reglab/statecodes huggingface dataset:
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter C - NORTH CAROLINA INDUSTRIAL COMMISSION RULES FOR UTILIZATION OF REHABILITATION PROFESSIONALS IN WORKERS' COMPENSATION CLAIMS › Section .0100 - ADMINISTRATION › Section 23C .0105 - QUALIFICATIONS REQUIRED

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Rehabilitation
				  professionals in cases subject to the rules in this Subchapter shall follow the
				  Code of Ethics specific to their certification as well as any statutes specific
				  to their occupation.
(b)
				  Rehabilitation professionals who are Registered Nurses providing medical
				  rehabilitation services in North Carolina must have a North Carolina license to
				  practice and are subject to the requirements of the North Carolina Nursing
				  Practice Act. Rehabilitation professionals who are Registered Nurses providing
				  medical rehabilitation services outside North Carolina must have a license to
				  practice in the state in which the medical care is provided.
(c) To provide medical rehabilitation
				  services and vocational rehabilitation services in cases subject to the Rules
				  in this Subchapter, rehabilitation professionals must either be a qualified
				  rehabilitation professional or a conditional rehabilitation professional as set
				  forth in this Rule.
(d) To qualify
				  as a qualified rehabilitation professional, a rehabilitation professional must:
(1) possess one of the following
				  certifications:
(A) Certified Rehabilitation
				  Counselor (CRC), as certified by the Commission on Rehabilitation Counselor
				  Certification;
(B) Certified
				  Registered Rehabilitation Nurse (CRRN), as certified by the Rehabilitation
				  Nursing Certification Board;
(C)
				  Certified Disability Management Specialist (CDMS), as certified by the
				  Certification of Disability Management Specialists Commission;
(D) Certified Vocational Evaluator (CVE), as
				  certified by the Commission on Rehabilitation Counselor
				  Certification;
(E) Certified
				  Occupational Health Nurse-Specialist (COHN-S), as certified by the American
				  Board of Occupational Health Nurses;
(F) Certified Occupational Health Nurse
				  (COHN), as certified by the American Board of Occupational Health
				  Nurses;
(G) Orthopaedic Nurse
				  Certified (ONC), as certified by the Orthopaedic Nurses Certification Board;
				  or
(H) Certified Case Manager
				  (CCM), as certified by the Commission for Case Manager Certification;
				  or
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter C - NORTH CAROLINA INDUSTRIAL COMMISSION RULES FOR UTILIZATION OF REHABILITATION PROFESSIONALS IN WORKERS' COMPENSATION CLAIMS › Section .0100 - ADMINISTRATION › Section 23C .0106 - PROFESSIONAL RESPONSIBILITY OF THE REHABILITATION PROFESSIONAL IN WORKERS' COMPENSATION CLAIMS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) A
				  rehabilitation professional shall exercise independent professional judgment in
				  making and documenting recommendations for medical and vocational
				  rehabilitation for an injured worker, including any alternatives for medical
				  treatment and cost-effective return-to-work options. It is not the role of the
				  rehabilitation professional to direct medical care.
(b) A rehabilitation professional shall
				  inform the parties of his or her assignment and role in the case. Upon
				  assignment, a rehabilitation professional shall disclose to health care
				  providers and the parties any possible conflict of interest, including any
				  compensation and the carrier's or employer's ownership of or affiliation with
				  the rehabilitation professional.
(c) Subject to the provisions for medical
				  care and treatment set forth in the Workers' Compensation Act, the medical
				  rehabilitation professional may explain medical information to the worker and
				  shall discuss with the worker all treatment options appropriate to the worker's
				  conditions, but shall not advocate any one source for treatment or change in
				  treatment.
(d) As case consultants
				  or expert witnesses, rehabilitation professionals shall provide unbiased,
				  objective opinions. The limits of their relationships shall be defined through
				  written or oral means in accordance with the following, applicable professional
				  codes of ethics or professional conduct, which are hereby incorporated by
				  reference, including subsequent amendments and editions:
(1) for Certified Rehabilitation Counselors
				  and Certified Vocational Evaluators, the Commission on Rehabilitation Counselor
				  Certification Code of Professional Ethics;
(2) for Certified Registered Rehabilitation
				  Nurses and Orthopaedic Nurse Certifieds, the Code of Ethics for
				  Nurses;
(3) for Certified
				  Disability Management Specialists, the Certification of Disability Management
				  Specialists Commission Code of Professional Conduct;
(4) for Certified Occupational Health Nurses
				  and Certified Occupational Health Nurse-Specialists, the American Association
				  of Occupational Health Nurses, Inc. Code of Ethics; and
(5) for Certified Case Managers, the Code of
				  Professional Conduct for Case Managers.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter C - NORTH CAROLINA INDUSTRIAL COMMISSION RULES FOR UTILIZATION OF REHABILITATION PROFESSIONALS IN WORKERS' COMPENSATION CLAIMS › Section .0100 - ADMINISTRATION › Section 23C .0109 - VOCATIONAL REHABILITATION SERVICES AND RETURN TO WORK

