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Ncic form 28u 2002-2026
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- Click ‘Get Form’ to open the ncic form 28u 2002 in the editor.
- Begin by filling in your personal information, including your name, address, and social security number. Ensure accuracy as this information is crucial for processing your request.
- In Section A, clearly state your request for total disability compensation to be resumed. Include the dates of your trial return to work and the reason for no longer working.
- Obtain a statement from your authorized treating physician certifying that you are unable to continue working due to your injury. This should include their signature and medical specialty.
- If applicable, complete Section B by authorizing your last employer to release employment information regarding your trial return to work. Sign and date this section.
- Once completed, send a copy of the form to both your employer and the carrier/administrator. Mail the original document to the Industrial Commission at the provided address.
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