NORTH CAROLINA INDUSTRIAL COMMISSION

Help Line: (800) 688-8349, (919) 807-2501, or infospec@ic.nc.gov
Fraud and Insurance Compliance Hotline: (888) 891-4895 or fraudcomplaints@ic.nc.gov

Frequently Asked Questions (FAQs)

List of FAQs

The following is a list of Frequently Asked Questions (FAQs) that we receive by phone and E-mail. They are arranged by Category, with the most common questions at the top. You may use the links to the right of this box to go directly to a list of FAQs related to the subject you are searching for.

Most Common Frequently Asked Questions

This is a list of the most commonly asked questions.

Who is required to provide workers’ compensation coverage?
What if my employer does not have workers’ compensation insurance?

The employee should report the lack of workers’ compensation insurance or approved self-insurance to the NCIC Fraud Section and, if injured, should file a Form 18 and Form 33 with the Commission. Please e-mail your completed Form 18 to forms@ic.nc.gov.

What must an employee do when an injury occurs?

Report the injury to the employer, orally and in writing, immediately and in any event within 30 days.

How can I identify the insurance carrier for my employer?

Information regarding the workers’ compensation carrier for your employer may be obtained from the Industrial Commission in one of the following three manners:

  1. Searching the Insurance Coverage Search System;
  2. You have filed a Form 18 asserting a claim against the employer.
  3. The employer or carrier has filed a Form 19 reporting your injury.

The Industrial Commission sends out an acknowledgement letter when a Form 18 is processed that contains information about the insurance carrier. However, if you have not yet received an acknowledgement letter and you need this information, you may contact the Industrial Commission. It is not required that you provide insurance carrier information when completing a Form 18 if you do not have that information.

What should be done if the employer fails or refuses to report an injury?

The Employee should file a claim (Form 18 or 18B) within two years of the accident with the Industrial Commission. Please e-mail completed forms to forms@ic.nc.gov.

Who provides and directs medical treatment?

The employer or its insurance company, subject to any Commission orders, provides and directs medical treatment. The employee may petition the Commission to change physicians or approve a physician of employee’s selection when good grounds are shown. However, payment by the employer or carrier is not guaranteed unless written permission to change physicians is obtained from the employer, carrier, or Commission before the treatment is rendered.

Chiropractic Rules:

If the employer grants permission to seek medical treatment from a chiropractor, the employee is entitled to 20 visits if medically necessary. If additional visits are needed, the chiropractor should request this authorization from the employer.

When can reimbursement for sick travel be collected?

If employees travel 20 miles or more round trip for medical treatment in workers’ compensation cases, they are entitled to collect for mileage at the rate of 25 cents a mile for travel prior to June 1, 2000; 31 cents a mile for travel between June 1, 2000 and January 17, 2006; 44.5 cents a mile for travel between January 18 and December 31, 2006; 48.5 cents a mile for travel between January 1 and December 31, 2007; 50.5 cents a mile for travel between January 1 and June 30, 2008; 58.5 cents a mile for travel between July 1 and December 31, 2008; 55 cents a mile for travel during 2009; 50 cents a mile for travel during 2010; 51 cents a mile for travel between January 1 and June 30, 2011; 55.5 cents a mile for travel between July 1, 2011 and December 31, 2012; 56.5 cents a mile for travel between January 1, 2013 and December 31, 2013; and 56 cents a mile for travel after January 1, 2014.

Note: The Industrial Commission has given the self-insurers and insurance carriers permission to pay drug and travel expenses directly to the employee without approval from the Commission.
What happens if, in an emergency, the employer fails or refuses to provide medical treatment?

The employee may obtain the necessary treatment from a physician or hospital of his own choice, but must promptly request the Commission’s approval.

When do I become eligible for lost wage compensation?

No compensation is due for the first seven (7) days of lost time unless the disability exceeds 21 days. Therefore, the first check will not include payment for days 1-7. Payment for those days will be made should the disability continue beyond 21 days.

How often are compensation payments made?

Weekly, but the Commission can authorize payments on a monthly basis in some circumstances.

At what rate of pay?

66 2/3% of the average weekly wage, not to exceed $884.00* (2013 maximum) per week.