Current through Register Vol. 39, No. 2, July 15, 2024
(a)
				  When performing the vocational assessment and formulating and drafting the
				  individualized written rehabilitation plan for the employee required by
				  G.S.
				  97-32.2(c), the vocational
				  rehabilitation professional shall follow
				  G.S.
				  97-32.2.
(b) Job placement activities may not be
				  commenced until after a vocational assessment and an individualized written
				  rehabilitation plan for vocational rehabilitation services specifying the goals
				  and the priority for return-to-work options have been completed in the case in
				  accordance with
				  G.S.
				  97-32.2. Job placement activities shall be
				  directed as defined by Rule .0103(5) of this Subchapter or by applicable
				  statute.
(c) Return-to-work options
				  should be considered in the following order of priority:
(1) current job, current employer;
(2) new job, current employer;
(3) on-the-job training, current
				  employer;
(4) new job, new
				  employer;
(5) on-the-job training,
				  new employer;
(6) formal education
				  or vocational training to prepare the worker for a job with current or new
				  employer; and
(7) self-employment,
				  only when its feasibility is documented with reference to the employee's
				  aptitudes and training, adequate capitalization, and market
				  conditions.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter C - NORTH CAROLINA INDUSTRIAL COMMISSION RULES FOR UTILIZATION OF REHABILITATION PROFESSIONALS IN WORKERS' COMPENSATION CLAIMS › Section .0100 - ADMINISTRATION › Section 23C .0110 - CHANGE OF REHABILITATION PROFESSIONAL

Current through Register Vol. 39, No. 2, July 15, 2024
(a) By
				  agreement or stipulation of the parties, the rehabilitation professional may be
				  changed.
(b) A rehabilitation
				  professional may be removed from a case upon motion by either party or by the
				  Commission for good cause. The motion shall be filed with the Executive
				  Secretary's Office and served upon all parties and the rehabilitation
				  professional. Any party or the rehabilitation professional may file a response
				  to the motion within 10 days.
(c) A
				  party or the rehabilitation professional may request reconsideration of a
				  ruling or appeal from an order as provided in
				  11 NCAC
				  23A .0702 or pursuant to
				  G.S.
				  97-83 and
				  G.S.
				  97-84.
Authority
					 G.S.
					 97-25.4;
					 97-25.5;
					 97-32.2;
					 97-80;
					 97-83;
					 97-84;
Eff. January 1,
					 1996;
Amended Eff. November 1, 2014; June 1, 2000;
Recodified from
					 04 NCAC
					 10C .0110 Eff. June 1,
					 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter C - NORTH CAROLINA INDUSTRIAL COMMISSION RULES FOR UTILIZATION OF REHABILITATION PROFESSIONALS IN WORKERS' COMPENSATION CLAIMS › Section .0200 - RULES OF THE COMMISSION › Section 23C .0201 - WAIVER OF RULES

Current through Register Vol. 39, No. 2, July 15, 2024
In the interests of justice or to promote judicial economy
					 the Commission may, except as otherwise provided by the rules in this
					 Subchapter, waive or vary the requirements or provisions of any of the rules in
					 this Subchapter in a case pending before the Commission upon written
					 application of a party or upon its own initiative only if the employee is not
					 represented by counsel. Factors the Commission shall use in determining whether
					 to grant the waiver are:
(1) the
				  necessity of a waiver;
(2) the
				  party's responsibility for the conditions creating the need for a
				  waiver;
(3) the party's prior
				  requests for a waiver;
(4) the
				  precedential value of such a waiver;
(5) notice to and opposition by the opposing
				  parties; and
(6) the harm to the
				  party if the waiver is not granted.
Authority
					 G.S.
					 97-25.4;
					 97-80;
Eff. November
					 1, 2014;
Recodified from
					 04 NCAC
					 10C .0201 Eff. June 1,
					 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter D - WORKERS' COMPENSATION RULES FOR MANAGED CARE ORGANIZATIONS › Section .0100 - RULES › Section 23D .0101 - PURPOSE

Current through Register Vol. 39, No. 2, July 15, 2024
The rules in this Subchapter are intended to facilitate the
					 timely and cost-effective delivery of appropriate medical compensation services
					 to fulfill the employer's duty to provide such services as are reasonably
					 necessary to effect a cure, give relief, or shorten the period of disability
					 resulting from compensable injuries through the use of Managed Care
					 Organizations (MCOs). The rules in this Subchapter do not affect informal lists
					 or "employer networks" of providers assembled by employers or insurers for
					 their own referrals.
Authority
					 G.S.
					 97-2(19);
					 97-2(20);
					 97-2(21);
					 97-25;
					 97-25.2;
					 97-25.3(e);
					 97-25.4(a);
					 97-26(b);
					 97-26(c);
Eff. January 1, 1996;
Amended Eff. July 1, 2014;
Recodified from
					 04 NCAC
					 10D .0101 Eff. June 1,
					 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter D - WORKERS' COMPENSATION RULES FOR MANAGED CARE ORGANIZATIONS › Section .0100 - RULES › Section 23D .0102 - DEFINITIONS

