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Get Nc 28c 2017-2025
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How to fill out the NC 28C online
The NC 28C form is a crucial document used for reporting compensation and medical payments in settled workers' compensation cases in North Carolina. This guide provides step-by-step instructions to ensure you fill out the form accurately and efficiently online.
Follow the steps to complete the NC 28C form online.
- Click the ‘Get Form’ button to obtain the NC 28C form and open it in your preferred editing tool.
- Begin by filling out the top section of the form, including the IC file number, employer code, carrier code, and carrier file number.
- Provide the employer's FEIN and ensure that the form is marked as applicable only for settled cases.
- Enter the employee’s name and the employer's name in the designated fields.
- Complete the employer’s address, including city, state, and zip code.
- Fill in the employee's home and work telephone numbers, and include the last four digits of their Social Security number.
- Indicate the employee's sex by checking the appropriate box.
- Next, you will need to report the date of the accident or the date when the disability from occupational disease began.
- Indicate whether the employee's salary was continued during their period of absence due to the injury.
- Complete sections for temporary total, temporary partial, and permanent partial payments, noting the number of weeks and the respective total dollar amounts.
- Record any disfigurement amounts paid and benefits for the loss of any organ or body part.
- Sum the amounts from lines three through seven for the total compensation paid.
- Enter the compromise settlement agreement amount, followed by the total amount of medical expenses paid.
- Finalize the form by filling in the name of the employer or carrier/administrator, their title, and obtaining the necessary signature and date.
- After completing the form, ensure that all required sections are filled out accurately. You can save changes, download, print, or share the form as needed.
Complete your documents online to ensure ease and efficiency in submission.
Typically, a person must be missing for seven years to be declared legally dead in North Carolina, barring evidence to the contrary. The court oversees this process to ensure thorough evaluation and legitimacy in declaring someone dead. Understanding these parameters through the NC 28C guidelines can assist families in making informed decisions during difficult times.
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