reglab/statecodes huggingface dataset:
North Dakota Administrative Code › Title 92 - Workforce Safety and Insurance › Article 92-01 - General Administration › Chapter 92-01-02 - Rules of Procedure - North Dakota Workers' Compensation Act › Section 92-01-02-23.2 - Employers to provide security instrument

Current through Supplement No. 393, July, 2024
The organization may require an employer to provide a bond,
				  letter of credit, cash deposit, or other security instrument approved by the
				  organization to guarantee payment of workers' compensation premium. The
				  required security instrument is in addition to any other required installment
				  payment obligations.
1. A security
				instrument or cash deposit may be required if:
a. The employer does not have a permanent
				place of business in this state;
b.
				The employer is not a resident of this state;
c. The employer does not have a payment
				history or previously underwritten account with the organization; or
d. The employer has a previous delinquency
				with the organization.
North Dakota Administrative Code › Title 92 - Workforce Safety and Insurance › Article 92-01 - General Administration › Chapter 92-01-02 - Rules of Procedure - North Dakota Workers' Compensation Act › Section 92-01-02-27 - Medical and hospital fees - Reimbursement methods

Current through Supplement No. 393, July, 2024
Maximum medical and hospital fees paid by the organization,
				  including reimbursement for pharmaceuticals and durable medical equipment, are
				  determined in accordance with the most current edition of the organization's
				  fee schedule guidelines. Reimbursement for services and procedures not
				  addressed within the fee schedules will be determined on a "by report" basis,
				  in which case a description of the nature, extent and need for the procedure or
				  service, including the time, skills, equipment, and any other pertinent facts
				  necessary to furnish the procedure or service, must be provided to the
				  organization.
General Authority:
NDCC 65-02-08
Law Implemented:
NDCC
					 65-02-08
North Dakota Administrative Code › Title 92 - Workforce Safety and Insurance › Article 92-01 - General Administration › Chapter 92-01-02 - Rules of Procedure - North Dakota Workers' Compensation Act › Section 92-01-02-29 - Medical services - Definitions

Current through Supplement No. 393, July, 2024
The definitions found in North Dakota Century Code title 65
				  apply to terms contained in this title. In addition, unless the context
				  otherwise requires, for purposes of sections
				  92-01-02-27 through
				  92-01-02-48:
1. "Bill audit" means the review of medical
				bills and associated medical records by the organization or the managed care
				vendor, including review for duplications, omissions, actual delivery of billed
				services and items, accuracy of charges and associated coding, coding
				documentation guidelines, coverage, concurrent billing for covered and
				noncovered services, and application of fee schedules.
2. "Case management" means the ongoing
				coordination of medical services provided to a claimant, including:
a. Developing a treatment plan to provide
				appropriate medical services to a claimant.
b. Systematically monitoring the treatment
				rendered and the medical progress of the claimant.
c. Assessing whether alternative medical
				services are appropriate and delivered in a cost-effective manner based upon
				acceptable medical standards.
d.
				Ensuring the claimant is following the prescribed medical plan.
e. Formulating a plan for keeping the
				claimant safely at work or expediting a safe return to work.
North Dakota Administrative Code › Title 92 - Workforce Safety and Insurance › Article 92-01 - General Administration › Chapter 92-01-02 - Rules of Procedure - North Dakota Workers' Compensation Act › Section 92-01-02-29.2 - Acceptance of rules and fees

Current through Supplement No. 393, July, 2024
Medical service providers rendering treatment of any kind,
				  regardless of the state or country where services are provided, including
				  inpatient and outpatient services, to a claimant who comes under the
				  organization's jurisdiction must comply with managed care services under these
				  rules. All providers shall cooperate with the organization and the managed care
				  vendor and shall provide to the organization or the managed care vendor,
				  without additional charge, the medical information requested in relation to the
				  reviewed service.
General Authority: NDCC 65-02-08, 65-02-20, 65-05-07
Law Implemented: NDCC 65-02-20,
					 65-05-07
North Dakota Administrative Code › Title 92 - Workforce Safety and Insurance › Article 92-01 - General Administration › Chapter 92-01-02 - Rules of Procedure - North Dakota Workers' Compensation Act › Section 92-01-02-29.3 - Motor vehicle purchase and modification

Current through Supplement No. 393, July, 2024
1. An injured employee must obtain a primary
				health care provider's order of medical necessity supported by objective
				medical findings before the purchase of a specially equipped motor vehicle or
				modification of a vehicle may be approved. The primary health care provider's
				order must contain the following:
a.
				Patient's name;
b. Date of
				patient's face-to-face examination;
c. Pertinent diagnosis or conditions that
				relate to the need for device or modification;
d. Description of what is ordered;
e. Length of need;
f. Primary health care provider's signature;
				and
g. Date of primary health care
				provider's signature.
North Dakota Administrative Code › Title 92 - Workforce Safety and Insurance › Article 92-01 - General Administration › Chapter 92-01-02 - Rules of Procedure - North Dakota Workers' Compensation Act › Section 92-01-02-29.4 - Home modifications