Current through Register Vol. 39, No. 2, July 15, 2024
As used in this Subchapter:
(1) "Employer" means an employer as defined
				  by G.S.
				  97-2(3) who is obligated by
				  the Workers' Compensation Act to pay or provide indemnity or medical
				  compensation, including any insurance carrier, self-insurance fund, third party
				  administrator or other person, firm or corporation undertaking to pay or adjust
				  claims on behalf of the employer's employees.
(2) "Act" means the North Carolina Workers'
				  Compensation Act, Chapter 97, Article 1 (G.S.
				  97-1 through
				  G.S.
				  97-101.1).
(3) "Employer network" means any group of
				  providers assembled by or for an entity liable for medical compensation that
				  agrees to accept the referrals of that entity's workers' compensation patients,
				  and from among whom an adjuster, officer, employee, or insured patient of the
				  entity chooses the initial provider; provided, the entity has no right to sell
				  the services of the providers to a third party.
Authority
					 G.S.
					 58-50-50;
					 97-2(3);
					 97-2(20);
					 97-2(21);
					 97-25;
					 97-25.2;
					 97-26(b);
					 97-26(c);
					 97-77;
					 97-79;
Eff. January 1,
					 1996;
Amended Eff. July 1, 2014;
Recodified from
					 04 NCAC
					 10D .0102 Eff. June 1,
					 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter D - WORKERS' COMPENSATION RULES FOR MANAGED CARE ORGANIZATIONS › Section .0100 - RULES › Section 23D .0103 - QUALIFICATION BY DEPARTMENT OF INSURANCE

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 97-2(21);
					 97-25;
Eff. January 1,
					 1996;
Repealed Eff. July 1, 2014;
Recodified from
					 04 NCAC
					 10D .0103 Eff. June 1,
					 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter D - WORKERS' COMPENSATION RULES FOR MANAGED CARE ORGANIZATIONS › Section .0100 - RULES › Section 23D .0104 - QUALIFICATION AND REVOCATION

Current through Register Vol. 39, No. 2, July 15, 2024
For ineffective delivery of medical services, failure to
					 comply with applicable laws, rules or regulations, and failure to respond to
					 lawful orders of the Commission or other regulatory authorities, the Commission
					 shall change the provider of medical compensation in accordance with the
					 Workers' Compensation Act.
Authority
					 G.S.
					 97-25;
					 97-25.2;
Eff. January
					 1, 1996;
Amended Eff. July 1, 2014;
Recodified from
					 04 NCAC
					 10D .0104 Eff. June 1,
					 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter D - WORKERS' COMPENSATION RULES FOR MANAGED CARE ORGANIZATIONS › Section .0100 - RULES › Section 23D .0105 - NOTICE TO COMMISSION

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Upon
				  contracting with an employer to provide medical compensation services, an MCO
				  shall provide to the Commission the following:
(1) a copy of that portion of the contract
				  containing the provisions specified in Rule .0106 of this Subchapter and the
				  method for determining payment to the MCO, excluding those of its terms kept
				  confidential by the North Carolina Department of Insurance, initialed by the
				  employer;
(2) a copy of its current
				  certificate(s) issued annually by the North Carolina Department of Insurance
				  pursuant to G.S. Chapter 58; and
(3) the name and address of all owners or
				  shareholders, or related groups of owners or shareholders, holding more than 10
				  percent interest in the MCO, and whether they are or have any relationship with
				  a provider.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter D - WORKERS' COMPENSATION RULES FOR MANAGED CARE ORGANIZATIONS › Section .0100 - RULES › Section 23D .0106 - CONTRACT PROVISIONS

Current through Register Vol. 39, No. 2, July 15, 2024
An MCO's contract with an employer subject to the Rules in
					 this Subchapter shall include:
(1) the
				  principal place(s) of employment of the covered employees, including
				  address(es) and phone number(s) of the workplace(s);
(2) the name, title, mailing address, phone
				  number, fax number, and email address, if any, of an officer or responsible
				  employee of the MCO empowered to assent to the treatment or referral of covered
				  employees, capable of obtaining and providing complete business, administrative
				  and medical records generated pursuant to the contract, and empowered to
				  resolve routine disputes with employees, employers and providers under the
				  Commission's jurisdiction;
(3) the
				  name, title, mailing address, phone number, fax number, and email address, if
				  any, of an adjuster, officer, agent or employee of the employer empowered to
				  negotiate the resolution of routine medical compensation disputes, and receive
				  orders of the Commission on behalf of the employer;
(4) an acknowledgment that the MCO is bound
				  by applicable requirements of Chapters 58 and 97 of the North Carolina General
				  Statutes and the rules in this Subchapter, and is subject to orders of the
				  Commission to the same extent as the employer;
(5) the agreement of the employer that it
				  will cooperate and assist in furnishing its employees and supervisors with a
				  phone number and instructions for obtaining emergency treatment and contacting
				  the MCO upon injury to any employee during the workday or on the employer's
				  premises requiring physician attention;
(6) a dispute resolution plan in accordance
				  with G.S.
				  97-25.2, including provisions for notice of
				  decision in appeals within 30 days, or within 72 hours of appeal when the
				  regular appeals process would cause a delay in the rendering of health care
				  that would be detrimental to the health of the employee;
(7) a description of physician panels,
				  including specialties represented, and the employee's right to select his or
				  her attending physician from the appropriate panel, and to subsequently change
				  attending physicians once within the members of the panel; and
(8) whether the MCO or employer will be
				  responsible for securing the services of "out of network" providers when
				  needed.
Authority
					 G.S.
					 97-25.2;
Eff. January 1,
					 1996;
Amended Eff. July 1, 2014;
Recodified from
					 04 NCAC
					 10D .0106 Eff. June 1,
					 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter D - WORKERS' COMPENSATION RULES FOR MANAGED CARE ORGANIZATIONS › Section .0100 - RULES › Section 23D .0107 - INFORMATION FOR EMPLOYEE

