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Workers’ Compensation

Medicare Aims to Shut Down Non-CMS-Approved WCMSAs

The Centers for Medicare and Medicaid Services (CMS) issued an updated Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide – Version 3.5, on January 10, 2022. In that Reference Guide, CMS reiterated that submitting a WCMSA proposal for review is never required, but is recommended, as the WCMSA review process is “the only process that […]

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EDFP Form Filing Requirement in NC

All NC Industrial Commission (NCIC) Forms (except the EDI Form 19, Employer’s Report of Employee’s Injury to the [NC] Industrial Commission) must be filed via the NCIC’s Electronic Document Filing Portal (EDFP): www.ic.nc.gov/docfiling.html The NCIC will not accept Forms via any other method (i.e., via email, via fax, via USPS). The “Login” to the EDFP can be found […]

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Calculating Average Weekly Wage With Multiple Jobs

“When an employee who holds two separate jobs is injured in one of them, his compensation is based only upon his average weekly wages earned in the employment producing the injury.” Joyner v. A. J. Carey Oil Co., 266 N.C. 519, 521, 146 S.E.2d 447, 449 (1966), citing Barnhardt v. Yellow Cab Co., 266 N.C. […]

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Avoiding a $400 Sanction: Responding to Notice From the Commission of a Form 18/Claim Being Filed

With regard to the Employer’s (Carrier’s/TPA’s) obligation to respond to notice from the Commission of the Employee’s filing (with the Commission) of their Form 18, Notice of Accident to Employer and Claim of Employee, the North Carolina Workers’ Compensation Act N.C.G.S. § 97-18(j) states: “When an employee files a claim for compensation with the Commission, the Commission may order […]

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Form 90 Best Practice

Per North Carolina Rule 903(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 N.C.G.S. § 97-29 or N.C.G.S. § 97-30 to complete a Form 90 Report of Earnings when reasonably necessary but not more than once every six months.” The best […]

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The Role of Nurse Case Managers in North Carolina

Under the North Carolina Industrial Commission Rules, Nurse Case Managers are considered rehabilitation professionals as they manage medical cases and coordinate rehabilitation services. 11 NCAC 23C .0103(1). In performing their duties, Nurse Case Managers must be neutral, providing “unbiased, objective opinions.” 11 NCAC 23C .0106(d). Further, Nurse Case Managers shall “provide copies of all correspondence […]

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AB5: A New Standard for Worker Classification – Part 3

In several recent articles, we discussed the potential impact of AB5 (now referred to as California Labor Code § 2775). The law went into effect on January 1, 2020, addressing the classification of workers as employees or independent contractors.  Several lawsuits were filed challenging AB5. In one the California Trucking Association filed a lawsuit contending […]

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Hedrick Gardner Recognized as a Best Law Firm by U.S. News – Best Lawyers® 2022

November 4, 2021. Hedrick Gardner Kincheloe & Garofalo LLP received several top rankings in the U.S. News – Best Lawyers® 2022 “Best Law Firms” report. The firm received Tier 1 regional rankings, the highest category awarded, in eight categories. The full firm report is as follows: Metropolitan Tier 1 Charlotte: Insurance Law Personal Injury Litigation – Defendants […]

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Medicare Provides New Way to Terminate Ongoing Responsibility for Medicals (ORM)

The Centers for Medicare and Medicaid Services (CMS) issued an updated Section 111 NGHP User Guide – Version 6.4, on June 11, 2021. CMS will now allow the termination of ORM if the following criteria are met. Where there is no practical likelihood of associated future medical treatment, which is reflected by meeting ALL of the following: […]

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