North Carolina Administrative Code

11 NCAC 23B .0207 HEARINGS OF CLAIMS BY PRISON INMATES History Note: Authority G.S. 97-101.1; 143-296; 143-300; Eff. January 1, 1989; Recodified from 04 NCAC 10B .0204 Eff. April 17, 2000; Amended Eff. July 1, 2014; May 1, 2000; Recodified from 04 NCAC 10B .0207 Eff. June 1, 2018…

11 NCAC 23B .0208 HEARING COSTS Costs assessed pursuant to Rule 11 NCAC 23E .0202 in tort claims shall be due upon receipt of a bill or statement from the Commission. History Note: Authority G.S. 7A-305; 143-291.1; 143-291.2; 143-300; Eff. July 1, 2014; Recodified from 04 NCAC 10…

SECTION .0300 - APPEALS TO FULL COMMISSION 11 NCAC 23B .0301 SCOPE The rules in this Section are the applicable Rules for appeals of cases brought pursuant to Article 31 of Chapter 143 of the General Statutes to the Full Commission. History Note: Authority G.S. 143-292; 143-300; …

11 NCAC 23B .0302 Appeals TO THE FULL COMMISSION (a) Notice of appeal shall be made to the Commission within 15 days from the date when notice of the Deputy Commissioner's Order or Decision and Order has been received by the appellant. The notice of appeal shall specify, by tort …

11 NCAC 23B .0303 Proposed Issues on Appeal History Note: Authority G.S. 143-292; 143-300; 362 N.C. 191 (2008); Eff. January 1, 1989; Amended Eff. July 1, 2014; January 1, 2011; May 1, 2000; Recodified from 04 NCAC 10B .0303 Eff. June 1, 2018; Repealed Eff. March 1, 2019.

11 NCAC 23B .0304 DISMISSALS OF APPEALS History Note: Authority G.S. 143-300; Eff. January 1, 1989; Recodified from 04 NCAC 10B .0305 Eff. April 17, 2000; Amended Eff. May 1, 2000; Repealed Eff. July 1, 2014; Recodified from 04 NCAC 10B .0304 Eff. June 1, 2018.

11 NCAC 23B .0305 Briefs to the Full Commission History Note: Authority G.S. 143-296; 143-300; Eff. January 1, 1989; Recodified from 04 NCAC 10B .0306 Eff. April 17, 2000; Amended Eff. July 1, 2014; May 1, 2000; Recodified from 04 NCAC 10B .0305 Eff. June 1, 2018; Repealed Eff. M…

11 NCAC 23B .0306 MOTION FOR NEW HEARING History Note: Authority G.S. 143-292; 143-296; 143-300; Eff. January 1, 1989; Recodified from 04 NCAC 10B .0310 Eff. April 17, 2000; Amended Eff. May 1, 2000; Repealed Eff. July 1, 2014; Recodified from 04 NCAC 10B .0306 Eff. June 1, 2018.

11 NCAC 23B .0307 MOTIONS BEFORE THE FULL COMMISSION (a) After notice of appeal has been given to the Full Commission, all motions related to the claim before the Full Commission shall be in writing and filed with the Full Commission with a statement confirming that copies have b…

11 NCAC 23B .0308 STAYS If a case is appealed to the Full Commission, all Orders or Decision and Orders of a Deputy Commissioner shall be stayed pending appeal. History Note: Authority G.S. 143-292; 143-296; 143-300; Eff. May 1, 2000; Amended Eff. July 1, 2014; Recodified from 04…

11 NCAC 23B .0309 NEW EVIDENCE History Note: Authority G.S. 143-300; Eff. January 1, 1989; Amended Eff. May 1, 2000; Repealed Eff. July 1, 2014; Recodified from 04 NCAC 10B .0309 Eff. June 1, 2018.

11 NCAC 23B .0310 ORAL ARGUMENT (a) A party may waive oral argument at any time with approval of the Commission. Upon the request of a party or on its own initiative, the Commission may review the case and file an Order or Decision and Order without oral argument. (b) When presen…

SECTION .0400 - APPEALS TO THE COURT OF APPEALS 11 NCAC 23B .0401 Scope The rules in this Section are the applicable Rules for appeals to the Court of Appeals pursuant to Article 31 of Chapter 143 of the General Statutes. History Note: Authority G.S. 143-293; 143-300; Eff. Januar…

11 NCAC 23B .0402 STAYS If a case is appealed to the Court of Appeals, all Orders or Decision and Orders of the Full Commission shall be stayed pending appeal. History Note: Authority G.S. 143-292; 143-294; 143-296; 143-300; Eff. January 1, 1989; Amended Eff. July 1, 2014; May 1,…

11 NCAC 23B .0403 MOTIONS FOR COURT OF APPEALS CASES (a) Prior to the docketing of the record on appeal in the Court of Appeals, all motions filed by the parties regarding an appeal to the Court of Appeals shall be addressed to and ruled upon by the Chair of the Commission, or th…

11 NCAC 23B .0404 REMAND FROM 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 hea…

SECTION .0500 – RULES OF THE COMMISSION 11 NCAC 23B .0501 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 23B .0502 RULEMAKING History Note: Authority G.S. 143-300; Eff. January 1, 1989; Repealed Eff. July 1, 2014; Recodified from 04 NCAC 10B .0502 Eff. June 1, 2018.