Current through Register Vol. 39, No. 2, July 15, 2024
(a)
				  Following the onset of an injury, the employer or MCO shall provide to the
				  employee a printed explanation of the system being utilized for his care,
				  suitable for sharing with emergency, "out-of-network", and referral physicians,
				  that shall be filed with any Form 19 submitted to the Commission; provided,
				  that electronic filers may otherwise notify the Commission of the identity of
				  the MCO. This statement shall include the following information:
(1) the offices to contact concerning medical
				  treatment for the injury, including a telephone number;
(2) if known at that time, the employee's
				  chosen treating physician, including a phone number for seeking medical
				  assistance outside normal business hours if the injury might cause such a
				  need;
(3) the applicable methods
				  for choosing and changing treating physicians and resolving disputes concerning
				  physicians or treatment pursuant to
				  G.S.
				  97-25.2;
(4) that the MCO can provide access to
				  licensed physicians of all specialties;
(5) the employer's obligation to pay for
				  treatment for which the employee is referred to the MCO, whether or not the
				  employer admits liability for the injury per
				  G.S.
				  97-90(e);
(6) the employee's duty to cooperate in
				  treatment, and right to secure treatment at his or her own expense that does
				  not interfere with the treating physician's treatment; and
(7) the Commission's File Number, if known
				  when filed.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter D - WORKERS' COMPENSATION RULES FOR MANAGED CARE ORGANIZATIONS › Section .0100 - RULES › Section 23D .0108 - INCLUSIVE PROVIDER PANELS

Current through Register Vol. 39, No. 2, July 15, 2024
Following the onset of an injury, and upon an employee's
					 first request to change attending physician, the MCO shall provide the employee
					 with a list of reasonably accessible and available panel physicians qualified
					 to treat or manage the primary condition for which the employer has accepted
					 liability or authorized treatment from which the employee may select the
					 attending physician. The employer and MCO shall provide for access to all
					 medical compensation services, and include in its panels, or otherwise make
					 available for the employee's choice, one or more licensed physicians
					 representing all specialties available in the community to provide necessary
					 treatment for the employee's primary compensable condition.
Authority
					 G.S.
					 97-2(19);
					 97-2(20);
					 97-25;
					 97-25.2;
Eff. January
					 1, 1996;
Amended Eff. July 1, 2014;
Recodified from
					 04 NCAC
					 10D .0108 Eff. June 1,
					 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter D - WORKERS' COMPENSATION RULES FOR MANAGED CARE ORGANIZATIONS › Section .0100 - RULES › Section 23D .0109 - QUALITY ASSURANCE AND UTILIZATION REVIEW

Current through Register Vol. 39, No. 2, July 15, 2024
An MCO subject to the Rules in this Subchapter shall comply
					 with the requirements of the North Carolina Department of Insurance for quality
					 assurance and utilization review plans, and upon request, provide the
					 Commission with copies of records generated by, or utilized in, the operation
					 of those programs, and copies of plans or amendments to plans not yet filed
					 with the Department of Insurance.
Authority
					 G.S.
					 97-25.2;
Eff. January 1,
					 1996;
Amended Eff. July 1, 2014;
Recodified from
					 04 NCAC
					 10D .0109 Eff. June 1,
					 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter D - WORKERS' COMPENSATION RULES FOR MANAGED CARE ORGANIZATIONS › Section .0100 - RULES › Section 23D .0110 - WAIVER OF RULES

Current through Register Vol. 39, No. 2, July 15, 2024
In the interests of justice or to promote judicial economy,
					 the Commission may, except as otherwise provided by the rules in this
					 Subchapter, waive or vary the requirements or provisions of any of the rules in
					 this Subchapter in a case pending before the Commission upon written
					 application of a party or upon its own initiative only if the employee is not
					 represented by counsel. Factors the Commission shall use in determining whether
					 to grant the waiver are:
(1) the
				  necessity of a waiver;
(2) the
				  party's responsibility for the conditions creating the need for a
				  waiver;
(3) the party's prior
				  requests for a waiver;
(4) the
				  precedential value of such a waiver;
(5) notice to and opposition by the opposing
				  parties; and
(6) the harm to the
				  party if the waiver is not granted.
Authority
					 G.S.
					 97-25.2;
					 97-80(a);
Eff. January 1, 1996;
Amended Eff. July 1, 2014;
Recodified from
					 04 NCAC
					 10D .0110 Eff. June 1,
					 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter E - ADMINISTRATIVE RULES OF THE INDUSTRIAL COMMISSION › Section .0100 - ADMINISTRATION › Section 23E .0101 - INSTRUCTIONS FOR FILING A PETITION FOR RULE-MAKING

