When a North Carolina injured worker tries returning to work and cannot continue, Form 28U asks that total disability compensation be resumed immediately. The worker names the trial employer, the dates worked and the reasons for stopping. The request must carry an authorized treating physician's statement that the worker is unable to continue the trial return to work because of the compensable injury.
The employee completes Section A and, if the trial job was with a different employer, the Section B release of employment information. An authorized treating physician completes item 3, the Treating Physician's Statement, with medical specialty, signature, printed name, date and address.
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Employee's Request that Compensation be Reinstated After Unsuccessful Trial Return to Work
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An authorized treating physician. Item 3 of Section A says the employee must obtain the Treating Physician's Statement from an authorized treating physician, who certifies that the employee is unable to continue the trial return to work because of the injury for which compensation has been paid, and adds a medical specialty.
The employee requests that total disability compensation be resumed immediately, names the employer for the trial return to work, gives the date first worked and the date last worked, and explains in detail the reasons for no longer working. The date of the original injury or disability is also required.
No. The physician completes and signs the statement and returns the form to the employee. The employee sends the original to the Industrial Commission and a copy to the employer and carrier/administrator from whom compensation was received.