reglab/statecodes huggingface dataset:
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter F - ELECTRONIC BILLING RULES › Section .0100 - ADMINISTRATION › Section 23F .0107 - COMMUNICATION BETWEEN HEALTH CARE PROVIDERS AND PAYERS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Any communication between the health care
				  provider and the payer related to medical bill processing shall be of
				  sufficient detail to allow the responder to easily identify the information
				  required to resolve the issue or question related to the medical bill. Generic
				  statements that simply state a conclusion such as "payer improperly reduced the
				  bill" or "health care provider did not document" or other similar phrases with
				  no further description of the factual basis for the sender's position do not
				  satisfy the requirements of this Rule.
(b) When communicating with the health care
				  provider, agent, or assignee, the payer may utilize the ASC X12 Reason Codes,
				  or the NCPDP Reject Codes, to communicate with the health care provider, agent,
				  or assignee.
(c) Communication
				  between the health care provider and payer related to medical bill processing
				  shall be made by telephone or electronic transmission unless the information
				  cannot be sent by those media, in which case the sender shall send the
				  information by mail or personal delivery.
Authority
					 G.S.
					 97-26(g1);
					 97-80(a);
Eff. July 1, 2014;
Recodified from
					 04 NCAC
					 10F .0107 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 .0108 - EFFECTIVE DATE

Current through Register Vol. 39, No. 2, July 15, 2024
This Chapter applies to all medical services and products
					 provided on or after March 1, 2014. For medical services and products provided
					 prior to March 1, 2014, medical billing and processing shall be in accordance
					 with the rules in effect at the time the health care was
					 provided.
Authority
					 G.S.
					 97-26(g1);
					 97-80;
Eff. July 1,
					 2014;
Recodified from
					 04 NCAC
					 10F .0108 Eff. June 1,
					 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter G - NORTH CAROLINA INDUSTRIAL COMMISSION RULES FOR MEDIATED SETTLEMENT AND NEUTRAL EVALUATION CONFERENCES › Section .0100 - MEDIATION AND SETTLEMENT › Section 23G .0103 - THE MEDIATED SETTLEMENT CONFERENCE

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Where
				  Conference Is to Be Held. Unless all parties in a workers' compensation case or
				  a state tort claims case and the mediator otherwise agree, the mediated
				  settlement conference shall be held in the county where the case is pending.
				  The mediator shall reserve a place and make arrangements for the conference and
				  give notice to all attorneys and unrepresented parties of the time and location
				  of the conference.
(b) When
				  Conference Is to Be Held. The conference shall be held at the time agreed to by
				  the parties and the mediator, or if the parties do not agree, at the time
				  specified by the mediator.
(c)
				  Request to Extend Date of Completion. In the interests of justice, the
				  Commission may extend the deadline for completion of the conference upon the
				  Commission's own motion, a motion or stipulation of the parties or the
				  suggestion of the mediator.
(d)
				  Recesses. The mediator may recess the conference at any time and may set times
				  for reconvening. If the time for reconvening is set before the conference is
				  recessed, no further notification is required for persons present at the
				  recessed conference.
(e) The
				  Mediated Settlement Conference Is Not to Delay Other Proceedings. A mediated
				  settlement conference is not cause for delay of other proceedings in the case,
				  including the completion of discovery and the filing or hearing of motions,
				  unless ordered by the Commission in the interests of justice. No depositions
				  shall be taken following a Commission order requiring mediation until mediation
				  is concluded, except by agreement of the parties or order of the Commission in
				  the interest of justice.
(f)
				  Inadmissibility of Negotiations by Parties and Attorneys. Evidence of
				  statements made and conduct occurring in a mediated settlement conference or
				  other settlement proceeding conducted pursuant to the Rules in this Subchapter,
				  whether attributable to a party, the mediator, other neutral, or a neutral
				  observer present at the settlement conference or proceeding, are not subject to
				  discovery and shall be inadmissible in any proceeding in the action or other
				  actions on the same claim, except:
(1)
				  proceedings for sanctions for violations of the attendance or payment of
				  mediation fee provisions contained in Rule .0104 and Rule.0107 of this
				  Subchapter;
(2) proceedings to
				  enforce or rescind a settlement of the action;
(3) disciplinary proceedings before the North
				  Carolina State Bar or any agency enforcing standards of conduct for mediators
				  or other neutrals, including the Commission; or
(4) proceedings to enforce laws concerning
				  juvenile or elder abuse.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter G - NORTH CAROLINA INDUSTRIAL COMMISSION RULES FOR MEDIATED SETTLEMENT AND NEUTRAL EVALUATION CONFERENCES › Section .0100 - MEDIATION AND SETTLEMENT › Section 23G .0104A - FOREIGN LANGUAGE INTERPRETERS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Any
				  party who is unable to speak or understand English shall so notify the
				  Commission, the mediator, and the opposing party or parties in writing, not
				  less than 21 days prior to the date of the mediated settlement conference. The
				  notice shall contain the party's primary language and how the party plans to
				  communicate in English during the mediation.
(b) The party requesting the assistance of a
				  qualified foreign language interpreter shall bear the costs.
(c) If the certified mediator, in his or her
				  discretion, notifies the parties of the need for a qualified foreign language
				  interpreter, the parties shall retain a disinterested interpreter who possesses
				  the qualifications listed in Paragraph (d) of this Rule to assist at the
				  mediated settlement conference. The fee of the foreign language interpreter and
				  any postponement fees necessitated by the need for a qualified foreign language
				  interpreter shall be shared by the parties unless the parties agree
				  otherwise.
(d) A qualified foreign
				  language interpreter shall possess sufficient experience and education, or a
				  combination of experience and education, in speaking and understanding English
				  and the foreign language to be interpreted, to qualify as an expert witness
				  pursuant to
				  G.S.
				  8C-1, Rule 702.
(e) Qualified foreign language interpreters
				  shall abide by the Code of Conduct and Ethics of Foreign Language Interpreters
				  and Translators, contained in Part 4 of
Policies and Best Practices for
				  the Use of Foreign Language Interpreting and Translating Services in the North
				  Carolina Court System
and promulgated by the North Carolina
				  Administrative Office of the Courts, and shall interpret, as word for word as
				  is practicable, without editing, commenting, or summarizing, testimony or other
				  communications. The Code of Conduct and Ethics of Foreign Language Interpreters
				  and Translators is hereby incorporated by reference and includes subsequent
				  amendments and editions. A copy may be obtained at no charge from the North
				  Carolina Administrative Office of the Court's website,
http://www.nccourts.org/Citizens/CPrograms/Foreign/Documents/guidelines.pdf
or upon request, at the offices of the Commission, as set forth in Rule
				  11 NCAC
				  23A .0101.
Authority
					 G.S.
					 97-80(a);
					 97-80(c);
					 143-296;
					 143-300;
Eff. January
					 1, 2011;
Amended Eff. July 1, 2014;
Recodified from
					 04 NCAC
					 10G .0104A Eff. June 1,
					 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter G - NORTH CAROLINA INDUSTRIAL COMMISSION RULES FOR MEDIATED SETTLEMENT AND NEUTRAL EVALUATION CONFERENCES › Section .0100 - MEDIATION AND SETTLEMENT › Section 23G .0105 - SANCTIONS