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Any
				  person may petition the Commission to adopt a new rule, or amend or repeal an
				  existing rule by submitting a rule-making petition to the Commission at 1240
				  Mail Service Center, Raleigh, NC 27699-1240. The petition must be titled
				  "Petition for Rule-making" and must include the following information:
(1) the name and address of the person
				  submitting the petition;
(2) a
				  citation to any rule for which an amendment or repeal is requested;
(3) a draft of any proposed rule or amended
				  rule;
(4) an explanation of why the
				  new rule or amendment or repeal of an existing rule is requested and the effect
				  of the new rule, amendment, or repeal on the procedures of the Commission;
				  and
(5) any other information the
				  person submitting the petition considers relevant.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter E - ADMINISTRATIVE RULES OF THE INDUSTRIAL COMMISSION › Section .0100 - ADMINISTRATION › Section 23E .0102 - MAILING LIST

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Any person or
				  agency desiring to be placed on the mailing list for the Commission's
				  rule-making notices issued pursuant to
				  G.S.
				  150B-21.2 may file a request in writing to
				  the Chairperson of the Commission at 1240 Mail Service Center Raleigh, NC
				  27699-1240.
(b) The request shall:
(1) include the person's name and
				  address;
(2) specify the subject
				  areas within the authority of the Commission for which notice is requested;
				  and
(3) state the calendar year(s)
				  for which the notice is desired.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter E - ADMINISTRATIVE RULES OF THE INDUSTRIAL COMMISSION › Section .0100 - ADMINISTRATION › Section 23E .0103 - ADMISSION OF OUT-OF-STATE ATTORNEYS TO APPEAR BEFORE THE COMMISSION

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Attorneys residing in and licensed to
				  practice law in another state who seek to be admitted to practice before the
				  Commission to represent a client in a claim pursuant to
				  G.S.
				  84-4.1 shall file a motion with the
				  Commission that complies with the requirements of
				  G.S.
				  84-4.1. The North Carolina attorney with whom
				  the out-of-state attorney associates pursuant to
				  G.S.
				  84-4.1(5) may file the
				  motion instead as long as it complies with the requirements of
				  G.S.
				  84-4.1.
(b) The motion shall be filed with the
				  Executive Secretary of the Commission except under the following circumstances:
(1) If the motion is filed in a claim that is
				  set for hearing before or pending decision by a Deputy Commissioner or the Full
				  Commission, the motion shall be filed with the Deputy Commissioner or chair of
				  the Full Commission panel, respectively.
(2) If the motion is filed in a claim
				  involving a form application regarding a death claim, the motion shall be filed
				  with the Director of Claims Administration.
(3) If the motion is filed in a claim
				  involving a stipulated Opinion and Award regarding a death claim, the motion
				  shall be filed with the Chief Deputy Commissioner.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter E - ADMINISTRATIVE RULES OF THE INDUSTRIAL COMMISSION › Section .0100 - ADMINISTRATION › Section 23E .0104 - SECURE LEAVE PERIODS FOR ATTORNEYS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Any
				  attorney may request one or more secure leave periods each year as provided in
				  this Rule.
(b) For the purpose of
				  this Paragraph only, a "secure leave period" is defined as a partial calendar
				  week or a complete calendar week. Within a calendar year, an attorney is
				  entitled to obtain secure leave periods totaling up to 15 business days for any
				  purpose.
(c) For the purpose of
				  this Paragraph only, a "secure leave period" is defined as a complete calendar
				  week. Within a 24-week period surrounding the birth or adoption of an
				  attorney's child, that attorney is entitled to have the benefit of up to 12
				  additional secure leave periods.
(d) To request a secure leave period, an
				  attorney shall file a written request, by letter or motion, containing the
				  information required by Paragraph (e) of this Rule with the Office of the Chair
				  within the time period provided in Paragraph (f) of this Rule. Upon such
				  filing, the Chair shall review the request. If the request is made pursuant to
				  Paragraph (b) or Paragraph (c) of this Rule and the request complies with
				  Paragraphs (e) and (f) of this Rule, the Chair shall issue a letter allowing
				  the requested secure leave period. The attorney shall not be required to appear
				  at any trial, hearing, deposition, or other proceeding before the Commission
				  during a secure leave period that is allowed.
(e) The request shall contain the following
				  information:
(1) the attorney's name, mailing
				  address, telephone number, email address, and state bar number;
(2) the date(s) for which secure leave is
				  being requested;
(3) the dates of
				  all other secure leave periods during the current calendar year that have
				  previously been designated by the attorney pursuant to this Rule;
(4) a statement that the secure leave period
				  is not being designated for the purpose of delaying, hindering, or interfering
				  with the disposition of any matter in any pending action or
				  proceeding;
(5) a statement that no
				  action or proceeding in which the attorney has entered an appearance has been
				  scheduled, tentatively set, or noticed for trial, hearing, deposition, or other
				  proceeding during the designated secure leave period; and
(6) for secure leave requests that arise
				  under Paragraph (c) of this Rule, the expected birth date or adoption date of
				  the child.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter E - ADMINISTRATIVE RULES OF THE INDUSTRIAL COMMISSION › Section .0200 - FEES › Section 23E .0201 - DOCUMENT AND RECORD FEES