Current through Supplement No. 393, July, 2024
1. An
				injured employee must obtain a primary health care provider's order of medical
				necessity supported by objective medical findings before the payment for home
				modifications can be approved. The primary health care provider's orders must
				contain the following:
a. Patient's
				name;
b. Date of patient's
				face-to-face examination;
c.
				Pertinent diagnosis or conditions that relate to the need for device or
				modification;
d. Description of
				what is ordered;
e. Length of
				need;
f. Primary health care
				provider's signature; and
g. Date
				of primary health care provider's signature.
North Dakota Administrative Code › Title 92 - Workforce Safety and Insurance › Article 92-01 - General Administration › Chapter 92-01-02 - Rules of Procedure - North Dakota Workers' Compensation Act › Section 92-01-02-29.5 - Power mobility devices

Current through Supplement No. 393, July, 2024
1. An
				injured employee must obtain a primary health care provider's order of medical
				necessity supported by objective medical findings before the purchase of a
				power mobility device may be approved by the organization. The primary health
				care provider's order must contain the following:
a. Patient's name;
b. Date of patient's face-to-face
				examination;
c. Pertinent diagnosis
				or conditions that relate to the need for device or modification;
d. Description of what is ordered;
e. Length of need;
f. Primary health care provider's signature;
				and
g. Date of primary health care
				provider's signature.
North Dakota Administrative Code › Title 92 - Workforce Safety and Insurance › Article 92-01 - General Administration › Chapter 92-01-02 - Rules of Procedure - North Dakota Workers' Compensation Act › Section 92-01-02-29.6 - Footwear

Current through Supplement No. 393, July, 2024
1. An injured
				employee shall obtain the primary health care provider's order of medical
				necessity supported by objective medical findings before the purchase of
				footwear may be approved by the organization. The primary health care
				provider's order must contain the following:
a. Patient's name;
b. Date of patient's face-to-face
				examination;
c. Pertinent diagnosis
				or conditions that relate to the work injury and the necessity of
				footwear;
d. Specific description
				of the type or brand or both of footwear being requested;
e. Primary health care provider's signature;
				and
f. Date of primary health care
				provider's signature.
North Dakota Administrative Code › Title 92 - Workforce Safety and Insurance › Article 92-01 - General Administration › Chapter 92-01-02 - Rules of Procedure - North Dakota Workers' Compensation Act › Section 92-01-02-29.7 - Prosthetics

Current through Supplement No. 393, July, 2024
1. For the initial
				prosthesis, an injured employee shall obtain the primary health care provider's
				order of medical necessity supported by objective medical findings before the
				purchase of a prosthesis may be approved by the organization. The primary
				health care provider's order must contain the following:
a. Patient's name;
b. Date of patient's face-to-face
				examination;
c. Pertinent diagnosis
				or conditions that relate to the work injury and the necessity of
				prosthesis;
d. Specific description
				of the type of prosthetic being requested;
e. Primary health care provider's signature;
				and
f. Date of primary health care
				provider's signature.
North Dakota Administrative Code › Title 92 - Workforce Safety and Insurance › Article 92-01 - General Administration › Chapter 92-01-02 - Rules of Procedure - North Dakota Workers' Compensation Act › Section 92-01-02-30 - Medical services

Current through Supplement No. 393, July, 2024
1. Medical
				services.
a. Medical services that are not
				medically necessary are not reimbursable.
b. Frequency and extent of treatment may not
				be more than the nature of the injury or process of recovery requires, and must
				be provided in accordance with utilization and treatment standards as
				prescribed by the organization or the managed care vendor. The organization may
				require evidence of the efficacy of treatment.
North Dakota Administrative Code › Title 92 - Workforce Safety and Insurance › Article 92-01 - General Administration › Chapter 92-01-02 - Rules of Procedure - North Dakota Workers' Compensation Act › Section 92-01-02-32 - Physician assistant rules

Current through Supplement No. 393, July, 2024
Physician assistants may be reimbursed within the scope of
				  their licenses for services performed under the supervision of a licensed
				  physician .
General Authority:
NDCC 65-02-08, 65-02-20,
					 65-05-07
Law Implemented:
NDCC 65-02-20,
					 65-05-07
North Dakota Administrative Code › Title 92 - Workforce Safety and Insurance › Article 92-01 - General Administration › Chapter 92-01-02 - Rules of Procedure - North Dakota Workers' Compensation Act › Section 92-01-02-32.1 - Physical therapy assistants, certified occupational therapy assistants, and certified athletic trainers