Current through Register Vol. 39, No. 2, July 15, 2024
If a person or party whose attendance at a mediated
					 settlement conference is required by Rule.0104 of this Subchapter fails to
					 attend or cancels, without Commission approval in accordance with Paragraph (f)
					 of Rule .0101 of this Subchapter, a duly ordered mediated settlement conference
					 without good cause, the Commission may impose upon the party any lawful
					 sanction, including holding the party in contempt or requiring the party to pay
					 fines, attorneys' fees, mediator fees and expenses and loss of earning incurred
					 by persons attending the conference. Any sanctions that are assessed against a
					 party consistent with the Workers' Comp Act, the Tort Claims Act and the Rules
					 in this Subchapter, including mediated settlement conference postponement fees
					 and sanctions for the unauthorized cancellation or failure to appear at the
					 conference, may be assessed against the party depending on whose conduct
					 necessitated the assessment of sanctions.
Authority
					 G.S.
					 97-80(a),(c);
					 143-296;
					 143-300; Rule 5 of Rules for
					 Mediated Settlement Conferences and Other Settlement Procedures in Superior
					 Court Civil Actions;
Eff. January 16, 1996;
Amended
					 Eff. October 1, 1998;
Recodified from
					 04 NCAC
					 10A .0616;
Amended Eff. July 1,
					 2014; June 1, 2000;
Recodified from
					 04 NCAC
					 10G .0105 Eff. June 1,
					 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter G - NORTH CAROLINA INDUSTRIAL COMMISSION RULES FOR MEDIATED SETTLEMENT AND NEUTRAL EVALUATION CONFERENCES › Section .0100 - MEDIATION AND SETTLEMENT › Section 23G .0106 - AUTHORITY AND DUTIES OF MEDIATORS

