North Dakota Administrative Code

Repealed effective April 1, 1997.

Any party has a right to be represented by an attorney at any stage in the proceedings regarding a claim. An attorney who represents an injured employee in a proceeding regarding a claim shall file a notice of legal representation signed by the injured employee prior to or togeth…

Upon receipt of a certificate of program completion from the decision review office, fees for legal services provided by employees' attorneys and legal assistants working under the direction of employees' attorneys must be paid if an administrative order reducing or denying benef…

An attorney representing a claimant shall submit to the organization, at least once a month, a statement of the time spent representing that claimant during that month. The statement must include the name and claim number of the claimant represented, the type of work performed, w…

Workforce safety and insurance recognizes payment for travel and lodging to and from medical treatment if reasonable and necessary. These expenses will be paid according to North Dakota Century Code section 65-05-28. The number of miles actually traveled is rebuttably presumed to…

1. Definitions. In this section: a. "Business entity" means any form of business organization, including proprietorships, partnerships, limited partnerships, cooperatives, limited liability companies, and corporations. b. "Constituent business" means a business entity or entities…

For purposes of application of North Dakota Century Code section 65-04-26.2, the relationship between a general contractor and subcontractor may be identified by the organization in any industry. History: Effective January 1, 2018. General Authority: NDCC 65-02-08, 65-04-26.2 Law…

failure to submit payroll reports. 1. The organization shall bill each employer for premiums as provided by North Dakota Century Code chapter 65-04. If an employer has an open account with the organization, the organization may send to the employer a payroll report on which the e…

The organization may alter an employer's payroll reporting period to conform with regular quarter endings (March thirty-first, June thirtieth, September thirtieth, December thirty-first) in cases where an employer's payroll reporting period would not normally coincide with a quar…

The organization may change the expiration date on the employer's account. The organization shall calculate premium based on actual taxable payroll for each employee up to the statutory payroll cap, prorated for the actual number of days in the adjusted payroll period. History: E…

If the noncompliance period of a new account is less than twelve months, the organization must prorate the payroll based on one-twelfth of the statutory payroll cap per employee, per month, for the period of time involved. If the payroll is less than one-twelfth of the statutory …

The following system is established for the experience rating of risks of employers contributing to the fund: 1. Definitions. In this section, unless the context otherwise requires: a. "Three-year losses" means the total sum of ratable losses accrued on claims occurring during th…

operations in this state. If an employer who is beginning operations in this state can prove that for similar operations in another jurisdiction the employer received an experience-rate-based discount on workers' compensation premiums in that jurisdiction, the organization may di…

Upon third-party recovery pursuant to North Dakota Century Code section 65-01-09 in claims which have been accepted by the organization and when the employer's experience rating has been affected, relief will be given to the employer from the date of injury to the balance of the …

Classifications and premium rates must be those classifications contained in the documents entitled "Classification Manual" and "Workforce Safety and Insurance Rates". When classifying employment or assigning a premium rate, the organization must use the edition of the manuals in…

Repealed pursuant to North Dakota Century Code section 28-32-18.1, effective July 16, 2003.

An employee may be deemed to regularly work at or from an employment principally localized in this state as defined in North Dakota Century Code sections 65-08-01 and 65-08.1-01 if the employee's out-of-state injury is sustained under circumstances in which the employee has worke…

The organization may, at its sole discretion, extend workers' compensation coverage by written agreement to North Dakota employers for their employees hired in North Dakota and working outside the United States for a limited period of time, provided the workers' compensation syst…

The organization may, at its sole discretion, extend workers' compensation coverage by written agreement to North Dakota employers for their employees engaged in law enforcement training outside the state for a limited period of time, provided the North Dakota employer provides d…

1. On March thirty-first of each year, the organization shall establish the interest rate to be charged to accounts with policy periods renewing between July first and June thirtieth of the following year, which elect to pay premium by installments. For the purposes of North Dako…

The organization, in its sole discretion, may accept payment by credit card for premiums, assessments, penalties, interest, reimbursements, or any other payment that is due the organization. History: Effective January 1, 1996; amended effective April 1, 1997; April 1, 2020. Gener…

The organization may require an employer to provide a bond, letter of credit, cash deposit, or other security instrument approved by the organization to guarantee payment of workers' compensation premium. The required security instrument is in addition to any other required insta…

1. If an employment opportunity suited to an employee's education, experience, and marketable skills is identified within thirty-five miles [56.33 kilometers] from the employee's home, the appropriate priority option must be identified as return to related occupation in the local…

1. Definitions: a. Amputations and loss as used in subsection 11 of North Dakota Century Code section 65-05-12.2. "Amputation of a thumb" means disarticulation at the metacarpal phalangeal joint. "Amputation of the second or distal phalanx of the thumb" means disarticulation at o…

Repealed effective July 1, 2006.

