North Carolina Administrative Code

11 NCAC 23A .0408 Application for or Stipulation to Additional Medical Compensation (a) An employee may file an application for additional medical compensation with the Office of the Executive Secretary for an order for payment of additional medical compensation within two years …

11 NCAC 23A .0409 Claims for Death Benefits (a) An employer shall notify the Commission of the occurrence of a death resulting from an injury or occupational disease allegedly arising out of and in the course of employment by filing a Form 19 Employer's Report of Employee's Injur…

11 NCAC 23A .0410 Communication for Medical Information (a) When an employer seeks to communicate pursuant to G.S. 97-25.6(c)(2) with an employee's authorized health care provider in writing, without the express authorization of the employee, to obtain relevant medical informatio…

11 NCAC 23A .0411 safety rules The process for the Commission to approve safety rules or regulations adopted by an employer as set forth in G.S. 97-12 is as follows: (1) The rules shall comply with the general provisions of the safety rules outlined by the American National Stand…

SECTION .0500 – AGREEMENTS 11 NCAC 23A .0501 Agreements for Prompt Payment of Compensation (a) To facilitate the payment of compensation within the time prescribed in G.S. 97-18, the Commission shall accept memoranda of agreement on Commission forms. These forms include the Form …

11 NCAC 23A .0502 Compromise Settlement Agreements (a) The Commission shall not approve a compromise settlement agreement unless it contains the following: (1) The employee knowingly and intentionally waives the right to further benefits under the Workers' Compensation Act for th…

11 NCAC 23A .0503 Notice of Last Payment Filing Requirement The form(s) required to be provided by G.S. 97-18(h) include the following: (1) Form 28B Report of Employer or Carrier/Administrator of Compensation and Medical Compensation Paid and Notice of Right to Additional Medical…

section .0600 – claims administration and procedures 11 NCAC 23A .0601 EMPLOYER'S OBLIGATIONS UPON NOTICE; DENIAL OF LIABILiTY; and Sanctions (a) Upon the employee's filing of a claim for compensation with the Commission, the Commission may order sanctions pursuant to G.S. 97-18(…

11 NCAC 23A .0602 Request for Hearing (a) Contested claims shall be set on the hearing docket only upon the written request of one of the parties for a hearing or rehearing of the case in dispute. Any request for hearing shall contain the following: (1) the basis of the disagreem…

11 NCAC 23A .0603 Responding to a Party's Request for Hearing (a) No later than 45 days from receipt of a request for hearing from a party, the opposing party or parties shall file with the Commission a response to the request for hearing. (b) The response shall contain the follo…

11 NCAC 23A .0604 Appointment of Guardian Ad Litem (a) Minors or incompetent individuals may bring an action only through their guardian ad litem. Upon the written application on a Form 42 Application for Appointment of Guardian Ad Litem, the Commission shall appoint the person a…

11 NCAC 23A .0605 Discovery In addition to depositions provided for in G.S. 97-80, parties may obtain discovery by the use of interrogatories and requests for production of documents as follows: (1) Any party may serve upon any other parties written interrogatories, up to 30 in n…

11 NCAC 23A .0606 Discovery - Post Hearing Discovery may not be conducted after the initial hearing on the merits of a case unless allowed by order of a Commissioner or Deputy Commissioner. In determining whether to allow further discovery, the Commissioner or Deputy Commissioner…

11 NCAC 23A .0607 Discovery of Records and Reports (a) Upon written request, any party shall provide to the requesting party without cost, a copy of all medical, vocational and rehabilitation reports, employment records, Commission forms, and written communications with health ca…

11 NCAC 23A .0608 Statement of Incident Leading to Claim (a) Upon the request of the employer or the employer's agent to take a written or a recorded statement, the employer or the employer's agent shall advise the employee that the statement may be used to determine whether the …

11 NCAC 23A .0609 Motions Practice (a) Motions and responses before a Deputy Commissioner: (1) in cases that are currently calendared for hearing before a Deputy Commissioner shall be filed in accordance with Rule .0108 of this Subchapter. (2) to reconsider or amend an Opinion an…

11 NCAC 23A .0610 Pre-Trial Agreement (a) A Pre-Trial Agreement shall be signed by the attorneys and filed with the Commission in accordance with Rule .0108 of this Subchapter 10 days before the hearing, unless a shorter time period is ordered upon agreement of the parties. (b) T…

