North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter A - WORKERS' COMPENSATION RULES › Section .0400 - DISABILITY, COMPENSATION, FEES › Section 23A .0405 - REINSTATEMENT OF COMPENSATION

Current through Register Vol. 39, No. 2, July 15, 2024
(a) In a
				  claim in which the employer, carrier, or administrator has admitted liability,
				  when an employee seeks reinstatement of compensation pursuant to
				  G.S.
				  97-18(k), the employee may
				  notify the employer, carrier, or administrator and the employer's, carrier's,
				  or administrator's attorney of record on a Form 23
Application to
				  Reinstate Payment of Disability Compensation
or by the filing of a
				  Form 33
Request that Claim be Assigned for Hearing
.
(b) When reinstatement is sought by the
				  filing of a Form 23
Application to Reinstate Payment of Disability
				  Compensation
, the original Form 23
Application to Reinstate
				  Payment of Disability Compensation
and the attached documents shall be
				  filed with the Commission in accordance with Rule .0108 of this Subchapter, and
				  a copy of the Form 23 and attached documents shall contemporaneously be sent to
				  the employer, carrier, or administrator and the employer's, carrier's, or
				  administrator's attorney of record. The employee shall specify the grounds and
				  the alleged facts supporting the application and shall complete the blank space
				  in the "Important Notice to Employer" portion of Form 23
Application to
				  Reinstate Payment of Disability Compensation
by inserting a date 17
				  days from the date the employee serves the completed Form 23
Application to Reinstate Payment of Disability Compensation
on
				  the employer, carrier, or administrator and the attorney of record, if any. The
				  Form 23
Application to Reinstate Payment of Disability
				  Compensation
shall specify the number of pages of documents attached
				  that are to be considered by the Commission. Within 17 days from the date the
				  employee serves the completed Form 23
Application to Reinstate Payment
				  of Disability Compensation
on the employer, carrier, or administrator
				  and the attorney of record, if any, the employer, carrier, or administrator
				  shall complete Section B of the Form 23
Application to Reinstate
				  Payment of Disability Compensation
and file it with the Commission in
				  accordance with Rule .0108 of this Subchapter and send a copy contemporaneously
				  to the employee or the employee's attorney of record.
(c) If the employer, carrier, or
				  administrator does not object within the time allowed, the Commission shall
				  review the Form 23
Application to Reinstate Payment of Disability
				  Compensation
and the attached documentation and, without an informal
				  hearing, issue an Administrative Decision and Order as to whether there is
				  sufficient basis under the Workers' Compensation Act to reinstate compensation.
				  This Administrative Decision and Order shall be issued within five days of the
				  expiration of the time within which the employer, carrier, or administrator
				  could have filed a response to the Form 23
Application to Reinstate
				  Payment of Disability Compensation
. Either party may seek review of
				  the Administrative Decision and Order as provided by Rule .0702 of this
				  Subchapter.
(d) If the employer,
				  carrier, or administrator timely objects to the Form 23
Application to
				  Reinstate Payment of Disability Compensation
, the Commission shall
				  conduct an informal hearing within 25 days of the receipt by the Commission of
				  the Form 23
Application to Reinstate Payment of Disability
				  Compensation
unless the time is extended for good cause shown. The
				  informal hearing may be conducted with the parties or their attorneys of record
				  personally present with the Commission. The Commission shall make arrangements
				  for the informal hearing with a view toward conducting the hearing in the most
				  expeditious manner. The informal hearing shall be no more than 30 minutes, with
				  each side being given 10 minutes to present its case and five minutes for
				  rebuttal. Notwithstanding the foregoing, the employee may waive the right to an
				  informal hearing and proceed to a formal hearing by filing a request for
				  hearing on a Form 33
Request that Claim be Assigned for
				  Hearing
. Either party may appeal the Administrative Decision and Order
				  of the Commission as provided by Rule .0702 of this Subchapter. A Deputy
				  Commissioner shall conduct a hearing which shall be a hearing de novo. The
				  hearing shall be peremptorily set and shall not require a Form 33
Request that Claim be Assigned for Hearing
. The employee has
				  the burden of producing evidence on the issue of the employee's application to
				  reinstate compensation. If the Deputy Commissioner reverses an order previously
				  granting a Form 23
Application to Reinstate Payment of Disability
				  Compensation
motion, the employer shall promptly terminate
				  compensation or otherwise comply with the Deputy Commissioner's decision,
				  notwithstanding any appeal or application for review to the Full Commission
				  under G.S. 97-85.
(e) If the Commission is unable to render a
				  decision after the informal hearing, the Commission shall issue an order to
				  that effect, which shall be in lieu of a Form 33
Request that Claim be
				  Assigned for Hearing
, and the case shall be placed on the formal
				  hearing docket. If additional issues are to be addressed, the employee,
				  employer, carrier, or administrator shall file a Form 33
Request that
				  Claim be Assigned for Hearing
or notify the Commission that a formal
				  hearing is not currently necessary within 30 days of the date of the
				  Administrative Decision or Order. The effect of placing the case on the docket
				  shall be the same as if the Form 23
Application to Reinstate Payment of
				  Disability Compensation
was denied, and compensation shall not be
				  reinstated until such time as the case is decided by a Commissioner or a Deputy
				  Commissioner following a formal hearing.
Authority
					 G.S.
					 97-18(k);
					 97-80(a);
Eff. January 1, 1990;
Amended Eff. February 1, 2016; November 1,
					 2014;
Recodified from
					 04 NCAC
					 10A .0405 Eff. June 1,
					 2018.