Current through Supplement No. 393, July, 2024
Physical therapist assistants, certified occupational
				  therapist assistants, and certified athletic trainers may be reimbursed when
				  providing treatment under the direction and general supervision of the physical
				  therapist or occupational therapist. Physical and occupational therapists are
				  responsible for the assistants under their direction and supervision.
				  Examination, evaluation, diagnosis, prognosis, and outcomes are the sole
				  responsibility of the physical therapist and occupational therapist. Physical
				  therapist assistants, certified occupational therapist assistants, and
				  certified athletic trainers are not allowed to perform functional capacity
				  evaluations. Treatment by physical therapy aides or physical therapy
				  technicians is neither recognized nor will be reimbursed.
General Authority:
NDCC 65-02-08, 65-02-20,
					 65-05-07
Law Implemented:
NDCC 65-02-20,
					 65-05-07
North Dakota Administrative Code › Title 92 - Workforce Safety and Insurance › Article 92-01 - General Administration › Chapter 92-01-02 - Rules of Procedure - North Dakota Workers' Compensation Act › Section 92-01-02-33 - Utilization review and quality assurance

Current through Supplement No. 393, July, 2024
The organization has instituted a program of utilization
				  review and quality assurance to monitor and control the use of health care
				  services. The organization shall develop and identify the mode and manner of
				  submissions for utilization review and quality assurance requests.
1. Prior authorization for services must be
				obtained from the organization or its managed care vendor at least seventy-two
				hours or three business days in advance of providing certain medical treatment,
				equipment, or supplies. Medical services requiring prior authorization or
				preservice review are outlined in section 92-01-02-34. Emergency medical
				services may be provided without prior authorization, but notification is
				required within twenty-four hours of, or by the end of the next business day
				following, initiation of emergency treatment. Reimbursement may be withheld, or
				recovery of prior payments made, if utilization review does not confirm the
				medical necessity of emergency medical services.
2. Documentation of the need for and efficacy
				of continued medical care by the allied health care professional is required at
				the direction or request of the organization or the managed care vendor while a
				claim is open.
3. The organization
				may require second opinion consultations prior to the authorization of
				reimbursement for surgery and for conservative care which extends past sixty
				days following the initial visit.
4. The organization may require preoperative
				psychosocial screens and psychological evaluations prior to the authorization
				of reimbursement for surgery. The organization may select the evaluators who
				will perform the screens and evaluations.
5. The organization may use the Official
				Disability Guidelines, the American College of Occupational and Environmental
				Medicine's Occupational Medicine Practice Guidelines, Guide to Physical Therapy
				Practice, The Medical Disability Advisor, Diagnosis and Treatment for
				Physicians and Therapists Upper Extremity Rehabilitation, Treatment Guidelines
				of the American Society of Hand Therapists, American Medical Association Guides
				to the Evaluation of Disease and Injury Causation, or any other treatment and
				disability guidelines or standards it deems appropriate to administer claims.
General Authority:
NDCC 65-02-08, 65-02-20,
					 65-05-07
Law Implemented:
NDCC 65-02-20,
					 65-05-07
North Dakota Administrative Code › Title 92 - Workforce Safety and Insurance › Article 92-01 - General Administration › Chapter 92-01-02 - Rules of Procedure - North Dakota Workers' Compensation Act › Section 92-01-02-38 - Changes of health care providers

Current through Supplement No. 393, July, 2024
1. All changes from
				one health care provider to another must be approved by the organization.
				Normally, changes will be allowed only after the injured employee has been
				under the care of the primary health care provider for sufficient time for the
				health care provider to complete necessary diagnostic studies, establish an
				appropriate treatment regimen, and evaluate the efficacy of the therapeutic
				program.
2. North Dakota Century
				Code section 65-05-28 governs choice of health care provider. For purposes of
				this rule, the following are not considered changes of health care provider by
				the injured employee:
a. Emergency services by
				a health care provider;
b.
				Examinations at the request of the organization;
c. Consultations or referrals initiated by
				the health care provider;
d.
				Referrals to radiologists and pathologists for diagnostic studies;
e. When injured employees are required to
				change health care providers to receive compensable medical services or time
				loss authorization because their health care provider is no longer qualified as
				a primary health care provider; or
f. Changes of primary health care provider
				required due to conditions beyond the injured employee's control. This would
				include when the health care provider terminates practice or leaves the
				area.
North Dakota Administrative Code › Title 92 - Workforce Safety and Insurance › Article 92-01 - General Administration › Chapter 92-01-02 - Rules of Procedure - North Dakota Workers' Compensation Act › Section 92-01-02-40

Current through Supplement No. 393, July, 2024
General Authority:
NDCC 65-02-08, 65-02-20,
					 65-05-07
Law Implemented:
NDCC 65-02-20,
					 65-05-07
North Dakota Administrative Code › Title 92 - Workforce Safety and Insurance › Article 92-01 - General Administration › Chapter 92-01-02 - Rules of Procedure - North Dakota Workers' Compensation Act › Section 92-01-02-41 - Independent medical examinations - Definitions