11 NCAC 23A .0611 Hearings Before the Commission (a) The Commission may, on its own motion, order a hearing or rehearing of any case in dispute. The Commission shall set a contested case for hearing in a location deemed convenient to witnesses and the Commission. (b) In setting c…

11 NCAC 23A .0612 DEPOSITIONS (a) Prior to a hearing before a Deputy Commissioner, the parties shall confer to determine the methods by which medical evidence will be submitted. The parties shall stipulate in a Pre-Trial Agreement to the admission of all relevant medical records,…

11 NCAC 23A .0613 EXPERT WITNESSES AND FEES (a) The parties shall file with the Deputy Commissioner or Commissioner in accordance with Rule .0108 of this Subchapter within 15 days following the hearing, a list identifying all expert witnesses to be deposed and the deposition date…

11 NCAC 23A .0614 Health Care Provider Fee Dispute Procedure (a) Health care providers seeking to resolve a dispute regarding payment of charges for medical compensation shall make an inquiry directly to the employer or employer's workers compensation insurance carrier responsibl…

11 NCAC 23A .0615 Cases Removed from a Hearing Calendar (a) A claim may be removed from a hearing calendar by motion of the party requesting the hearing or by the Commission upon its own motion in the interests of justice or to promote judicial economy. (b) Upon settlement of a c…

11 NCAC 23A .0616 Dismissals (a) No claim filed under the Workers' Compensation Act shall be dismissed without prejudice, except upon order of the Commission in the interest of justice. No voluntary dismissal shall be granted after the record in a case is closed. Unless otherwise…

11 NCAC 23A .0617 Attorneys Retained for Proceedings (a) Any attorney who is retained by a party in a proceeding before the Commission shall comply with the applicable rules of the North Carolina State Bar. A copy of a notice of representation shall be served upon all other couns…

11 NCAC 23A .0618 Disqualification of a Commissioner or Deputy Commissioner History Note: Authority G.S. 97-79(b); 97-80(a); Eff. November 1, 2014; Recodified from 04 NCAC 10A .0618 Eff. June 1, 2018; Repealed Eff. December 1, 2018.

11 NCAC 23A .0619 Foreign Language and sign language Interpreters (a) When a person who does not speak or understand the English language or who is speech or hearing impaired is either called to testify in a hearing, other than in an informal hearing conducted pursuant to G.S. 97…

11 NCAC 23A .0620 written Communications with the commission (a) This Rule shall apply to written communications related to a case before the Commission that are not governed by statute or another rule in this Subchapter. (b) Written communications sent to the Commission shall be…

SECTION .0700 - APPEALS 11 NCAC 23A .0701 REVIEW BY THE FULL COMMISSION (a) Notice of Appeal. Application for review shall be made to the Commission within 15 days from the date when notice of the Deputy Commissioner's Opinion and Award was given. A letter requesting review shall…

11 NCAC 23A .0702 REVIEW OF ADMINISTRATIVE DECISIONS (a) Administrative decisions include orders, decisions, and awards made in a summary manner, without findings of fact, including decisions on the following: (1) applications to approve agreements to pay compensation and medical…

11 NCAC 23A .0703 Appeal to the Court of Appeals (a) The time to file a notice of appeal, and bonds therefrom, including in forma pauperis affidavits, to the North Carolina Court of Appeals from the Full Commission is governed by the provisions of G.S. 97-86. (b) A motion to reco…

11 NCAC 23A .0704 Remand from the Appellate Courts When a case is remanded to the Commission from the appellate courts, each party may file a statement, with or without a brief, to the Full Commission setting forth its position on the actions or proceedings, including evidentiary…

SECTION .0800 – RULES OF THE COMMISSION 11 NCAC 23A .0801 WAIVER of Rules 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…

11 NCAC 23A .0802 SANCTIONS History Note: Authority G.S. 1A-1, Rule 37; 97-18; 97-80(a); 97-88.1; Eff. January 1, 1990; Amended Eff. June 1, 2000; Repealed Eff. November 1, 2014; Recodified from 04 NCAC 10A .0802 Eff. June 1, 2018.