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The fees in
				  this Rule apply to all subject areas within the authority of the
				  Commission.
(b) Upon written
				  request, to the extent permitted by Article 1 of Chapter 97, Article 31 of
				  Chapter 143, and Chapter 132 of the North Carolina General Statutes,
				  transcripts of Commission proceedings, copies of recordings of Commission
				  proceedings, copies of exhibits from Commission proceedings, and copies of all
				  other public documents are available at the "actual cost" as defined by
				  G.S.
				  132-6.2(b). The Commission
				  shall provide the "actual cost" on the Commission's website.
(c) Certified copies are available upon
				  request at a cost of one dollar ($1.00) per certification in addition to any
				  other applicable cost for the document. Electronic copy certification is not
				  available.
(d) Documents shall be
				  sent via certified mail upon request at the actual cost established by the
				  United States Postal Service.
(e)
				  North Carolina sales tax shall be added if applicable.
Authority
					 G.S.
					 7A-305;
					 97-73;
					 97-79;
					 97-80;
					 132-6.2;
					 143-291.1;
					 143-291.2;
					 143-300;
Eff.
					 November 1, 2014;
Recodified from
					 04 NCAC
					 10E .0201 Eff. June 1,
					 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter E - ADMINISTRATIVE RULES OF THE INDUSTRIAL COMMISSION › Section .0200 - FEES › Section 23E .0202 - HEARING COSTS OR FEES

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The following
				  hearing costs or fees apply to all subject areas within the authority of the
				  Commission other than workers' compensation cases:
(1) one hundred twenty dollars ($120.00) for
				  a hearing before a Deputy Commissioner to be charged after the hearing has been
				  held;
(2) one hundred twenty
				  dollars ($120.00) if a case is continued after the case is calendared for a
				  specific hearing date, to be paid by the requesting party or parties;
(3) one hundred twenty dollars ($120.00) if a
				  case is withdrawn, removed, or dismissed after the case is calendared for a
				  specific hearing date;
(4) two
				  hundred twenty dollars ($220.00) for a hearing before the Full Commission to be
				  charged after the hearing has been held; and
(5) one hundred twenty dollars ($120.00) if
				  one of the following occurs after an appeal or request for review is scheduled
				  for a specific hearing date before the Full Commission:
(A) the appeal or request for review is
				  withdrawn; or
(B) the appeal or
				  request for review is dismissed for failure to prosecute or perfect the appeal
				  or request for review.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter E - ADMINISTRATIVE RULES OF THE INDUSTRIAL COMMISSION › Section .0200 - FEES › Section 23E .0203 - FEES SET BY THE COMMISSION

Current through Register Vol. 39, No. 2, July 15, 2024
(a) In
				  workers' compensation cases, the Commission sets the following fees:
(1) four hundred dollars ($400.00) for the
				  processing of a compromise settlement agreement to be paid 50 percent by the
				  employee and 50 percent by the employer(s) or the employer's carrier(s). The
				  employer(s) or the employer's carrier(s) shall pay such fee in full when
				  submitting the agreement to the Commission and, unless the parties agree
				  otherwise, shall be entitled to a credit for the employee's 50 percent share of
				  such fee against settlement proceeds;
(2) two hundred dollars ($200.00) for the
				  processing of a I.C. Form MSC5,
Report of Mediator
, to be paid
				  50 percent by the employee and 50 percent by the employer(s) or the employer's
				  carrier(s). The employer(s) or the employer's carrier(s) shall pay such fee in
				  full upon receipt of an invoice from the Commission and, unless the parties
				  agree otherwise, shall be reimbursed for the employee's share of such fees when
				  the case is concluded from any compensation that may be determined to be due to
				  the employee. The employer(s) or the employer's carrier(s) may withhold funds
				  from any award for this purpose; and
(3) a fee equal to the filing fee required to
				  file of a civil action in the Superior Court division of the General Court of
				  Justice for the processing of a Form 33I
Intervenor's Request that
				  Claim be Assigned for Hearing
, to be paid by the intervenor.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter E - ADMINISTRATIVE RULES OF THE INDUSTRIAL COMMISSION › Section .0200 - FEES › Section 23E .0204 - ACCIDENT PREVENTION AND SAFETY EDUCATIONAL PROGRAM FEES

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The following fees shall be assessed for
				  accident prevention and safety educational programs:
(1) one hundred twenty-five dollars ($125.00)
				  per person for an Accident Prevention Awareness (APCAP) Workshop;
(2) seventy-five dollars ($75.00) per person
				  for an Advanced APCAP Workshop;
(3)
				  thirty dollars ($30.00) per person for a Safety and Health Workshop;
(4) twenty dollars ($20.00) per person for a
				  First Aid, CPR, and AED Course, plus fifteen dollars ($15.00) per person for
				  materials;
(5) fifteen dollars per
				  person ($15.00) for a First Aid Course, plus twelve dollars ($12.00) per person
				  for materials;
(6) fifteen dollars
				  per person ($15.00) for a CPR and AED Course, plus twelve dollars ($12.00) per
				  person for materials;
(7) twenty
				  dollars ($20.00) per person for a Defensive Driving Course, plus four dollars
				  ($4.00) per person for materials;
(8) fifty dollars ($50.00) per person for a
				  Hazardous Waste Operations and Emergency Response (HAZWOPER) Course or
				  Refresher Course;
(9) thirty
				  dollars ($30.00) per person for a HAZWOPER Awareness Course;
(10) twenty-five dollars ($25.00) per person
				  for a Work Zone Flagger Course, plus five dollars ($5.00) for
				  materials;
(11) thirty dollars
				  ($30.00) per person for a Trenching Competent Person Course;
(12) thirty-five dollars ($35.00) per person
				  for a Competent Person Scaffolding Course;
(13) forty-five dollars ($45.00) per person
				  for an eight-hour National Fire Protection Association (NFPA) E Arc Flash
				  Course;
(14) thirty dollars
				  ($30.00) per person for a four-hour NFPA E Arc Flash Course;
(15) fifty dollars ($50.00) per person for a
				  Safety for Supervisors Course;
(16)
				  one hundred fifty dollars ($150.00) per person for a Safety Leadership
				  Course;
(17) a two hundred dollar
				  ($200.00) flat fee for a (five to eight-hour) Workplace Training;
(18) a one hundred-fifty dollar ($150.00)
				  flat fee for a (three to four-hour)Workplace Training (3-4 hours);
				  and
(19) a one hundred dollar
				  ($100.00) flat fee for a (one to two-hour) Workplace Training.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter E - ADMINISTRATIVE RULES OF THE INDUSTRIAL COMMISSION › Section .0300 - RULES OF THE COMMISSION › Section 23E .0301 - WAIVER OF RULES