Current through Register Vol. 39, No. 2, July 15, 2024
(a)
				  Control of Conference. The mediator shall at all times be in control of the
				  mediated settlement conference and the procedures to be followed. Except as
				  otherwise set forth in the Rules in this Subchapter with regard to the
				  finalization of the parties' agreement, there shall be no audio, video,
				  electronic or stenographic recording of the mediation process by any
				  participant.
(b) Private
				  Consultation. The mediator may meet and consult privately with any participant
				  prior to or during the conference. The fact that private communications have
				  occurred with a participant shall be disclosed to all other participants at the
				  beginning of the conference.
(c)
				  Scheduling the Conference. The mediator shall make a good faith effort to
				  schedule the conference at a time that is convenient with the parties,
				  attorneys and mediator. In the absence of agreement, the mediator shall select
				  the date for the conference.
(d)
				  Information to the Parties. The mediator shall define and describe the
				  following to the parties at the beginning of the mediated settlement
				  conference:
(1) the process of
				  mediation;
(2) the differences
				  between mediation and other forms of conflict resolution;
(3) the costs of the conference;
(4) the facts that the conference is not a
				  trial or hearing, the mediator is not acting in the capacity of a Commissioner
				  or Deputy Commissioner and shall not act in such capacity in the subject case
				  at any time in the future, and the parties retain their right to a hearing if
				  the parties do not reach a settlement;
(5) the circumstances under which the
				  mediator may meet alone with any of the parties or with any other
				  person;
(6) whether and under what
				  conditions, communications with the mediator will be held in confidence during
				  the conference;
(7) the
				  inadmissibility of conduct and statements as provided by
				  G.S.
				  8C-1, Rule 408 and Paragraph (f) of Rule.
				  0103 of this Subchapter;
(8) the
				  duties and responsibilities of the mediator and the parties; and
(9) the fact that any agreement reached will
				  be reached by mutual consent of the parties.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter G - NORTH CAROLINA INDUSTRIAL COMMISSION RULES FOR MEDIATED SETTLEMENT AND NEUTRAL EVALUATION CONFERENCES › Section .0100 - MEDIATION AND SETTLEMENT › Section 23G .0108 - MEDIATOR CERTIFICATION AND DECERTIFICATION

Current through Register Vol. 39, No. 2, July 15, 2024
(a)
				  Party Selection. The parties may, by mutual consent, select any North Carolina
				  Dispute Resolution Commission-certified mediator, with or without the
				  qualifications in Paragraph (b) of this Rule, as the parties'
				  mediator.
(b) Appointment of
				  Mediators. If the parties have agreed or been ordered to mediate, and cannot
				  agree on the selection of a mediator, the Commission shall appoint a mediator,
				  who holds current certification from the North Carolina Dispute Resolution
				  Commission that he or she is qualified to carry out mandatory mediations in the
				  Superior Courts of the State of North Carolina and who has filed a declaration
				  with the Commission, on forms provided by the Commission, stating that the
				  declarant agrees to accept and perform mediations of disputes before the
				  Commission with reasonable frequency when called upon for the fees and at the
				  rates of payment specified by the Commission. A mediator making this
				  declaration shall notify the Commission when any of the facts declared are no
				  longer accurate.
(c) Failure of
				  Mediator to Appear at Conference. If a mediator fails to appear at a scheduled
				  mediated settlement conference, the mediator is not entitled to the
				  administrative fee for the case.
Authority
					 G.S.
					 97-80(a),(c);
					 143-296;
					 143-300; Rule 8 of Rules for
					 Mediated Settlement Conferences and Other Settlement Procedures in Superior
					 Court Civil Actions;
Eff. January 16, 1996;
Amended
					 Eff. October 1, 1998;
Recodified from
					 04 NCAC
					 10A .0616;
Amended Eff. July 1,
					 2014; January 1, 2011; June 1, 2000;
Recodified from
					 04 NCAC
					 10G .0108 Eff. June 1,
					 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter G - NORTH CAROLINA INDUSTRIAL COMMISSION RULES FOR MEDIATED SETTLEMENT AND NEUTRAL EVALUATION CONFERENCES › Section .0100 - MEDIATION AND SETTLEMENT › Section 23G .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.
					 97-80(a);
					 97-80(c);
					 143-296;
					 143-300;
Eff. January
					 16, 1996;
Amended Eff. October 1, 1998;
Recodified from
					 04 NCAC
					 10A .0616;
Amended Eff. July 1,
					 2014; June 1, 2000;
Recodified from
					 04 NCAC
					 10G .0110 Eff. June 1,
					 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter G - NORTH CAROLINA INDUSTRIAL COMMISSION RULES FOR MEDIATED SETTLEMENT AND NEUTRAL EVALUATION CONFERENCES › Section .0100 - MEDIATION AND SETTLEMENT › Section 23G .0111 - MOTIONS

