We use cookies to improve security, personalize the user experience, enhance our marketing activities (including cooperating with our marketing partners) and for other business use.
Click "here" to read our Cookie Policy. By clicking "Accept" you agree to the use of cookies. Read less
Read more
Accept
Loading
Form preview
  • US Legal Forms
  • Form Library
  • Labor Forms
  • North Carolina Labor Forms
  • Nc Form 28u 2016

Get Nc Form 28u 2016

IN The Use Of This Form Is Required Under The Provisions of The Workers' Compensation Act ( Employee’s Name Employer's Name Address Employer’s Address City ( State ) ( Home Telephone / Sex Telephone Number City State Zip City State Zip Insurance Carrier Zip ) Work Telephone M F Social Security Number ) Carrier's Address ( / Date of Birth ) ( Carrier's Telephone Number ) Fax Number SECTION A. EMPLOYEE: COMPLETE AND MAIL TO EMPLOYER AND CARRIER/ADMINISTRATOR.

How it works

  1. Open form

    Open form follow the instructions

  2. Easily sign form

    Easily sign the form with your finger

  3. Share form

    Send filled & signed form or save

How to fill out the NC Form 28U online

Filling out the NC Form 28U is essential for individuals seeking to request reinstatement of their compensation following an unsuccessful trial return to work. This guide provides clear, step-by-step instructions to help users accurately complete the form online.

Follow the steps to successfully complete the NC Form 28U.

  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. Begin by entering your employee identification number in the Emp. Code # field, followed by the Carrier Code # and your Employer FEIN. This information is critical for linking your request with your records.
  3. Enter your full legal name in the Employee’s Name field, followed by your Employer's Name and the Employer’s Address. Make sure to include the city, state, and zip code for accurate processing.
  4. Provide your home telephone number, work telephone number, and your date of birth. Include your Social Security Number for identification purposes.
  5. In Section A, clearly state your request for the total disability compensation to be resumed immediately. Specify the name of the employer where you had a trial return to work, along with the start and end dates of that employment.
  6. Detail the reasons you are no longer able to work in the space provided. This section allows you to explain your circumstances to support your request.
  7. Obtain a statement from your authorized treating physician, confirming you are unable to continue the trial work return due to your injury. Ensure the statement includes the physician's name, medical specialty, and signature.
  8. If your return to work was with the same employer from whom you received workers' compensation, sign at the designated section and skip to the end. If it was with a different employer, continue to complete Section B.
  9. In Section B, fill out the last employer's name and address, granting them the authority to release specific employment information regarding your trial return to work.
  10. Make sure to sign and date the document where indicated. After completing the form, ensure a copy is sent to your employer and carrier/administrator while sending the original to the Industrial Commission.
  11. After reviewing the completed form for accuracy, users can save changes, download, print, or share the document as necessary.

Complete your NC Form 28U online today to streamline your compensation reinstatement request.

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.

Related content

Form 28U - Notice of Accident to Employer - NC.gov
SECTION A. EMPLOYEE: COMPLETE AND MAIL TO EMPLOYER AND CARRIER/ADMINISTRATOR, AND TO THE...
Learn more
North Carolina State Government WORKERS ' ...
This form is used to notify the NCIC of a claim and will be provided by the employer or...
Learn more
User manual and system documentation of WAVEWATCH...
by EM Center · 2016 — While code management of this system is undertaken by the...
Learn more

Related links form

Birth Abroad Certificate Helena Montana Form Temporary Guardianship Employees Pension Scheme 1995 Form Annex 1 Notification Form Ship Stations Radio Regulations Rr Article 20

Questions & Answers

Get answers to your most pressing questions about US Legal Forms API.

Contact support

Yes, you can be fired while on workers' compensation in North Carolina, especially if your employer cites issues unrelated to your claim, such as performance or company policy violations. Employers cannot retaliate against you solely for filing a claim but can terminate employment under legitimate circumstances. It's essential to understand your rights and seek assistance from legal resources or platforms like uSlegalforms to navigate these complex situations, including forms such as the NC Form 28U.

Filing a workers' comp claim in North Carolina involves several steps. First, inform your employer about your injury or illness, then ensure they file Form 18 promptly. After this, you may need to complete additional forms, including the NC Form 28U, which helps detail your medical treatment and lost wages. By following these steps, you can set the stage for successful claim processing.

Employers in North Carolina must report an employee's injury to their insurance carrier within 30 days of the incident. However, employees should also be aware that they need to file their own claims for benefits with the North Carolina Industrial Commission within two years from the date of the injury. Timely documentation is crucial, so using tools like NC Form 28U can streamline your claims process and help avoid missing important deadlines.

In North Carolina, employers are generally not mandated to hold your job during your time on workers' comp. Each situation depends on company policy, individual agreements, and the nature of your injury. Open communication with your employer can clarify their stance on job security. Always consult resources such as NC Form 28U to understand your rights and the implications of your claim.

Yes, it's possible to lose your position while on workers' compensation in North Carolina, especially if your employer does not have a job protection policy. If your employer closes, downsizes, or decides to replace you, they may terminate your employment. Staying informed about your rights and discussing your situation with HR can help minimize risks. Additionally, the NC Form 28U can provide essential information on how to protect your benefits during this time.

In North Carolina, employers are not legally required to hold your job while you are on workers' compensation. However, many companies have policies that may protect your position, depending on company guidelines. It's crucial to review your employer's policies and communicate openly with them during your recovery. If you're unsure of your rights, resources like the NC Form 28U can help clarify your situation.

Form 18 in North Carolina workers' compensation is a vital document used to notify the North Carolina Industrial Commission about a workplace injury. This form initiates the claims process and should be filed promptly to prevent delays. Understanding how to complete Form 18 correctly sets the foundation for your claim, paving the way for potential compensation. Additionally, utilizing NC Form 28U can offer further insights into your eligibility for benefits.

To fill out a joint declaration form, carefully follow the provided instructions specific to the form type. Make sure to include both parties' information, such as names and signatures, and any relevant details about the agreement. Ensure clarity and completeness to avoid delays in processing. Consult uslegalforms for templates and further insights on completing such forms.

Filling out workers' comp paperwork involves collecting essential information regarding the incident and the employee's condition. Start by documenting the details of the injury, employee information, and any witness accounts. Ensure all forms are completed accurately and submitted promptly. If you need assistance, consider using resources from uslegalforms for comprehensive support.

Claiming 0 or 1 on your W4 depends on your financial situation. If you prefer to have a larger amount withheld for taxes, consider claiming 0. If you want to receive more in your paycheck, you might claim 1. It's wise to consult resources like uslegalforms for personalized assistance in understanding the implications of your choice.

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
If you believe that this page should be taken down, please follow our DMCA take down processhere.

Industry-leading security and compliance

US Legal Forms protects your data by complying with industry-specific security standards.
  • In businnes since 1997
    25+ years providing professional legal documents.
  • Accredited business
    Guarantees that a business meets BBB accreditation standards in the US and Canada.
  • Secured by Braintree
    Validated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.
Get NC Form 28U
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
NC Form 28U
This form is available in several versions.
Select the version you need from the drop-down list below.
2017 NC Form 28U
Select form
  • 2017 NC Form 28U
  • 2016 NC Form 28U
  • 2002 NC Form 28U
Select form