Current through Register Vol. 39, No. 2, July 15, 2024
In the interests of justice or to promote judicial economy,
					 the Commission may, except as otherwise provided by the rules in this
					 Subchapter, waive or vary the requirements or provisions of any of the rules in
					 this Subchapter in a case pending before the Commission upon written
					 application of a party or upon its own initiative only if the employee is not
					 represented by counsel. Factors the Commission shall use in determining whether
					 to grant the waiver are:
(1) the
				  necessity of a waiver;
(2) the
				  party's responsibility for the conditions creating the need for a
				  waiver;
(3) the party's prior
				  requests for a waiver;
(4) the
				  precedential value of such a waiver;
(5) notice to and opposition by the opposing
				  parties; and
(6) the harm to the
				  party if the waiver is not granted.
Authority
					 G.S.
					 97-25.2;
					 97-25.4;
					 97-73;
					 97-80;
					 130A-425(d);
					 143-166.4;
					 143-296;
					 143-300;
Eff. July 1,
					 2014;
Recodified from
					 04 NCAC
					 10E .0301 Eff. June 1,
					 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter E - ADMINISTRATIVE RULES OF THE INDUSTRIAL COMMISSION › Section .0300 - RULES OF THE COMMISSION › Section 23E .0302 - EMERGENCY ORDERS AND DIRECTIVES OF THE CHIEF JUSTICE OF THE NORTH CAROLINA SUPREME COURT

Current through Register Vol. 39, No. 2, July 15, 2024
(a) This Rule
				  applies to all matters within the authority and jurisdiction of the Commission
				  and to all Subchapters of the Commission's rules.
(b) In the interests of justice or to protect
				  the public health or safety, the Commission may waive or modify any portion of
				  its rules in order to bring them in conformity with an emergency Order or
				  directive of the Chief Justice of the North Carolina Supreme Court that is in
				  effect. The Commission shall consider the following factors in determining
				  whether to grant the waiver or modification:
(1) the necessity of waiving or modifying the
				  rule; and
(2) the impact of waiving
				  or modifying the rule on the regulated parties and on the Commission.
If the Commission waives or modifies a rule to bring it
					 into conformity with any emergency Order or directive of the Chief Justice of
					 the North Carolina Supreme Court, the Commission shall post a notice of the
					 waiver or modification of the rule on its website unless the waiver or
					 modification is case-specific and not generally applicable to the regulated
					 public. For a waiver or modification that is case-specific and not generally
					 applicable to the regulated public, the Commission shall notify the parties in
					 the case of the waiver or modification via an order of the Commission.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter F - ELECTRONIC BILLING RULES › Section .0100 - ADMINISTRATION › Section 23F .0101 - ELECTRONIC MEDICAL BILLING AND PAYMENT REQUIREMENT

Current through Register Vol. 39, No. 2, July 15, 2024
Carriers and licensed health care providers shall utilize
					 electronic billing and payment in workers' compensation claims. Carriers and
					 health care providers shall develop and implement electronic billing and
					 payment processes consistent with
					 45 CFR
					 162. Carriers and health care providers shall
					 comply with this Rule on or before March 1, 2014.
					 45 CFR
					 162 is hereby incorporated by reference and
					 includes subsequent amendments and editions. A copy may be obtained at no
					 charge from the National Archives and Records Administration's website,
					 http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&tpl=/ecfrbrowse/Title45/45cfr162_main_02.tpl,
					 or upon request, at the offices of the Commission, located in the Dobbs
					 Building, 430 North Salisbury Street, Raleigh, North Carolina, between the
					 hours of 8:00 a.m. and 5:00 p.m.
Authority
					 G.S.
					 97-26(g1);
					 97-80;
Eff. July 1,
					 2014;
Recodified from
					 04 NCAC
					 10F .0101 Eff. June 1,
					 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter F - ELECTRONIC BILLING RULES › Section .0100 - ADMINISTRATION › Section 23F .0102 - DEFINITIONS