Current through Register Vol. 39, No. 2, July 15, 2024
Unless otherwise indicated by the Rules in this Subchapter
					 or an applicable order by the Commission in the interests of justice or
					 judicial economy, motions pursuant to the Rules in this Subchapter shall be
					 addressed to the Commission's Dispute Resolution Coordinator and served on all
					 parties to the claim and the settlement procedure. Responses may be filed with
					 the Commission within 10 days after the date of receipt of the motion.
					 Notwithstanding the above, the Commission may, in the interests of justice, act
					 upon oral motions, or act upon motions prior to the expiration of the 10-day
					 response period. Motions shall be decided without oral argument unless
					 otherwise ordered in the interests of justice. Any appeals from orders issued
					 pursuant to a motion under the Rules in this Subchapter shall be addressed to
					 the attention of the Commission Chair or the Chair's designee for appropriate
					 action.
Authority
					 G.S.
					 97-80(a),(c);
					 143-296;
					 143-300;
Eff. January
					 16, 1996;
Amended Eff. October 1, 1998;
Recodified from
					 04 NCAC
					 10A .0616;
Amended Eff. July 1,
					 2014; January 1, 2011; June 1, 2000;
Recodified from
					 04 NCAC
					 10G .0111 Eff. June 1,
					 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter G - NORTH CAROLINA INDUSTRIAL COMMISSION RULES FOR MEDIATED SETTLEMENT AND NEUTRAL EVALUATION CONFERENCES › Section .0100 - MEDIATION AND SETTLEMENT › Section 23G .0112 - MISCELLANEOUS

Current through Register Vol. 39, No. 2, July 15, 2024
Throughout the Rules in this Subchapter any reference to
					 the number of days within which any act may be performed shall mean and refer
					 to calendar days, and shall include Saturdays, Sundays and holidays established
					 by the State Personnel Commission. Provided, however, that if the last day (a)
					 to file a motion, (b) to give notice of the selection of a mediator, or (c) for
					 a pro se plaintiff to give notice that the plaintiff requests mediation is a
					 Saturday, Sunday or holiday established by the State Personnel Commission, the
					 motion or notice may be filed or given on the next day that is not a Saturday,
					 Sunday or holiday established by the State Personnel
					 Commission.
Authority
					 G.S.
					 97-80(a),(c);
					 143-296;
					 143-300;
Eff. January
					 16, 1996;
Amended Eff. October 1, 1998;
Recodified from
					 04 NCAC
					 10A .0616;
Amended Eff. July 1,
					 2014; June 1, 2000;
Recodified from
					 04 NCAC
					 10G .0112 Eff. June 1,
					 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter H - RULES OF THE INDUSTRIAL COMMISSION RELATING TO THE PUBLIC SAFETY EMPLOYEES' DEATH BENEFITS ACT › Section .0100 - ADMINISTRATION › Section 23H .0101 - LOCATION OF OFFICES AND HOURS OF BUSINESS

Current through Register Vol. 39, No. 2, July 15, 2024
For purposes of this Subsection, the offices of the North
					 Carolina Industrial Commission are located in the Dobbs Building, 430 North
					 Salisbury Street, Raleigh, North Carolina. Documents that are not being filed
					 electronically may be filed between the hours of 8:00 a.m. and 5:00 p.m. only.
					 Documents permitted to be filed electronically may be filed until 11:59 p.m. on
					 the required filing date.
Authority
					 G.S.
					 143-166.4;
Eff. November 1,
					 1977;
Amended Eff. July 1, 2014;
Recodified from
					 04 NCAC
					 10H .0101 Eff. June 1,
					 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter H - RULES OF THE INDUSTRIAL COMMISSION RELATING TO THE PUBLIC SAFETY EMPLOYEES' DEATH BENEFITS ACT › Section .0200 - RULES OF COMMISSION › Section 23H .0201 - DETERMINATION OF CLAIMS BY THE COMMISSION

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Upon
				  application for an award under the provisions of the Public Safety Employees'
				  Death Benefits Act, the Commission shall determine whether sufficient evidence
				  is contained in the Commission's workers' compensation or other files upon
				  which to base an order for the payment of benefits. If the Commission is
				  satisfied that such an order should be issued, it shall, without conducting a
				  hearing, file an award directing the payment of benefits.
(b) If the Commission is of the opinion that
				  the Commission's workers' compensation or other files have insufficient
				  evidence upon which to base an award for the payment of benefits, the
				  Commission shall place the case upon the Commission's hearing docket. The
				  Commission shall set a contested case for hearing in a location deemed
				  convenient to witnesses and the Commission.
Authority
					 G.S.
					 143-166.4;
Eff. August 1,
					 1979;
Amended Eff. July 1, 2014;
Recodified from
					 04 NCAC
					 10H .0201 Eff. June 1, 2018;
Amended Eff. January 1, 2019.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter H - RULES OF THE INDUSTRIAL COMMISSION RELATING TO THE PUBLIC SAFETY EMPLOYEES' DEATH BENEFITS ACT › Section .0200 - RULES OF COMMISSION › Section 23H .0202 - HEARINGS BEFORE THE COMMISSION

