North Carolina Medical Treatment and Complete Cheat Sheet
North Carolina medical treatment has become a very important driver in Workers Comp Costs in the last decade. I am attending the North Carolina Safety Conference this week. One of my favorite law firms had put up a vendor booth. After speaking with Ginny Allen at their booth, I decided to add in a bit of their Workers Comp cheat sheet in this post. The whole cheat sheet can be found here.
If you have ever handled or run across Worker Comp in NC from any angle, I recommend downloading the full cheat sheet by using this link. All they want is your email address. They are far from spammers, so signing up will not cause your inbox to explode with junk mail. Please pay attention to the 7 business day waiting period on medical authorization as to not buy medical treatment that you may not have authorized in the first place. We have seen many companies getting burned on this rule lately.
Below is an excerpt from the sheet on North Carolina Medical treatment – (IC = Industrial Commission)
North Carolina Medical Treatment In admitted claims, the employer and carrier have the right to direct medical treatment. In case of controversy, the IC may order treatment in its discretion. The IC may at any time upon the request of the employee order a change of treatment or designate other treatment suggested by employee subject to IC approval. The refusal of employee to accept any medical, hospital, surgical, vocational rehabilitation, or other treatment when ordered by the IC may bar employee from further compensation and no compensation shall be paid during the period of suspension unless the IC orders that the circumstances justify the refusal.
The right to medical treatment shall terminate two years after the employer’s last payment of medical or indemnity compensation unless: 1) the employee fi les an application for additional medical treatment which is approved by the IC; or 2) the IC on its own motion orders further medical treatment. Employees are entitled to reimbursement for sick travel when the travel is medically necessary and the mileage is 20 or more miles round-trip. The reimbursement rate in 2014 is 56 cents per mile (56.5 cents for 2013). Travel expenses for an employee’s second opinion on the rating are not reimbursable.
If a medical bill has not been paid by the carrier within 60 days after the bill was properly submitted to the carrier, a 10% penalty can be ordered by the IC. To the extent the carrier requires preauthorization for in-patient treatment or surgery, when the carrier receives a preauthorization request on a Form 25PR, a response is required within seven business days unless an extension of time is obtained from the IC. If no timely response, the surgery or in-patient treatment is authorized by default. § 97-25.3. Rule 1001.
North Carolina medical treatment may not be that complicated to administer under WC. However, not following the rules can cost a company dearly. I had commented on this rule from CSH’s WC news alert. You should also sign up for this service. It is freebies.
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