11 NCAC 23B .0503 SANCTIONS 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, an Order o…

SubChapter 23C - North Carolina Industrial Commission Rules for Utilization of Rehabilitation Professionals in Workers' Compensation Claims SECTION .0100 – ADMINISTRATION 11 NCAC 23C .0101 APPLICABILTY OF THE RULES (a) The rules in this Subchapter apply to: (1) cases in which the…

11 NCAC 23C .0102 PURPOSE OF THE RULES History Note: Authority G.S. 97-25.4; Eff. January 1, 1996; Repealed Eff. November 1, 2014; Recodified from 04 NCAC 10C .0102 Eff. June 1, 2018.

11 NCAC 23C .0103 DEFINITIONS As used in this Subchapter: (1) "Rehabilitation professional" means a medical case manager, a coordinator of medical rehabilitation services, or a vocational rehabilitation professional providing vocational rehabilitation services, including state, p…

11 NCAC 23C .0104 GOALS OF REHABILITATION History Note: Authority G.S. 97-25.4; Eff. January 1, 1996; Repealed Eff. June 1, 2000; Recodified from 04 NCAC 10C .0104 Eff. June 1, 2018.

11 NCAC 23C .0105 QUALIFICATIONS REQUIRED (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 a…

11 NCAC 23C .0106 PROFESSIONAL RESPONSIBILITY OF THE REHABILITATION PROFESSIONAL IN WORKERS' COMPENSATION CLAIMS (a) A rehabilitation professional shall exercise independent professional judgment in making and documenting recommendations for medical and vocational rehabilitation …

11 NCAC 23C .0107 COMMUNICATION (a) The insurance carrier shall notify the Commission and all parties on a Form 25N Notice to the Commission of Assignment of Rehabilitation Professional when a rehabilitation professional is assigned to a case and identify the purpose of the rehab…

11 NCAC 23C .0108 INTERACTION WITH PHYSICIANS (a) At the initial visit with a physician the rehabilitation professional shall provide identification in the form of a company identification or business card and explain the rehabilitation professional's role in the case. (b) In all…

11 NCAC 23C .0109 VOCATIONAL REHABILITATION SERVICES AND RETURN TO WORK (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 profession…

11 NCAC 23C .0110 CHANGE OF REHABILITATION PROFESSIONAL (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. Th…

SECTION .0200 – RULES OF THE COMMISSION 11 NCAC 23C .0201 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 …

SUBCHAPTER 23D – WORKERS' COMPENSATION RULES FOR MANAGED CARE ORGANIZATIONS SECTION .0100 – Rules 11 NCAC 23D .0101 PURPOSE The rules in this Subchapter are intended to facilitate the timely and cost-effective delivery of appropriate medical compensation services to fulfill the e…

11 NCAC 23D .0102 DEFINITIONS 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…

11 NCAC 23D .0103 QUALIFICATION BY DEPARTMENT OF INSURANCE History Note: 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.

11 NCAC 23D .0104 QUALIFICATION AND REVOCATION 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 pr…

11 NCAC 23D .0105 NOTICE TO COMMISSION (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 Subcha…

11 NCAC 23D .0106 CONTRACT PROVISIONS 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, m…

11 NCAC 23D .0107 INFORMATION FOR EMPLOYEE (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…

11 NCAC 23D .0108 INCLUSIVE PROVIDER PANELS 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 th…

11 NCAC 23D .0109 Quality Assurance and Utilization Review 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 …

11 NCAC 23D .0110 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 in this Subchapter in a case pending be…

SUBCHAPTER 23E – ADMINISTRATIVE RULES OF THE INDUSTRIAL COMMISSION SECTION .0100 – ADMINISTRATION 11 NCAC 23E .0101 INSTRUCTIONS FOR FILING A PETITION FOR RULE-MAKING (a) Any person may petition the Commission to adopt a new rule, or amend or repeal an existing rule by submitting…

11 NCAC 23E .0102 MAILING LIST (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 …

11 NCAC 23E .0103 ADMISSION OF OUT-OF-STATE ATTORNEYS TO APPEAR BEFORE THE COMMISSION (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 f…

11 NCAC 23E .0104 SECURE LEAVE PERIODS FOR ATTORNEYS (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 …

SECTION .0200 – FEES 11 NCAC 23E .0201 Document and Record Fees (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…

11 NCAC 23E .0202 HEARING COSTS OR FEES (a) (Effective until July 1, 2015) The following hearing costs or fees apply to all subject areas within the authority of the Commission: (1) one hundred twenty dollars ($120.00) for a hearing before a Deputy Commissioner to be charged afte…

11 NCAC 23E .0203 FEES SET BY THE COMMISSION (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…

11 NCAC 23E .0204 ACCIDENT PREVENTION AND SAFETY EDUCATIONAL PROGRAM FEES (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) Worksh…

SECTION .0300 – RULES OF THE COMMISSION 11 NCAC 23E .0301 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 23E .0302 emergency orders and directives of the chief justice of the north carolina supreme court (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 justic…