Michael F. Easley, Governor
Buck Lattimore, Chairman

Bernadine S. Ballance, Commissioner
Thomas J. Bolch, Commissioner
Laura K. Mavretic, Commissioner
Christopher Scott, Commissioner
Dianne C. Sellers, Commissioner
Pamela T. Young, Commissioner

North Carolina
Industrial Commission




At the request of the North Carolina Bar Association Workers’ Compensation Section Council, on October 20, 2003 the Industrial Commission adopted a new Form 28C to be used in place of a Form 28B for cases that have been settled by Compromise Settlement Agreement (“clinchered”). The NCBA Workers’ Compensation Section recommended creation of this new form to delete portions of the Form 28B concerning the right to future benefits which do not apply to cases that have been settled. The new Form 28C is available under the “Forms” section of the Commission website. The Commission also made minor revisions to the following forms, which are available under “Forms”: Forms 19, 25C, 25N, and 28B.

N.C. Industrial Commission · 4340 Mail Service Center · Raleigh, NC 27699-4340
Main Telephone: (919) 807-2500 · Fax: (919) 715-0282
NCIC Home Page: http://www.comp.state.nc.us/