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The
				  Commissioner or Deputy Commissioner before whom a case regarding the Public
				  Safety Employees' Death Benefits Act is set for hearing, shall order the
				  parties to participate in a pre-trial conference. This conference shall be
				  conducted at such place and by such method as the Commissioner or Deputy
				  Commissioner deems appropriate in consideration of the interests of justice and
				  judicial economy, including conference telephone calls.
(b) The Commission shall give notice of
				  hearing in every case. Postponement or continuance of a scheduled hearing shall
				  be granted in the interests of justice or to promote judicial
				  economy.
(c) Notice of the hearing
				  shall be given to the Attorney General of the State of North Carolina, who may
				  appear as amicus curiae.
Authority
					 G.S.
					 143-166.4;
Eff. August 1,
					 1979;
Amended Eff. July 1, 2014;
Recodified from
					 04 NCAC
					 10H .0202 Eff. June 1, 2018;
Amended Eff. January 1, 2019.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter H - RULES OF THE INDUSTRIAL COMMISSION RELATING TO THE PUBLIC SAFETY EMPLOYEES' DEATH BENEFITS ACT › Section .0200 - RULES OF COMMISSION › Section 23H .0203 - APPOINTMENT OF GUARDIAN AD LITEM

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Infants or
				  incompetents may bring an action under this Subchapter only through their
				  guardian
ad litem
. The Commission shall appoint a person as
				  guardian
ad litem
if the Commission determines it to be in the
				  best interest of the infant or incompetent. The Commission shall appoint a
				  guardian
ad litem
only after due inquiry as to the fitness of
				  the person to be appointed.
(b) No
				  compensation due or owed to the infant or incompetent shall be paid directly to
				  the guardian
ad litem
.
(c) The Commission may assess a fee to be
				  paid to an attorney who serves as a guardian
ad litem
for
				  actual services rendered upon receipt of an affidavit of actual time spent in
				  representation of the infant or incompetent.
Authority
					 G.S.
					 143-166.4;
Eff. August 1,
					 1979;
Amended Eff. July 1, 2014;
Recodified from
					 04 NCAC
					 10H .0203 Eff. June 1,
					 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter H - RULES OF THE INDUSTRIAL COMMISSION RELATING TO THE PUBLIC SAFETY EMPLOYEES' DEATH BENEFITS ACT › Section .0200 - RULES OF COMMISSION › Section 23H .0204 - WRITTEN OR RECORDED STATEMENT

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Upon
				  the request of the employer or his agent to take a written or a recorded
				  statement in an action pursuant to Article 12A of Chapter 143 of the General
				  Statutes, the employer or his agent shall advise any person eligible for
				  payments that the statement may be used to determine whether the claim will be
				  paid or denied. Any person eligible for payments who gives the employer, its
				  carrier, or any agent either a written or recorded statement of the facts and
				  circumstances surrounding the decedent's injury shall be furnished a copy of
				  such statement within 45 days after request. Any person eligible for payments
				  shall immediately be furnished with a copy of the written or recorded statement
				  following a denial of the claim. A copy shall be furnished at the expense of
				  the party to whom the statement was given.
(b) If any party fails to comply with this
				  Rule, a Commissioner or Deputy Commissioner shall enter an order prohibiting
				  that party from introducing the statement into evidence or using any part of
				  the statement.
Authority
					 G.S.
					 143-166.4;
Eff. August 1,
					 1979;
Amended Eff. July 1, 2014;
Recodified from
					 04 NCAC
					 10H .0204 Eff. June 1,
					 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter H - RULES OF THE INDUSTRIAL COMMISSION RELATING TO THE PUBLIC SAFETY EMPLOYEES' DEATH BENEFITS ACT › Section .0200 - RULES OF COMMISSION › Section 23H .0205 - REVIEW BY THE FULL COMMISSION

Current through Register Vol. 39, No. 2, July 15, 2024
(a) A
				  party may request a review of an award filed by a Deputy Commissioner in an
				  action pursuant to Article 12A of Chapter 143 of the General Statutes by filing
				  a letter expressing a request for review to the Full Commission within 15 days
				  of receipt of the award. The award is binding on the parties if not
				  appealed.
(b) After receipt of
				  notice of review, the Commission shall supply to the appellant and to the
				  appellee a transcript of the record upon which the award is based and from
				  which a review is being taken to the Full Commission. The appellant shall,
				  within ten days of receipt of transcript of the record, file with the
				  Commission a written statement of the particular grounds for the appeal, with
				  service on all opposing parties.
(c) Grounds for review not set forth are
				  deemed to be abandoned and argument thereon shall not be heard before the Full
				  Commission.
(d) When a review is
				  made to the Full Commission, the appellant's brief, if any, in support of his
				  ground for appeal shall be filed with the Commission, with service on all
				  opposing parties no less than 15 days prior to the hearing on review. The
				  appellee shall have five days in which to file a reply brief, if deemed
				  necessary, with the Commission, with service on all opposing parties.
(e) Any motions by either party shall be
				  filed with the Full Commission, with service on all opposing parties.
(f) Upon the request of a party, or its own
				  motion, the Commission may waive oral arguments in the interests of justice or
				  to promote judicial economy. In the event of such waiver, the Full Commission
				  shall file an award based on the record and briefs.
Authority
					 G.S.
					 143-166.4;
Eff. August 1,
					 1979;
Amended Eff. July 1, 2014;
Recodified from
					 04 NCAC
					 10H .0205 Eff. June 1,
					 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter H - RULES OF THE INDUSTRIAL COMMISSION RELATING TO THE PUBLIC SAFETY EMPLOYEES' DEATH BENEFITS ACT › Section .0200 - RULES OF COMMISSION › Section 23H .0206 - 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.
					 97-80(a);
					 143-166.4;
Eff. July
					 1, 2014;
Recodified from
					 04 NCAC
					 10H .0206 Eff. June 1,
					 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter I - CHILDHOOD VACCINE-RELATED INJURY RULES OF THE NORTH CAROLINA INDUSTRIAL COMMISSION › Section .0100 - ADMINISTRATION › Section 23I .0101 - LOCATIONS OF OFFICES AND HOURS OF BUSINESS