Current through Register Vol. 39, No. 2, July 15, 2024
As used in this Subchapter:
(1) "Clearinghouse" means a public or private
				  entity, including a billing service, repricing company, community health
				  management information system or community health information system, and
				  "value-added" networks and switches, that is an agent of either the payer or
				  the provider and that may perform the following functions:
(a) Processes or facilitates the processing
				  of medical billing information received from a client in a nonstandard format
				  or containing nonstandard data content into standard data elements or a
				  standard transaction for further processing of a bill related transaction;
				  or
(b) Receives a standard
				  transaction from another entity and processes or facilitates the processing of
				  medical billing information into nonstandard format or nonstandard data content
				  for a client entity.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter F - ELECTRONIC BILLING RULES › Section .0100 - ADMINISTRATION › Section 23F .0103 - FORMATS FOR ELECTRONIC MEDICAL BILL PROCESSING

Current through Register Vol. 39, No. 2, July 15, 2024
(a)
				  Beginning March 1, 2014, electronic medical billing transactions shall be
				  conducted using the electronic formats adopted under the Code of Federal
				  Regulations, Title 45, part 162, subparts K, N, and P. Whenever a standard
				  format is replaced with a newer standard, the most recent standard shall be
				  used. The requirement to use a new version shall commence on the effective date
				  of the new version as published in the Code of Federal Regulations.
(b) Nothing in this Subchapter shall prohibit
				  payers and health care providers from using a direct data entry methodology for
				  complying with these requirements, provided the methodology complies with the
				  data content requirements of the adopted formats and these Rules.
Authority
					 G.S.
					 97-26;
					 97-26(g1);
					 97-80;
Eff. January 1,
					 1996;
Recodified from
					 04 NCAC
					 10F .0102 Eff. July 1, 2014;
Amended Eff. July 1, 2014;
Recodified from
					 04 NCAC
					 10F .0103 Eff. June 1,
					 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter F - ELECTRONIC BILLING RULES › Section .0100 - ADMINISTRATION › Section 23F .0104 - BILLING CODE SETS

Current through Register Vol. 39, No. 2, July 15, 2024
Billing codes and modifier systems identified below are
					 valid codes for the specified workers' compensation transactions, in addition
					 to any code sets defined by the standards adopted in
					 11 NCAC
					 23F .0103:
(1) "CDT-4 Codes" that refers to the codes
				  and nomenclature prescribed by the American Dental Association.
(2) "CPT-4 Codes" that refers to the
				  procedural terminology and codes contained in the "Current Procedural
				  Terminology, Fourth Edition," as published by the American Medical
				  Association.
(3) "Diagnosis Related
				  Group (DRG)" that refers to the inpatient classification scheme used by CMS for
				  hospital inpatient reimbursement.
(4) "Healthcare Common Procedure Coding
				  System" (HCPCS) that refers to a coding system which describes products,
				  supplies, procedures, and health professional services and that includes CPT-4
				  codes, alphanumeric codes, and related modifiers.
(5) "ICD-9-CM Codes" that refers to diagnosis
				  and procedure codes in the International Classification of Diseases, Ninth
				  Revision, Clinical Modification published by the United States Department of
				  Health and Human Services.
(6)
				  "ICD-10-CM/PCS" that refers to diagnosis and procedure codes in the
				  International Classification of Diseases, Tenth Edition, Clinical
				  Modification/Procedure Coding System.
(7) National Drug Codes (NDC) of the United
				  States Food and Drug Administration.
(8) "Revenue Codes" that refers to the
				  4-digit coding system developed and maintained by the National Uniform Billing
				  Committee for billing inpatient and outpatient hospital services, home health
				  services, and hospice services.
(9)
				  "National Uniform Billing Committee Codes" that refers to the code structure
				  and instructions established for use by the National Uniform Billing Committee
				  (NUBC).
Authority
					 G.S.
					 97-26(g1);
					 97-80;
Eff. July 1,
					 2014;
Recodified from
					 04 NCAC
					 10F .0104 Eff. June 1,
					 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter F - ELECTRONIC BILLING RULES › Section .0100 - ADMINISTRATION › Section 23F .0105 - ELECTRONIC MEDICAL BILLING, REIMBURSEMENT, AND DOCUMENTATION

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Payers and payer agents shall:
(1) accept electronic medical bills submitted
				  in accordance with the standards adopted in this Subchapter;
(2) transmit acknowledgments and remittance
				  advice in compliance with the standards adopted in this Subchapter in response
				  to electronically submitted medical bills; and
(3) utilize methods to receive electronic
				  documentation required for the adjudication of a bill.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter F - ELECTRONIC BILLING RULES › Section .0100 - ADMINISTRATION › Section 23F .0106 - EMPLOYER, INSURANCE CARRIER, MANAGED CARE ORGANIZATION, OR AGENTS' RECEIPT OF MEDICAL BILLS FROM HEALTH CARE PROVIDERS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Upon
				  receipt of medical bills submitted in accordance with the rules in this
				  Subchapter, a payer shall evaluate each bill's conformance with the criteria of
				  a complete medical bill. A payer shall not return to the health care provider
				  medical bills that are complete, unless the bill is a duplicate bill. Within 21
				  days of receipt of an incomplete medical bill, a payer or its agent shall
				  either:
(1) Complete the bill by adding
				  missing health care provider identification or demographic information already
				  known to the payer; or
(2) Return
				  the bill to the sender, in accordance with this Paragraph.