Current through Supplement No. 393, July, 2024
1. The organization may request an
				independent medical examination or independent medical review pursuant to North
				Dakota Century Code section 65-05-28:
a. To
				establish a diagnosis or to clarify a prior diagnosis that may be controversial
				or ill-defined.
b. To outline a
				program of rational treatment, if treatment or progress is
				controversial.
c. To establish
				medical data from which it may be determined whether the medical condition is
				related, or not related, to the injury.
d. To determine whether and to what extent a
				preexisting medical condition is aggravated by an occupational
				injury.
e. To establish when the
				injured employee has reached maximum medical improvement or medically
				stationary status.
f. To establish
				a percentage of rating for permanent impairment.
g. To determine whether a claim should be
				reopened for further treatment on the basis of aggravation of a compensable
				injury or significant change in a medical condition.
h. To determine whether over utilization by a
				medical service provider has occurred.
i. To determine whether a change in medical
				service provider is indicated.
j.
				To determine whether treatment is necessary if the injured employee appears to
				be making no progress in recuperation.
k. When the medical service provider has not
				provided current medical reports.
North Dakota Administrative Code › Title 92 - Workforce Safety and Insurance › Article 92-01 - General Administration › Chapter 92-01-02 - Rules of Procedure - North Dakota Workers' Compensation Act › Section 92-01-02-43 - Home nursing care

Current through Supplement No. 393, July, 2024
1. When the primary
				health care provider believes special or attendant (home nurse) care is needed,
				the health care provider shall submit the following information:
a. A description of the special or home
				nursing care required, including the estimated time required (i.e.,
				catheterization, three times per day, thirty minutes; bathing, two times per
				day, one hour; toilet transfers as needed, dressing change, four times per day,
				two hours).
b. The skill level or
				special training required to administer care (i.e., R.N.; L.P.N.; family member
				who has received special training; or no special training required).
c. If known, the name and address of a person
				or facility willing to provide care.
d. The length of time special or home nursing
				care will be required.
North Dakota Administrative Code › Title 92 - Workforce Safety and Insurance › Article 92-01 - General Administration › Chapter 92-01-02 - Rules of Procedure - North Dakota Workers' Compensation Act › Section 92-01-02-44 - Special programs

Current through Supplement No. 393, July, 2024
The organization may enter into special agreements for
				  services provided by, or under the direction of, licensed medical service
				  providers authorized to bill the organization. Special agreements may be made
				  for services not covered under the fee schedule and may include
				  multidisciplinary or interdisciplinary programs such as pain management, work
				  hardening, and physical conditioning. Special programs include new programs and
				  pilot projects to streamline, waive, or modify selected managed care rules to
				  provide medical care for injured employees with greater efficiency.
The organization shall establish payment rates for special
				  agreements and may establish outcome criteria, measures of effectiveness,
				  minimum staffing levels, certification requirements, special reporting
				  requirements, and other criteria to ensure injured employees receive good
				  quality and effective services at a reasonable cost. The organization may
				  terminate special agreements and programs upon thirty days' notice to the
				  medical service provider.
General Authority:
NDCC 65-02-08, 65-02-20,
					 65-05-07
Law Implemented:
NDCC 65-02-20,
					 65-05-07
North Dakota Administrative Code › Title 92 - Workforce Safety and Insurance › Article 92-01 - General Administration › Chapter 92-01-02 - Rules of Procedure - North Dakota Workers' Compensation Act › Section 92-01-02-45 - Organization responsibilities

Current through Supplement No. 393, July, 2024
1. As soon
				as reasonably possible after receiving a bill, the organization shall:
a. Pay the charge or any portion of the bill
				that is not denied;
b. Deny all or
				a portion of the bill on the basis that the injury is not compensable, or the
				service or charge is excessive or not medically necessary; or
c. Request specific additional information to
				determine whether the charge or service is excessive or not medically necessary
				or whether the condition is compensable.
North Dakota Administrative Code › Title 92 - Workforce Safety and Insurance › Article 92-01 - General Administration › Chapter 92-01-02 - Rules of Procedure - North Dakota Workers' Compensation Act › Section 92-01-02-45.1 - Medical service provider responsibilities and billings