Current through Register Vol. 39, No. 2, July 15, 2024
For purposes of this Subsection, the offices of the North
					 Carolina Industrial Commission are located in the Dobbs Building, 430 North
					 Salisbury Street, Raleigh, North Carolina. Documents pertaining to the
					 Childhood Vaccine-Related Injury claims that are not being filed electronically
					 may be filed between the hours of 8:00 a.m. and 5:00 p.m. only. Documents
					 permitted to be filed electronically may be filed until 11:59 p.m. on the
					 required filing date.
Authority
					 G.S.
					 130A-424;
					 130A-425(d);
Eff. January 20, 1995;
Amended Eff. July 1, 2014;
Recodified from
					 04 NCAC
					 10I .0101 Eff. June 1,
					 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter I - CHILDHOOD VACCINE-RELATED INJURY RULES OF THE NORTH CAROLINA INDUSTRIAL COMMISSION › Section .0100 - ADMINISTRATION › Section 23I .0102 - OFFICIAL FORMS

Current through Register Vol. 39, No. 2, July 15, 2024
The use of any printed forms related to Childhood
					 Vaccine-Related Injury claims, other than those provided by the Commission is
					 prohibited, except that insurance carriers, self-insurers, attorneys and other
					 parties may reproduce forms for their own use, provided:
(1) no statement, question, or information
				  blank contained on the Commission form is omitted from the substituted form;
				  and
(2) the substituted form is
				  identical in size and format with the Commission form.
Authority
					 G.S.
					 130A-424;
					 130A-425(d);
Eff. January 20, 1995;
Amended Eff. July 1, 2014;
Recodified from
					 04 NCAC
					 10I .0102 Eff. June 1,
					 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter I - CHILDHOOD VACCINE-RELATED INJURY RULES OF THE NORTH CAROLINA INDUSTRIAL COMMISSION › Section .0200 - RULES OF COMMISSION › Section 23I .0201 - PROCEDURE

Current through Register Vol. 39, No. 2, July 15, 2024
When a claim is filed in accordance with
					 G.S.
					 130A-425(b), the respondent
					 shall determine and report its position to the claimant and the Commission on
					 the issues listed in
					 G.S.
					 130A-426(a) within 90 days.
					 If the respondent agrees that the claimant has established damages which
					 entitle claimant to money compensation meeting or exceeding the maximum amount
					 set forth in
					 G.S.
					 130A-427(b), the Commission
					 shall so notify the claimant and respondent, and further notify them of the
					 services the Department of Human Resources proposes to provide pursuant to
					 G.S.
					 130A-427(a)(5). The
					 Commission shall allow the parties an opportunity to settle the matter before
					 proceeding to hearing.
Authority
					 G.S.
					 130A-423;
					 130A-424;
					 130A-425;
					 130A-427;
Eff.
					 January 20, 1995;
Amended Eff. July 1, 2014;
Recodified
					 from 04
					 NCAC 10I .0201 Eff. June 1,
					 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter I - CHILDHOOD VACCINE-RELATED INJURY RULES OF THE NORTH CAROLINA INDUSTRIAL COMMISSION › Section .0200 - RULES OF COMMISSION › Section 23I .0202 - ATTORNEYS' FEES

