section .0900 report of earnings

 

04 NCAC 10A .0901 Check Endorsement

If a self-insured employer, carrier or third party administrator places "check endorsement" language on the back of an employee's check, the following language (or language approved by the Commission as equivalent) shall be used:

 

By endorsing this check, I certify that I have not worked for or earned wages from any business or individual during the period covered by this check, or that I have reported any earnings to the employer or carrier paying me workers' compensation benefits. I understand that making a false statement by endorsing this benefit check may result in civil and criminal penalties.

 

History Note: Authority G.S. 97-80(a); 97-88.2;

Eff. June 1, 2000;

Amended Eff. November 1, 2014.