a formal acceptance of the claim by the employer/carrier, which stands in contrast to situations where the return to work process documented by Form 28 might occur, indicating progression in the employee’s recovery and case status.

Lastly, Form 61, which allows for the denial of a workers' compensation claim by an employer or insurance carrier, contrasts with Form 28 by representing a different pathway in the response to a claim. While Form 28 deals with the scenario of an employee returning to work, Form 61 is utilized when the employer or insurer disputes the claim’s validity. This document highlights the spectrum of outcomes within the workers' compensation process, from acceptance and management of recovering employees’ return to work to the denial of claims, illustrating the diverse administrative processes involved in these cases.

When completing the North Carolina Industrial Commission Form 28, which is a Return to Work Report, there are certain practices that one should follow to ensure the accuracy and effectiveness of the submission. Below is a list of recommended actions to take, as well as actions to avoid, to facilitate a smooth return-to-work process for employees recovering from workplace injuries.

Things You Should Do:

1. Ensure all sections of the form are completed fully and accurately. This includes the employee's name, date of injury, and the date they returned to work.

2. Include detailed information if the employee is returning to work at reduced wages or for a different employer, as outlined in Sections B and C of the form.

3. Verify that the employee is not returning to work on a trial basis as specified by N.C. Gen. Stat. § 97-32.1. If so, use Form 28T instead.

4. Send the original form to the specified NCIC address, and distribute copies to the employee and the employee's attorney if one is involved.

5. Accurately report the employee's wage rate if they are returning to work at reduced wages to ensure proper calculation of any partial disability compensation.

6. Consult the North Carolina Industrial Commission's guidelines or legal counsel if you are unsure about how to complete the form or if you have questions about the employee's return to work status.

Things You Shouldn't Do:

1. Do not leave any sections blank. If a section does not apply, indicate this with "N/A" for not applicable.

2. Avoid guessing or estimating dates and figures. Verify all information for accuracy before submitting the form.

3. Do not use Form 28 for employees returning to work on a trial basis. The correct form for such situations is Form 28T.

4. Refrain from sending incomplete forms. Incomplete submissions can lead to delays in processing and potential issues for the employee.

5. Do not overlook the requirement to send a copy of the form to the employee and, if applicable, their attorney. This step is crucial for maintaining transparent communication.

6. Avoid delaying the submission of Form 28. Timely reporting is essential for the continuation of benefits and compliance with workers' compensation regulations.

By adhering to these guidelines, employers can assist their employees in a successful return to work while ensuring compliance with North Carolina's workers' compensation regulations.

Understanding the North Carolina Form 28 requires clearing up some common misconceptions that employees and employers alike often have. This form is crucial in the process of workers' compensation claims, especially when an employee returns to work after an injury. Here are four misconceptions about the North Carolina Form 28:

• Form 28 is the only document needed when an employee returns to work: This is a misconception. While Form 28 is required for reporting the return to work, depending on the circumstances, other forms like Form 28T for trial returns or Form 28B for reporting compensation might also be necessary. The specific form depends on whether the return is on a trial basis and if there are changes in compensation due to reduced wages or different employment.
• Any return to work negates the need for further workers' compensation: Some believe once an employee fills out Form 28 and returns to work, they are no longer eligible for any workers' compensation benefits. This is incorrect. Employees may be entitled to partial disability compensation if their current wages are lower than before their injury. The trial return to work period, not exceeding nine months, is designed to assess the employee's ability to work post-injury while potentially receiving partial compensation.
• Form 28 is only for the employer's records: While employers are responsible for completing and submitting Form 28, it's crucial to remember that a copy must be sent to the employee and their attorney, if they have one. This ensures that all parties are informed of the employee's return to work status and can address any issues with compensation or job duties.
• Form 28 applies in all return-to-work situations: This is not true. Form 28 is specifically not suitable when an employee is returning to work on a trial basis under N.C. Gen. Stat. § 97-32.1, which requires the use of Form 28T. Understanding when to use Form 28 versus Form 28T is crucial for compliance with the Workers' Compensation Act provisions and for accurately documenting the return-to-work process.

Correctly navigating the use of Form 28 and other related forms is essential for both employer and employee. It ensures that the return to work after an injury is properly managed and that any continuing benefits are appropriately handled. Clear communication and understanding of these documents help prevent unnecessary complications in workers' compensation claims.

The North Carolina Form 28, also known as the Return to Work Report, plays a crucial role in the process of managing workers' compensation claims. Understanding its purpose and requirements is essential for employers, employees, and insurers.

• Specific Usage: Form 28 is required under the Workers' Compensation Act in North Carolina for reporting an employee's return to work, except when the return is on a trial basis.
• Alternative Forms: Should the return to work be on a trial basis under N.C. Gen. Stat. § 97-32.1, Form 28T, not Form 28, must be utilized, indicating the special provisions for trial returns to work.
• Disability Compensation: The form serves as a notification that disability compensation will cease because the employee has resumed work, potentially affecting the employee's financial support.
• Trial Return to Work: Employees are entitled to a trial return to work lasting up to nine months, during which they might qualify for partial disability compensation if they earn less than before their injury.
• Unsuccessful Trial Work: In cases where a trial return to work is unsuccessful, employees should complete Form 28U to request the reinstatement of their compensation.
• Detailed Reporting: Form 28 requires detailed information about the employee's return, including the injury date, disability start date, and return to work date.
• Reduced Wages: If an employee returns to work at reduced wages, this must be noted in Section B, specifying the new wage rate.
• Change of Employer: Section C addresses situations where an employee returns to work for a different employer, requiring the new employer's details.

By completing and submitting the North Carolina Form 28 accurately, employers and insurance carriers contribute to a transparent and fair workers' compensation system. It ensures that employees' rights are protected while also fulfilling statutory obligations.