Current through Register Vol. 39, No. 2, July 15, 2024
An attorney seeking fees pursuant to
					 G.S.
					 130A-427(a)(4) shall submit
					 to the Commission a copy of the fee agreement, a request for payment of fee,
					 and an affidavit or itemized statement in support of an award of attorneys'
					 fees.
Authority
					 G.S.
					 130A-425(d);
					 130A-427(a)(4);
Eff. January 20, 1995;
Amended Eff. July 1, 2014;
Recodified from
					 04 NCAC
					 10I .0202 Eff. June 1,
					 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter I - CHILDHOOD VACCINE-RELATED INJURY RULES OF THE NORTH CAROLINA INDUSTRIAL COMMISSION › Section .0200 - RULES OF COMMISSION › Section 23I .0203 - 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.
					 97-80(a);
					 130A-425(d);
Eff. July 1, 2014;
Recodified from
					 04 NCAC
					 10I .0203 Eff. June 1,
					 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter I - CHILDHOOD VACCINE-RELATED INJURY RULES OF THE NORTH CAROLINA INDUSTRIAL COMMISSION › Section .0200 - RULES OF COMMISSION › Section 23I .0204 - SANCTIONS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The Commission
				  may, on its own initiative or motion of a party, impose a sanction against a
				  party or attorney or both when the Commission determines that such party, or
				  attorney, or both failed to comply with the Rules in this Subchapter. The
				  Commission may impose sanctions of the type and in the manner prescribed by
				  Rule 37 of the North Carolina Rules of Civil Procedure.
(b) Failure to timely file forms as required
				  by either the Rules in this Subchapter or pursuant to the Childhood
				  Vaccine-Related Injury Compensation Program may result in sanctions.
Authority
					 G.S.
					 130A-425(d);
Eff. July 1, 2014;
Recodified from
					 04 NCAC
					 10I .0204 Eff. June 1,
					 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter J - FEES FOR MEDICAL COMPENSATION › Section 0100 - FEES FOR MEDICAL COMPENSATION › Section 23J .0102 - FEES FOR PROFESSIONAL SERVICES

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Except
				  as otherwise provided in this Rule, maximum allowable amounts payable to health
				  care providers for professional services shall be based on the current year's
				  Medicare Part B Fee Schedule for North Carolina ("the Medicare base amount"),
				  as published by the Centers for Medicare & Medicaid Services ("CMS") or its
				  administrative contractor, including subsequent versions and editions. The
				  Medicare Part B Fee Schedule for North Carolina can be found at
http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/index.html
.
(b) The schedule of maximum reimbursement
				  rates for professional services is as follows:
(1) evaluation & management services are
				  140 percent of the Medicare base amount;
(2) physical medicine services are 140
				  percent of the Medicare base amount;
(3) emergency medicine services are 169
				  percent of the Medicare base amount;
(4) neurology services are 153 percent of the
				  Medicare base amount;
(5) pain
				  management services are 163 percent of the Medicare base amount;
(6) radiology services are 195 percent of the
				  Medicare base amount;
(7) major
				  surgery services are 195 percent of the Medicare base amount; and
(8) all other professional services are 150
				  percent of the Medicare base amount.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter J - FEES FOR MEDICAL COMPENSATION › Section 0100 - FEES FOR MEDICAL COMPENSATION › Section 23J .0103 - FEES FOR INSTITUTIONAL SERVICES

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Except
				  where otherwise provided, maximum allowable amounts for inpatient and
				  outpatient institutional services shall be based on the current federal fiscal
				  year's facility-specific Medicare rate established for each institutional
				  facility by the Centers for Medicare & Medicaid Services ("CMS").
				  "Facility-specific" rate means the all-inclusive amount eligible for payment by
				  Medicare for a claim, excluding pass-through payments. An institutional
				  facility may only be reimbursed for hospital outpatient institutional services
				  pursuant to this Paragraph and Paragraphs (c), (d), and (f) of this Rule if it
				  qualifies for payment by CMS as an outpatient hospital.
(b) The schedule of maximum reimbursement
				  rates for hospital inpatient institutional services is as follows:
(1) Beginning April 1, 2015, 190 percent of
				  the hospital's Medicare facility-specific amount.
(2) Beginning January 1, 2016, 180 percent of
				  the hospital's Medicare facility-specific amount.
(3) Beginning January 1, 2017, 160 percent of
				  the hospital's Medicare facility-specific amount.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter K - RULES FOR THE EUGENICS ASEXUALIZATION AND STERILIZATION COMPENSATION PROGRAM › Section .0100 - ADMINISTRATION › Section 23K .0101-.0103 - EXPIRED

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 143B-426.50;
					 143B-426.52(b),(d);
Temporary Adoption Eff. December 3, 2013 and shall expire on the earlier of the
					 date all claims made under this section are finally adjudicated or June 30,
					 2018 pursuant to
					 G.S.
					 143B-426.52(d);
Recodified from
					 04 NCAC
					 10K .0101-10K
					 .0103 Eff. June 1, 2018;
Temporary
					 Adoption Expired Eff. June 30, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter K - RULES FOR THE EUGENICS ASEXUALIZATION AND STERILIZATION COMPENSATION PROGRAM › Section .0200 - REVIEW BY DEPUTY COMMISSIONER › Section 23K .0201-.0203 - EXPIRED