Maximum medical and hospital fees paid by the organization, including reimbursement for pharmaceuticals and durable medical equipment, are determined in accordance with the most current edition of the organization's fee schedule guidelines or the organization's formulary and medi…

Repealed effective October 1, 1998.

The definitions found in North Dakota Century Code title 65 apply to terms contained in this title. In addition, unless the context otherwise requires, for purposes of sections 92-01-02-27 through 92-01-02-48: 1. "Bill audit" means the review of medical bills and associated medic…

1. A medical service or supply necessary to diagnose or treat a compensable injury, which is appropriate to the location of service, is medically necessary if it is widely accepted by the practicing peer group and has been determined to be safe and effective based on published, p…

Medical service providers rendering treatment of any kind, regardless of the state or country where services are provided, including inpatient and outpatient services, to a claimant who comes under the organization's jurisdiction must comply with managed care services under these…

1. An order is required from the primary health care provider with documentation of objective medical evidence that supports the necessity for purchase of a specially equipped motor vehicle or modification of an existing motor vehicle directly due to the compensable work injury. …

1. An order is required from the primary health care provider with documentation of objective medical evidence that supports the necessity for home modifications directly due to the compensable work injury. a. The order must be obtained and submitted to the organization prior to …

1. An order is required from the primary health care provider with documentation of objective medical evidence that supports the necessity for a power mobility device directly due to the compensable work injury. a. The order must be obtained and submitted to the organization prio…

1. An order is required from the primary health care provider with documentation of objective medical evidence that supports the necessity for purchase of footwear directly due to the compensable work injury. a. The order must be obtained and submitted to the organization prior t…

1. For the initial prosthesis an order is required from the primary health care provider with documentation of objective medical evidence that supports the necessity for purchase of a prosthesis directly due to the compensable work injury. a. The order must be obtained and submit…

1. Medical services. a. Medical services that are not medically necessary are not reimbursable. b. Frequency and extent of treatment may not be more than the nature of the injury or process of recovery requires, and must be provided in accordance with utilization and treatment st…

1. Treatment that falls within the scope and field of the treating allied health care professional's license to practice is reimbursable. 2. Paraprofessionals who are not independently licensed shall practice under the direct supervision of a licensed allied health care professio…

Physician assistants may be reimbursed within the scope of their licenses for services performed under the supervision of a licensed physician. History: Effective January 1, 1994; amended effective October 1, 1998; January 1, 2000; May 1, 2002; April 1, 2009; April 1, 2020. Gener…

certified athletic trainers. Physical therapist assistants, certified occupational therapist assistants, and certified athletic trainers may be reimbursed when providing treatment under the direction and general supervision of the physical therapist or occupational therapist. Phy…

The organization has instituted a program of utilization review and quality assurance to monitor and control the use of health care services. The organization shall develop and identify the mode and manner of submissions for utilization review and quality assurance requests. 1. P…

review. 1. Certain treatment procedures require prior authorization or preservice review by the organization or its managed care vendor. Requests for prior authorization or preservice review must include a statement of the condition diagnosed; their relationship to the compensabl…

Repealed effective October 1, 1998.

Repealed effective October 1, 1998.

Repealed effective October 1, 1998.

1. All changes from one health care provider to another must be approved by the organization. Normally, changes will be allowed only after the injured employee has been under the care of the primary health care provider for sufficient time for the health care provider to complete…

Repealed effective October 1, 1998.

Repealed effective January 1, 2022.

1. The organization may request an independent medical examination or independent medical review pursuant to North Dakota Century Code section 65-05-28. 2. The organization shall provide at least fourteen days' notice to the injured employee of an independent medical examination.…

Repealed effective October 1, 1998.

1. When the primary health care provider believes special or attendant (home nurse) care is needed, the health care provider shall submit the following information: a. A description of the special or home nursing care required, including the estimated time required (i.e., cathete…