North Carolina workers comp Form 28C is the employer’s or insurance carrier’s final report of the compensation paid on a workers’ comp claim. The employer or carrier/administrator files it, not the injured worker. The full title is “Report of Employer or Carrier/Administrator of Compensation Paid (final).” If you are hurt and have been getting benefits, this form still affects you. It tells the North Carolina Industrial Commission what was paid to you once payments end. Knowing what it says can help you catch mistakes early.
What the North Carolina Workers Comp Form 28C Is For
The North Carolina workers comp Form 28C closes out the record of payments on a claim. It is the “final” report. In other words, it shows what the employer or carrier says it paid you in compensation. In most cases, it is filed after the last check goes out. It is a report from the employer side. Typically, it is not an agreement that you sign.
Why should you care about a form you don’t file? Because it becomes part of your official claim file. For example, if a few weeks of wage benefits never reached you, the total on the form may not match your records. As a result, comparing the two is a simple way to protect yourself. Keep your check stubs, bank deposits, and letters from the carrier in one folder.
| Item | Details |
|---|---|
| Form number | Form 28C |
| Form title | Report of Employer or Carrier/Administrator of Compensation Paid (final) |
| Who files | Employer/carrier |
| Where filed | North Carolina Industrial Commission |
| Fee | No fee appears in our verified sources. Confirm with the Commission. |
| Official PDF | Form 28C official PDF |
Who Files the North Carolina Workers Comp Form 28C and When
The employer or its carrier/administrator files the North Carolina workers comp Form 28C. The injured worker does not complete it. However, you have every right to understand it. You can ask the carrier or your adjuster for a copy. You can also ask the North Carolina Industrial Commission how to see what is in your claim file.
Typically, the form is filed when compensation payments on the claim end. That might happen when you return to work. It might also happen when a final payment is made under an approved agreement or award. The timing rule belongs to the employer side. Still, the date payments stop can start your own clock for asking for more help.
If you are unsure whether your claim was ever properly reported, start with the basics. Our guide on North Carolina workers comp requirements explains what employers must do. It can help you tell whether something was missed.
How to Fill It Out and Where to Send It
The employer or carrier completes the form. In general, it asks for identifying details about the claim, the injured worker, the employer, and the carrier/administrator. It also asks for the periods benefits covered and the compensation paid. The goal is a clear, final picture of what was paid on the claim.
Common problems that can cause delays or a rejected filing include:
- A wrong or missing claim number
- Totals that don’t match the payment history
- Missing dates for when benefits started or stopped
- An unsigned form or missing preparer contact details
- Using an outdated version instead of the current form
Filers should always download the current version from the Commission. You can find the official North Carolina workers comp Form 28C PDF on the Commission’s website. The full list of forms, plus current filing instructions, is on the North Carolina Industrial Commission forms page. The Commission accepts many filings electronically. Check that page to confirm whether e-filing or mail applies before sending.
What Happens After You File
Once the North Carolina workers comp Form 28C is filed, the Commission adds it to the claim record. In most cases, nothing more happens if the numbers are right and everyone agrees. However, if you believe benefits stopped too soon, you are not stuck. You may be able to ask the Commission for more compensation or request a hearing. Time limits apply, so act sooner rather than later.
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For contact details and how the agency works, see our page on the North Carolina workers comp board. If your claim never got started properly, read how to file a North Carolina workers comp claim. Any figure or deadline that matters to your case should be confirmed with the Commission and a licensed attorney.
Frequently Asked Questions
Do I have to fill out the North Carolina workers comp Form 28C myself?
No. The employer or carrier/administrator files it. Your role is to review the payment totals and speak up if something looks wrong.
Does the North Carolina workers comp Form 28C mean my case is closed for good?
It is a final report of compensation paid, not a promise that your rights are gone. Many North Carolina claimants may still ask for more benefits within the legal time limit if their condition changes. Confirm your options with the Commission and a licensed attorney.
What if the totals on the North Carolina workers comp Form 28C are wrong?
Gather your check stubs, deposit records, and letters from the carrier. Contact the adjuster in writing first. If that does not fix it, contact the North Carolina Industrial Commission or a licensed attorney promptly.
North carolina workers comp form 28c: Quick Recap
If you remember one thing about north carolina workers comp form 28c, 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 north carolina workers comp form 28c should be confirmed with the agency before you act on it.
Questions about north carolina workers comp form 28c 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.