Nc form 28c 2026

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The document is a report form required by the North Carolina Industrial Commission for employers or carriers to report compensation and medical payments made under a compromise settlement agreement related to workers' compensation cases. It includes sections for employee and employer information, details of the accident, types of compensation paid, and total amounts. The form must be filed with the Industrial Commission.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the Employer FEIN and the Employee’s Name in the designated fields. Ensure accuracy as this information is crucial for processing.
Fill in the Employer's Name and Address, including City, State, and Zip Code. This helps identify the employer associated with the claim.
Provide details about the accident or disability date in section 1. This is essential for establishing the timeline of events.
Indicate whether salary was continued during the employee's absence in section 2. This affects compensation calculations.
Complete sections 3 through 7 by detailing temporary total, partial, and permanent partial weeks along with corresponding dollar amounts.
In section 8, sum up all amounts from lines 3 through 7 to provide a total compensation figure.
Finally, fill out your name, title, and signature at the bottom of the form before submitting it electronically via the provided portal link.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (86 Votes)
2017	4.3 Satisfied (151 Votes)
2003	4.1 Satisfied (59 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Who is exempt from workers comp in North Carolina?

Independent contractors, sole proprietors, business partners, or LLC members in a firm with no employees dont typically need workers compensation.

What forms are required when an employee is hired in NC?

The onboarding packet contains information about temporary employment with the State of North Carolina as well as Federal Form W-4, NC-4 and the Direct Deposit Enrollment Form. For Federal Form I-9, the recommended candidate completes Section 1 and the employing agency completes Section 2.

Is workers compensation mandatory in North Carolina?

Generally speaking, employers and companies in North Carolina are not required to purchase workers compensation coverage for independent contractors, freelancers and subcontractors.

Who is exempt from workers compensation in NC?

In North Carolina, common workers comp exemptions include independent contractors, domestic workers, farm laborers at small farms, injuries caused by intoxication or reckless behavior, and employees at businesses with fewer than 3 employees.

How long do you have to report a work injury in NC?

Under North Carolina law, every injured worker or their official representative should report an accident to an employer immediately or as soon as it is practicable. The notice must be given within 30 days of the date of the accident. If it is not, workers compensation benefits may not be payable.

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What is a form 26A in NC?

11 N.C. Admin. Code 23L . 0103 - FORM 26A - EMPLOYERS ADMISSION OF EMPLOYEES RIGHT TO PERMANENT PARTIAL DISABILITY | State Regulations | US Law | LII / Legal Information Institute.

Nc form 28c 2026

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