The nc form 90 workers comp document is the North Carolina Industrial Commission’s Form 90, titled “Report of Earnings.” The injured worker files it. It tells the employer or insurance company what money you earned from work while you were receiving workers’ comp benefits. If a letter with this form just arrived, take a breath. It’s a routine paperwork step, and it doesn’t mean your claim is in trouble.
What the Nc Form 90 Workers Comp Is For
Workers’ comp wage benefits replace part of the pay you lose because of a work injury. Your benefit can change if you earn money from any job during that time. For example, if you go back to light-duty or part-time work, you may still be owed partial benefits. To figure that out, the insurer needs to know what you actually earned. The nc form 90 workers comp report gives them that information in writing.
The form also protects you. A clear, honest record of your earnings helps prevent overpayments that you might have to pay back later. It can also show when you are owed partial benefits for a lower-paying job. In most cases, an accurate Form 90 keeps your checks steady and heads off disputes. Here are the basic facts:
| Item | Details |
|---|---|
| Form number | Form 90 |
| Form title | Report of Earnings |
| Who files | The injured worker |
| Agency | North Carolina Industrial Commission |
| Where filed | Usually returned to the employer or insurer that requested it; confirm whether a copy should also go to the Commission |
| Fee | No fee is listed for this form; confirm with the Commission |
| Official PDF | Form 90 Report of Earnings (PDF) |
Who Files the Nc Form 90 Workers Comp and When
The injured worker completes and signs the nc form 90 workers comp report. Your employer doesn’t fill it out for you, and neither does the insurer. However, they are usually the ones who send it to you and ask you to complete it. If you have a lawyer, they can help you review it before you sign.
Typically, the request comes while you are receiving weekly wage benefits. The insurer may ask for it more than once over the life of your claim. As a result, you might fill out this form a few times. Each time, you report the earnings for the period the request covers.
If you can’t meet the deadline, don’t just ignore the form. Contact the adjuster in writing and explain why. Keep a copy of everything you send. You can also learn more about the agency on our North Carolina workers comp board page.
How to Fill It Out and Where to Send It
Start by getting the current version of the nc form 90 workers comp form. Download the official Form 90 PDF, or browse the full list on the North Carolina Industrial Commission forms page. Using an outdated copy can cause delays.
The form typically asks for your name, your claim information, and the employer’s name. Then it asks about any work you did and the money you earned. That can include wages, self-employment income, and pay from a second job. In most cases, you list who paid you, the dates, and the amounts. Finally, you sign to confirm the information is true. The form warns that false statements can carry serious penalties.
Common mistakes that lead to problems include:
- Leaving the form unsigned or undated.
- Skipping small jobs, cash work, or side gigs.
- Writing “none” when you did earn something.
- Missing the claim number or using the wrong one.
- Sending it late or to the wrong address.
Return the completed nc form 90 workers comp report to whoever asked for it, usually the insurer or employer. Use the address or method shown in their request letter. Send it in a way you can track, like certified mail or email with a saved copy. Keep a full copy for your records.
What Happens After You File
After you return the form, the insurer reviews your reported earnings. If you earned nothing, your weekly benefits usually continue as before. If you earned money, the insurer may adjust your checks to reflect partial benefits. For example, a lower-paying light-duty job may still leave you owed part of the difference. If you disagree with a change, you can raise the issue with the Industrial Commission.
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Sometimes the insurer follows up with questions or asks for pay stubs. If they try to stop benefits because of a Form 90 issue, other Commission forms and procedures apply. You have the right to respond. For a full picture of the process, see our guide on how to file a North Carolina workers comp claim. You can also review North Carolina workers comp requirements to understand your rights.
Frequently Asked Questions
Do I have to report small or cash earnings on the nc form 90 workers comp report?
The form asks about earnings from work, and that generally includes small and cash jobs. Leaving income off can lead to an overpayment or a fraud claim. When in doubt, report it and ask a licensed attorney how it affects your benefits.
What if I didn’t work at all during the period?
You still need to fill out, sign, and return the form. Simply show that you had no earnings for the period. Ignoring the request can put your benefits at risk even if you earned nothing.
Can my benefits be stopped if I don’t return the nc form 90 workers comp form?
Many North Carolina claimants who don’t respond face a request to suspend benefits. The Commission’s rules control when and how that can happen. Confirm the exact process with the North Carolina Industrial Commission and a licensed attorney.
Nc form 90 workers comp: Quick Recap
If you remember one thing about nc form 90 workers comp, make it this: the rule is set by the state (or the federal program), not by the insurer, and the official source is linked above. Every figure on this page about nc form 90 workers comp should be confirmed with the agency before you act on it.
Questions about nc form 90 workers comp that this page does not answer are usually answered for free by the state workers’ comp agency’s information line — and, for a disputed claim, by a licensed attorney in a first consultation.
See your state’s exact numbers
What you are owed depends on your state’s benefit caps and deadlines. Start with your state’s settlement and claim guides for the exact figures.
Sources & How to Verify
The figures on this page come from official government and industry sources. Workers’ comp benefit caps, deadlines, and rules change, so always confirm the exact figure with your state’s workers’ comp board or a licensed attorney before acting. Settlement estimates are illustrative, and every case is different.
- Your state workers’ comp board, division, or commission: the official source for your state’s exact caps, deadlines, and forms — search “[your state] workers compensation board”
- U.S. Department of Labor (OWCP): dol.gov — federal workers’ compensation overview
- NCCI: ncci.com — workers’ comp rating and benefit data
- Social Security Administration: ssa.gov — benefit-cap and SSDI offset data
- Insurance Information Institute: iii.org — neutral workers’ comp background
Content last reviewed October 2026. If you notice an outdated figure, please contact us.
Related Guides
- North Carolina Workers Comp Board
- How to File a North Carolina Workers Comp Claim
- North Carolina Workers Comp Requirements
- Workers Comp Settlements by State (All 50)
- Workers Comp Claims by State (All 50)
- More in This Category
- Settlements by Injury
- Benefits Explained
- Workers Comp Glossary
Informational only — not legal, medical, or financial advice. Workers Comp Explained is an independent educational resource, not a law firm, insurer, or medical or financial advisor, and this page does not provide legal, medical, or financial advice. Workers’ compensation benefits, deadlines, and rules vary by state and change over time, and settlement estimates are illustrative only. Always confirm the exact figure and any deadline with your state’s workers’ compensation board and a licensed attorney before you act.