by Joe D. Delfino In a recent publication, we discussed the issue of what standard the North Carolina Industrial Commission and North Carolina Courts would use to interpret the provision of the North Carolina Workers’ Compensation Act dealing with the 500-week cap on weekly TTD benefits. By way of review, for workers’ compensation claims arising […]
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 […]
“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. […]
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 […]
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 […]
Option 1:In North Carolina, unlike many other states, pre-hearing depositions are not automatically allowed under the North Carolina Workers’ Compensation Act. If you want to take a pre-hearing deposition, you need either (1) the consent of the opposing party, or (2) an order from the Commission allowing you to take the deposition. See N.C. Gen. […]
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 […]
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: […]
Before June 24, 2011, injured employees were eligible for lifetime Temporary Total Disability (TTD) benefits for the duration of their disability. In 2011, the North Carolina legislature passed revisions to the Workers’ Compensation Act. One of the revisions altered N.C. Gen. Stat. § 97-29(b), which now states: The employee shall not be entitled to compensation […]
In our last article, we discussed the status and potential impact of AB5, a law recently passed in California which went into effect on January 1, 2020, addressing the classification of certain workers. By way of review, prior to AB5’s passage, the decision on whether a worker should be classified as an employee or an […]