Current through Supplement No. 393, July, 2024
1. A medical
				service provider shall comp lete the registration process and corresponding
				forms identified by the organization to receive payments for services.
2. A medical service provider may
				not submit a charge for a service which exceeds the amount the medical service
				provider charges for the same service in cases unrelated to workers'
				compensation injuries.
3. All bills
				must be fully itemized, including ICD codes, and services must be identified by
				code numbers found in the fee schedules or as provided in these rules. The
				definitions of commonality in the guidelines found in the current procedural
				terminology must be used as guides governing the descriptions of services,
				except as provided in the fee schedules or in these rules. All bills must be
				submitted to the organization within one year of the date of service or within
				one year of the date the organization accepts liability for the work injury or
				condition.
4. All medical service
				providers shall submit charges for medical services on the most current version
				of the UB 04, CMS 1500, or ADA form, or the corresponding electronic versions
				of each. All pharmacy charges must be submitted electronically to the
				organization's pharmacy managed care vendor using the current pharmacy
				transaction standard. Accepted electronic medical billing formats are outlined
				in section 92-01-02-45.2. Medical service bills may not include charges for
				more than one workers' compensation claim, and must include the following:
a. The injured employee's full name and
				address;
b. The injured employee's
				claim number and social security number;
c. Date and nature of injury;
d. The area of the body treated, with the
				appropriate ICD-10-CM code, including identification of right or left, as
				appropriate;
e. Date of service;
f. Facility's name and address and
				telephone number where the service was rendered;
g. Name of allied health care professional
				providing the service along with the rendering allied health care
				professional's national provider identifier (NPI);
h. Billing facility's name, address, zip
				code, telephone number; medical service provider's NPI and tax identification
				number; along with the billing facility's NPI;
i. Referring or ordering health care
				provider's NPI;
j. Place of
				service;
k. Appropriate procedure
				code or hospital revenue code;
l.
				Charge for each service;
m. Units
				of service;
n. If dental, tooth
				numbers;
o. Total bill charge.
North Dakota Administrative Code › Title 92 - Workforce Safety and Insurance › Article 92-01 - General Administration › Chapter 92-01-02 - Rules of Procedure - North Dakota Workers' Compensation Act › Section 92-01-02-45.2 - Medical service provider electronic billing responsibilities

Current through Supplement No. 393, July, 2024
Medical service providers shall submit electronic medical
				  bills and supporting documentation to the organization unless the health care
				  provider is exempt.
1. A medical
				service provider is exempt from the requirement of electronic submission of
				medical bills if:
a. The provider submits
				fewer than fifty bills per calendar year; or
b. The provider can sufficiently demonstrate
				electronic medical bill implementation will create an unreasonable financial
				hardship and can provide supporting documentation, such as financial statements
				or other documentation which reflect the financial hardship. The exemption
				process must be initiated by the medical service provider. Granting an
				exemption lies solely within the organization's discretion and is not subject
				to appeal.
North Dakota Administrative Code › Title 92 - Workforce Safety and Insurance › Article 92-01 - General Administration › Chapter 92-01-02 - Rules of Procedure - North Dakota Workers' Compensation Act › Section 92-01-02-46 - Medical services disputes

Current through Supplement No. 393, July, 2024
1. This rule
				provides the procedures followed for managed care disputes. Retrospective
				review is the procedure provided for disputing the denial of payment for a
				medical service charge based on failure to request prior authorization or
				preservice review. Binding dispute resolution is the procedure provided for
				disputing managed care recommendations, including bill audit and review.
				Disputes not arising from managed care follow the reconsideration and hearing
				procedures provided by North Dakota Century Code section 65-01-16.
2. When the organization denies payment for a
				medical service charge because the medical service provider did not properly
				request prior authorization or preservice review for that service, the medical
				service provider may request a retrospective review of that service. Requests
				for retrospective review must be made in writing, within thirty days after the
				notice that payment for the service is denied, addressed to the organization
				utilization review department. Requests for retrospective review should not be
				sent to the managed care vendor. The request must contain:
a. The injured employee's name.
b. The claim number.
c. The date of service.
d. A statement of why the medical service
				provider did not know and should not have known that the injury or condition
				may be a compensable injury.
e. The
				information required to perform a preservice review or prior authorization of
				the service.
If the medical service provider knew or should have known
				  that the patient may have a compensable work injury when the medical services
				  for that injury were provided, the request for retrospective review must be
				  denied. If the medical service provider did not know and should not have known
				  that the patient may have a compensable work injury when the medical services
				  for that injury were provided, a retrospective preservice review or
				  preauthorization may be done. The organization may determine if the medical
				  review is required to determine medical necessity, or if the medical review is
				  waived based on the supporting documentation. If the organization continues to
				  deny payment for the service, the medical service provider may request binding
				  dispute resolution under this rule.
North Dakota Administrative Code › Title 92 - Workforce Safety and Insurance › Article 92-01 - General Administration › Chapter 92-01-02 - Rules of Procedure - North Dakota Workers' Compensation Act › Section 92-01-02-46.1 - Pharmacy services disputes

Current through Supplement No. 393, July, 2024
1. Binding
				dispute resolution must be used for disputing managed care recommendations,
				including point of sale alterations or denials for pharmacy services. Disputes
				not arising from managed care must follow the reconsideration and hearing
				procedures provided by North Dakota Century Code section 65-01-16.
2. When the organization denies payment for a
				pharmacy service charge the medical service provider or injured employee may
				request review of that service. Requests for review must be made in writing,
				within thirty days after the initial denial of payment, addressed to the
				organization claims adjuster assigned to handle the injured employee's claim.
				Requests for review may not be sent to the managed care vendor. The request
				must contain:
a. The injured employee's
				name.
b. The claim
				number.
c. The date of service and
				service denied.
d. The specific
				relief sought.
e. The information
				required to perform a review of the service. If the organization continues to
				deny payment for the service, the medical service provider may request binding
				dispute resolution under this rule.
North Dakota Administrative Code › Title 92 - Workforce Safety and Insurance › Article 92-01 - General Administration › Chapter 92-01-02 - Rules of Procedure - North Dakota Workers' Compensation Act › Section 92-01-02-48 - Elements of filing