11 NCAC 23A .0803 RULEMAKING History Note: Authority G.S. 97-80(a); Eff. January 1, 1990; Repealed Eff. November 1, 2014; Recodified from 04 NCAC 10A .0803 Eff. June 1, 2018.

section .0900 – report of earnings 11 NCAC 23A .0901 Check Endorsement If a self-insured employer, carrier or third party administrator places "check endorsement" language on the back of an employee's check, the following language (or language approved by the Commission as equiva…

11 NCAC 23A .0902 Notice A self-insured employer, carrier or third party administrator shall not use check endorsement language on the back of an employee's workers' compensation benefit check unless the employee has been provided the following Notice sent by certified mail retur…

11 NCAC 23A .0903 Employee's Obligation to Report Earnings (a) A self-insured employer, carrier, or third-party administrator may require the employee who has filed a claim and is receiving wage loss benefits under G.S. 97-29 or G.S. 97-30 to complete a Form 90 Report of Earnings…

SECTION .1000 – PREAUTHORIZATION FOR MEDICAL TREATMENT 11 NCAC 23A .1001 PREAUTHORIZATION FOR SURGERY AND INPATIENT TREATMENT (a) An insurer that requires preauthorization must establish a preauthorization review policy that describes the process for requesting preauthorization r…

SUBCHAPTER 23B – TORT CLAIMS RULES SECTION .0100 – ADMINISTRATION 11 NCAC 23B .0101 LOCATION OF Main Office AND HOURS OF BUSINESS The main office of the North Carolina Industrial Commission is located in the Dobbs Building, 430 North Salisbury Street, Raleigh, North Carolina. Doc…

11 NCAC 23B .0102 OFFICIAL FORMS (a) Copies of the Commission's rules and forms regarding tort claims may be obtained by contacting the Commission in person at the address in Rule .0101 of this Section; by written request mailed to 1236 Mail Service Center, Raleigh, NC 27699-1236…

11 NCAC 23B .0103 FILING FEES (a) No tort claim shall be accepted for filing with the Commission unless the claim is accompanied by an attorney's check, certified check, money order, or electronic transfer of funds in payment of a filing fee in an amount equal to the filing fee r…

11 NCAC 23B .0104 ELECTRONIC FILINGS WITH THE COMMISSION; HOW TO FILE (a) All filings to the Commission in tort claims shall be submitted electronically in accordance with this Rule. Any document transmitted to the Commission in a manner not in accordance with this Rule shall not…

11 NCAC 23B .0105 Contact information (a) "Contact information" for purposes of this Rule shall include telephone number, facsimile number, email address, and mailing address. (b) All persons or entities without legal representation who have matters pending before the Commission …

11 NCAC 23B .0106 Notice by the commission (a) If service is provided by electronic mail, "receipt of such notice" pursuant to G.S. 143-292 and "receipt of the decision and order" of the Full Commission pursuant to G.S. 143-293 is complete one hour after it is sent by the Commiss…

SECTION .0200 - CLAIMS PROCEDURES 11 NCAC 23B .0201 RULES OF CIVIL PROCEDURE History Note: Authority G.S. 143-300; Eff. January 1, 1989; Amended Eff. January 1, 2011; May 1, 2000; Repealed Eff. July 1, 2014; Recodified from 04 NCAC 10B .0201 Eff. June 1, 2018.

11 NCAC 23B .0202 MEDICAL MALPRACTICE CLAIMS BY UNREPRESENTED PRISON INMATES In any tort claim filed by an unrepresented prison inmate in which the Commission determines that the plaintiff is alleging that a health care provider, as defined in G.S. 90-21.11, failed to comply with…

11 NCAC 23B .0203 INFANTS AND INCOMPETENTS (a) Persons seeking to appear on behalf of an infant or incompetent in accordance with G.S. 1A-1, Rule 17 shall apply on a Form T-42 Application for Appointment of Guardian ad Litem. The Commission shall appoint a guardian ad litem if it…

11 NCAC 23B .0204 MOTIONS (a) All motions regarding tort claims shall be filed pursuant to Rule .0104 of this Subchapter. (b) A motion shall state the grounds on which it is based with particularity, the relief sought, and the opposing party's position, or that the opposing party…

11 NCAC 23B .0205 MEDIATION (a) Any party participating in mediation shall be bound by the Rules for Mediated Settlement and Neutral Evaluation Conferences of the Commission, found in 11 NCAC 23G, except to the extent these Rules conflict with the Tort Claims Act or the other rul…

11 NCAC 23B .0206 HEARINGS (a) The Commission may, on its own motion, order a hearing, rehearing, or pre-trial conference of any tort claim in dispute. The Commission shall set the date, time, and location of the hearing, and provide notice of the hearing to the parties. Any pre-…