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 143B-426.52;
					 143B-426.52(d);
					 143B-426.53(a),(d);
Temporary Adoption Eff. December 3, 2013 and shall expire on the earlier of the
					 date all claims made under this section are finally adjudicated or June 30,
					 2018 pursuant to
					 G.S.
					 143B-426.52(d);
Recodified from
					 04 NCAC
					 10K .0201-10K
					 .0203 Eff. June 1, 2018;
Temporary
					 Adoption Expired Eff. June 30, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter K - RULES FOR THE EUGENICS ASEXUALIZATION AND STERILIZATION COMPENSATION PROGRAM › Section .0300 - APPEALS TO THE FULL COMMISSION › Section 23K .0301-.0302 - EXPIRED

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 143B-426.52(d);
					 143B-426.53(e);
Temporary Adoption Eff. December 3, 2013 and shall expire on the earlier of the
					 date all claims made under this section are finally adjudicated or June 30,
					 2018 pursuant to
					 G.S.
					 143B-426.52(d);
Recodified from
					 04 NCAC
					 10K .0301-10K
					 .0302 Eff. June 1, 2018;
Temporary
					 Adoption Expired Eff. June 30, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter K - RULES FOR THE EUGENICS ASEXUALIZATION AND STERILIZATION COMPENSATION PROGRAM › Section .0400 - APPEALS TO THE COURT OF APPEALS › Section 23K .0401-.0403 - EXPIRED

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 143-293;
					 143-294;
					 143B-426.50;
					 143B-426.52(d);
					 143B-426.53(f);
Temporary Adoption Eff. December 3, 2013 and shall expire on the earlier of the
					 date all claims made under this section are finally adjudicated or June 30,
					 2018 pursuant to
					 G.S.
					 143B-426.52(d).;
Recodified from
					 04 NCAC
					 10K .0401-10K
					 .0403 Eff. June 1, 2018;
Temporary
					 Adoption Expired Eff. June 30, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter K - RULES FOR THE EUGENICS ASEXUALIZATION AND STERILIZATION COMPENSATION PROGRAM › Section .0500 - RULES OF THE COMMISSION › Section 23K .0501 - EXPIRED - WAIVER OF RULES

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 143-293;
					 143B-426.50;
					 143B-426.52(d);
Temporary Adoption Eff. December 3, 2013 and shall expire on the earlier of the
					 date all claims made under this section are finally adjudicated or June 30,
					 2018 pursuant to
					 G.S.
					 143B-426.52(d);
Recodified from
					 04 NCAC
					 10K .0501 Eff. June 1, 2018;
Temporary Adoption Expired Eff. June 30,
					 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter M - RULES FOR THE UTILIZATION OF OPIOIDS, RELATED PRESCRIPTIONS, AND PAIN MANAGEMENT TREATMENT IN WORKERS' COMPENSATION CLAIMS › Section .0100 - GENERAL PROVISIONS › Section 23M .0101 - PURPOSE AND APPLICABILITY OF THE RULES

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The rules
				  in this Subchapter address the utilization of opioids, related prescriptions,
				  and pain management treatment in all claims arising under the provisions of the
				  Workers' Compensation Act. However, Section .0200 of this Subchapter shall not
				  apply to claims in which the employee received treatment with a targeted
				  controlled substance for more than 12 consecutive weeks immediately preceding
				  the effective date of the rules.
(b) The rules in this Subchapter apply to the
				  prescription of targeted controlled substances as defined in Rule .0102 of this
				  Section and the prescription of other modalities of pain management treatment
				  for the outpatient treatment of non-cancer pain in claims in which the employer
				  is providing medical compensation pursuant to the Workers' Compensation Act.
				  The rules in this Subchapter do not apply to prescriptions for medications to
				  be administered in a health care setting.
(c) The rules do not constitute medical
				  advice or a standard of medical care. Disputes regarding the treatment
				  addressed by these Rules shall be governed by
				  G.S.
				  97-25 and Rule
				  11 NCAC
				  23A .0609A.
Authority
					 G.S.
					 97-25;
					 97-25.4;
					 97-80(a); S.L.
					 2017-203, s. 4;
Eff. May 1, 2018;
Recodified from
					 04 NCAC
					 10M .0101 Eff. June 1,
					 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter M - RULES FOR THE UTILIZATION OF OPIOIDS, RELATED PRESCRIPTIONS, AND PAIN MANAGEMENT TREATMENT IN WORKERS' COMPENSATION CLAIMS › Section .0100 - GENERAL PROVISIONS › Section 23M .0103 - 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. 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;
					 97-25.4;
					 97-80(a); S.L.
					 2017-203, s. 4;
Eff. May 1, 2018;
Recodified from
					 04 NCAC
					 10M .0103 Eff. June 1,
					 2018.