Current through Supplement No. 393, July, 2024
1. For purposes of
				this section, unless the context otherwise requires:
a. "Appropriate record" means a legible
				medical record or report from a provider, or any other relevant and material
				information, substantiating the type, nature, extent, and work-relatedness of
				an injury, which is adequate to verify the level, type, and extent of services
				provided.
b. "Bill" means a
				provider's statement of charges and services rendered for treatment of a
				work-related injury.
c. "Bill
				review" means the review or audit of medical bills and any associated medical
				records by workforce safety and insurance and may include review for
				duplications, omissions, actual delivery of billed services and items, accuracy
				of charges and associated coding, and improper concurrent bills for services
				involving evaluation or treatment of work-related and non-work-related
				problems.
d. "Wage verification"
				means federal and state income tax returns; W-2 forms; daily, weekly, biweekly,
				semimonthly, or monthly employer payroll statements; and income statements
				prepared in accordance with generally accepted accounting practices.
North Dakota Administrative Code › Title 92 - Workforce Safety and Insurance › Article 92-01 - General Administration › Chapter 92-01-02 - Rules of Procedure - North Dakota Workers' Compensation Act › Section 92-01-02-49.1 - Determination of employment status

Current through Supplement No. 393, July, 2024
A person may apply to the organization for a determination of
				  whether that person is an employer as that term is defined by North Dakota
				  Century Code title 65. A person claiming not to be an employer under the
				  Workers' Compensation Act has the burden of proving by a preponderance of the
				  evidence that the person is not an employer. The request for a determination
				  must be in writing and must be supported by evidence of the employment status
				  of the requesting party. If the party is asserting an independent contractor
				  relationship, the party must submit copies of written contracts, if any,
				  establishing the relationship. The organization may request, and the party
				  shall provide promptly, any additional relevant information bearing on the
				  issue of the employer status of the party. After review of the evidence, the
				  organization shall issue its decision determining the employment status of the
				  requesting party under North Dakota Century Code title 65. This determination
				  is effective for no more than one year from the date of the decision and may be
				  reconsidered or revoked at any time by the organization. The requesting party
				  has a continuing obligation to notify the organization of any material change
				  in that party's business relationships, and a failure to notify the
				  organization of a material change shall nullify the organization's
				  certification as of the date of the change.
General Authority: NDCC 65-02-08
Law Implemented: NDCC
					 65-09-01
North Dakota Administrative Code › Title 92 - Workforce Safety and Insurance › Article 92-01 - General Administration › Chapter 92-01-02 - Rules of Procedure - North Dakota Workers' Compensation Act › Section 92-01-02-50 - Other states' coverage

Current through Supplement No. 393, July, 2024
1. The
				terms used in this section have the same meaning as in North Dakota Century
				Code title 65 and in North Dakota Administrative Code title 92, except:
a. "Covered employment" means hazardous
				employment principally localized in this state which involves incidental
				operations in another state. The term "covered employment" does not include
				employment in which the employer is required by the laws of that other state to
				purchase workers' compensation coverage in that other state.
b. "Employee" means any North Dakota employee
				as that term is defined in North Dakota Century Code section 65-01-02 who
				engages in covered employment and who is eligible to file for workers'
				compensation benefits in another state if the employee suffers a work-related
				illness or injury or dies as a result of work activities in that state. The
				term "employee" also includes a person with optional workers' compensation
				coverage in this state under North Dakota Century Code section 65-04-29 or
				65-07-01 who engages in covered employment and is eligible to file for workers'
				compensation benefits in another state if that person suffers a work-related
				illness or injury or dies as a result of work activities in that
				state.
c. "Employer" means an
				employer as defined in North Dakota Century Code section 65-01-02, who is not
				materially delinquent in payment of premium, and who has employees engaged in
				covered employment. An employer is not materially delinquent in payment of
				premium if the premium is no more than thirty days delinquent.
d. "Incidental operations" means business
				operations of an employer for fewer than thirty consecutive days in which the
				employer has no contacts sufficient, under the workers' compensation laws of
				that other state to subject the employer to liability for payment of workers'
				compensation premium in that other state and which operations do not require
				the employer to purchase workers' compensation insurance under the laws of that
				state.
North Dakota Administrative Code › Title 92 - Workforce Safety and Insurance › Article 92-01 - General Administration › Chapter 92-01-02 - Rules of Procedure - North Dakota Workers' Compensation Act › Section 92-01-02-51.1 - Payment of copies requested by subpoena

