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North Carolina Medical Treatment and Complete Cheat Sheet – Cranfill Sumner Hartzog


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.

Graphic Map of North Carolina Medical Treatment Safety Conference

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)

Picture of different North Carolina medical treatment In Hosptal

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.

Doctor And Nurse North Carolina Medical Treatment Of Patient At Hospital Bed

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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James J Moore - Workers Comp Expert

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Management Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications


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