Current through Supplement No. 393, July, 2024
Any person, as defined in North Dakota Century Code section
				  1-01-49, served with a subpoena by the organization which directs the
				  production of copies of documents may charge the organization copying costs.
				  Those persons shall charge, and the organization shall pay, no more than
				  twenty-five cents per page and up to ten hours for labor not to exceed
				  twenty-five dollars per hour. A payment for copies may exceed the amounts
				  listed herein if, in the discretion of the organization, the production has
				  been or will be uniquely taxing.
General Authority: NDCC 65-02-08
Law Implemented: NDCC
					 65-02-11
North Dakota Administrative Code › Title 92 - Workforce Safety and Insurance › Article 92-01 - General Administration › Chapter 92-01-02 - Rules of Procedure - North Dakota Workers' Compensation Act › Section 92-01-02-51.2 - Work defined

Current through Supplement No. 393, July, 2024
As used in subsection 3 of North Dakota Century Code section
				  65-05-08 and North Dakota Century Code section 65-05-33, "work" means physical
				  or mental effort exerted to do or to make something for any amount of
				  remuneration or physical or mental effort exerted to do or to make something
				  that a reasonable person would consider commonly done or made for remuneration.
General Authority: NDCC 65-02-08
Law Implemented: NDCC 65-05-08(3),
					 65-05-33
North Dakota Administrative Code › Title 92 - Workforce Safety and Insurance › Article 92-01 - General Administration › Chapter 92-01-02 - Rules of Procedure - North Dakota Workers' Compensation Act › Section 92-01-02-53 - Workforce safety and insurance scholarship fund - Application criteria - Refund

Current through Supplement No. 393, July, 2024
An applicant for a workers' compensation scholarship offered
				  under North Dakota Century Code section 65-05-20.1 must complete the
				  application form required by the organization. The form, at a minimum, must
				  require the applicant provide:
1.
				Name, address, date of birth, sex, social security number;
2. Educational history, including transcripts
				if requested;
3. Proof of
				association to the organizational claim leading to the application;
4. Access to receive information regarding
				other financial aid or assistance; and
5. Any other information the organization
				requires to administer this program.
The scholarship committee will use the information on the
				  application form to determine which applicants receive the scholarship and may
				  require an applicant to submit additional supporting information. The minimum
				  required grade point average is a two point zero on a four point zero scale, or
				  its equivalent. The organization may award individual scholarships in any
				  amount up to the maximum amounts provided in North Dakota Century Code section
				  65-05-20.1. Applicants who are awarded the scholarship one year must reapply to
				  receive the scholarship in a subsequent year. If the amount awarded to the
				  applicant is greater than the amount owed the institution over the course of
				  the school year, the excess award must be refunded to the organization. If the
				  applicant who is awarded a scholarship withdraws from the institution and there
				  are scholarship funds to be refunded, the institution shall refund those funds
				  to the organization according to the refund priorities of the
				  institution.
General Authority:
NDCC 65-02-08
Law Implemented:
NDCC
					 65-05-20.1
North Dakota Administrative Code › Title 92 - Workforce Safety and Insurance › Article 92-01 - General Administration › Chapter 92-01-02 - Rules of Procedure - North Dakota Workers' Compensation Act › Section 92-01-02-53.1 - Vocational rehabilitation grant program

Current through Supplement No. 393, July, 2024
The organization may award grants to entities to promote
				  injured workers' skill upgrading, remedial education, and optimal transition
				  into the labor force. To be eligible, entities must submit proposals that
				  identify a vocational need and explain how the entity intends to meet it within
				  a suggested period of time. When determining awards, the organization shall
				  consider the validity of the identified need, a proposal's cost-effectiveness
				  and its general impact on vocational services for injured workers. The awarding
				  of grants rests within the discretion of the organization. Upon request,
				  entities that are awarded grants must report to the organization regarding the
				  use and efficacy of a grant with as much specificity as the organization
				  reasonably requires. In event that grant is not used for the purposes for which
				  it was awarded or an entity is nonresponsive to reasonable requests for
				  reports, an entity may be required to repay the grant and the organization may
				  pursue repayment by civil action.
General Authority: NDCC 65-02-08
Law Implemented: NDCC
					 65-05.1-08(3)
North Dakota Administrative Code › Title 92 - Workforce Safety and Insurance › Article 92-01 - General Administration › Chapter 92-01-02 - Rules of Procedure - North Dakota Workers' Compensation Act › Section 92-01-02-55 - Dividend programs

Current through Supplement No. 393, July, 2024
The organization may offer dividends to qualifying employers.
				  Eligibility and distribution:
1.
				Dividends are not guaranteed.
2. If
				an employer's account has been in effect for less than an entire premium year,
				any dividend offered shall be prorated by the number of months the employer's
				account has been active with the organization. Premiums paid and losses
				incurred during a dividend review period defined by the organization, and other
				criteria identified by the organization, may be used to determine the amount of
				the dividend. Minimum premium and volunteer accounts are not eligible for
				dividend payments.
3. The
				organization shall offset past-due balances on any account by the dividend
				earned on that account.
4. A
				dividend is distributed in the form of a premium credit to an employer's
				account and may not reduce an employer's premium below the minimum premium. No
				monetary disbursements of dividends can be made by the organization.
5. An employer who is noncompliant,
				delinquent, uninsured, or who has failed to submit a payroll report may be
				ineligible for a dividend for the payroll period following the year in which
				the employer was noncompliant, delinquent, uninsured, or failed to submit a
				payroll report.
General Authority:
NDCC 65-02-08
Law Implemented:
NDCC
					 65-04-19.3
North Dakota Administrative Code › Title 92 - Workforce Safety and Insurance › Article 92-01 - General Administration › Chapter 92-01-02 - Rules of Procedure - North Dakota Workers' Compensation Act › Section 92-01-02-56

Current through Supplement No. 393, July, 2024
General Authority: NDCC 65-02-08
Law Implemented: NDCC
					 65-04-17.1
North Dakota Administrative Code › Title 92 - Workforce Safety and Insurance › Article 92-01 - General Administration › Chapter 92-01-02 - Rules of Procedure - North Dakota Workers' Compensation Act › Section 92-01-02-57 - Medical expense assessments

Current through Supplement No. 393, July, 2024
An employer may file an incident report with the organization
				  through the organization's web site. If an incident report is filed with the
				  organization by midnight central time of the next organization business day
				  following the workplace injury or incident and a claim is filed for benefits
				  within fourteen calendar days of the date of injury, the organization shall
				  waive the two hundred fifty dollar medical expense assessment.
The organization shall notify an employer by electronic
				  transmission or by regular mail of the assessment of a medical expense
				  assessment . The billing statement must inform the employer of the ability to
				  appeal the decision of the organization.
General Authority:
NDCC 65-02-08
Law Implemented:
NDCC 65-04-04.4,
					 65-04-19.3
North Dakota Administrative Code › Title 92 - Workforce Safety and Insurance › Article 92-01 - General Administration › Chapter 92-01-03 - Decision Review Office › Section 92-01-03-01 - History and functions of the decision review office

Current through Supplement No. 393, July, 2024
1.
History.
Legislation enacting
				the decision review office was passed in 1995 and is codified as North Dakota
				Century Code section 65-02-27. The legislation took effect on August 1, 1995.
2.
Functions.
The
				program has been developed to educate and provide assistance to injured
				employees in the workers' compensation system. The goal is to resolve claims
				disputes in a timely and professional manner. If an employee has a concern with
				a claim, the employee may contact the decision review office and request
				assistance.
General Authority: NDCC 65-02-08
Law Implemented: NDCC
					 65-02-27
North Dakota Administrative Code › Title 92 - Workforce Safety and Insurance › Article 92-01 - General Administration › Chapter 92-01-03 - Decision Review Office › Section 92-01-03-02 - Definitions

Current through Supplement No. 393, July, 2024
In this chapter:
1.
				"Act" means the North Dakota Workers Compensation Act.
2. "Attempt to resolve" means a prompt,
				active, honest, good-faith effort by the claimant to settle disputes with the
				organization, through the office.
3. "Benefits" means an obligation of the
				organization to provide a claimant with assistance as required by the
				Act.
4. "Certificate of completion"
				means the form sent to the claimant when the office closes its file, which
				acknowledges the claimant made a good-faith effort to resolve the
				dispute.
5. "Claimant" means an
				employee who has filed a claim for benefits with the organization.
6. "Decision review specialist" means a
				person employed by the office to assist a claimant in a disputed claim.
7. "Disputed claim" means a
				challenge to an order issued by the organization.
8. "Interested party" means:
a. The claimant.
b. The claims adjuster assigned to that
				claimant's claim.
c. A claims
				supervisor.
d. The claimant's
				employer or immediate supervisor.
e. The claimant's treating doctor.
f. A member of the organization's legal
				department.
g. Any other person the
				decision review specialist determines appropriate.
North Dakota Administrative Code › Title 92 - Workforce Safety and Insurance › Article 92-01 - General Administration › Chapter 92-01-03 - Decision Review Office › Section 92-01-03-03 - Request for assistance - Timely request for consideration or rehearing

Current through Supplement No. 393, July, 2024
A claimant shall request assistance with the resolution of a
				  dispute that arises from an order in writing within forty-five days from the
				  date of service of the order. An oral request is sufficient to toll the
				  statutory time limit for requesting rehearing if that request is followed by a
				  written request for assistance which is received by the office within ten days
				  after the oral request was made.
General Authority:
NDCC 65-02-08
Law Implemented:
NDCC 65-01-16,
					 65-02-27