* The maximum weekly benefit is adjusted annually.

How long is the employee eligible to receive lost-time weekly benefits?

Until the employee is able to return to work.

What is permanent partial disability?

Total loss or partial loss of use of a member of the body or inability to earn the same wages in any employment as earned at the time of injury.

Who determines permanent partial disability?

The Commission, based on the impairment ratings of physicians or evidence of consideration of wage earning capacity.

What happens when the employer refuses to acknowledge the claim?

When liability for payment of compensation is denied, the Commission, claimant, his or her attorney (if any), and all known providers of health care shall be promptly notified of the reason for such denial. The denial Form 61 shall not be worded in general terms, but must detail the exact reason for the denial of liability.

If a claim is denied by the insurance company or self-insurer, the employee may request a hearing before the Industrial Commission by submitting a Form 33, Request for Hearing.

Medical providers may bill the employee only after it has finally been determined that it is not a compensable workers’ compensation claim.

How can I use EDI to send information to the Industrial Commission?

The NC Industrial Commission has established a method of reporting workers' compensation claims electronically using EDI (Electronic Data Interchange). First Reports of Injury and Subsequent Reports of Injury may be submitted electronically. Reporting of Medical Billing can also be submitted electronically. To find out more about EDI, please go to http://www.ncicedi.info. For more information specific to the Industrial Commission and EDI, you can view or download a more detailed FAQ by clicking here. For questions not answered here or for support with EDI, you may send an E-Mail to ncicedi@ic.nc.gov.

Executive Secretary FAQs

These Frequently Asked Questions relate to the Office of The Executive Secretary.

When is payment due under a Compromise Settlement Agreement (CSA)?

After the Compromise Settlement Agreement package is received by the Commission from the defendants and reviewed by the Executive Secretary’s Office for fairness and equitableness to the parties and compliance with all statutory and rule provisions, an Order approving the CSA may be issued. Once the notice of the Order is received by the defendants, the defendants must issue payment to the plaintiff within 10 days. Therefore, the payment is due within 10 days from notice of the Order. If the payment is not issued within 14 days after the date the payment was due (24 days total from receipt of the notice), then the payment is subject to a 10% late payment penalty.

If I have not received a weekly temporary total disability compensation check in several weeks, what can I do?

After calling the representative of the carrier/administrator to attempt to resolve the issue regarding failure to receive weekly payments, file a motion or written request with the Executive Secretary’s Office to request a 10% late payment penalty. Attach documentation that shows information stated in the request and supports the request.

I have received a Form 24 Application to Terminate my workers’ compensation and I do not agree with the statements in the filing. What do I do?

File a response to the Form 24 Application with the Executive Secretary’s Office within 17 days of the date the Form 24 Application was mailed to you. It is helpful to attach documentation that shows information stated in the response and supports the response.

I have a request or issue about my medical treatment that I cannot resolve with the opposing party. What can I do?

You may file a written request as a motion to medicalmotions@ic.nc.gov if you wish to have an administrative review of the issue. Include supporting documentation. You may file a Form 33 Request for Hearing for review by a Deputy Commissioner at an evidentiary hearing.

What should I send in with a request for an Order distributing a third party recovery?*
  • Copy of a document reflecting the third party settlement amount
  • Statement from the workers’ compensation carrier regarding the lien (either the full amount or the amount the carrier is accepting in satisfaction of the lien)
  • Plaintiff’s attorney’s fee contract
  • Plaintiff’s attorney’s itemized list of case expenses
  • Proposed Order
*See N.C. Gen. Stat. § 97-10.2 for further details on the distribution of third party recoveries.
Is there a preferred method of transmission of motions to the Executive Secretary’s Office?

The preferred method is through e-mail directly with the contact person for the subject matter on which the motion is filed. See staff contact list and e-mail addresses.

Do I have to provide a certificate of service of a motion on the opposing party?

Yes. Also, please provide the address, and any other contact information you may have available (including e-mail addresses) for the opposing party.

How many days do I have to respond to a Motion that has been served on me?

10 days from the date it is received by you, and then there are 3 days added for mail or processing time.

Should I submit a Proposed Order with the Motion?

Yes, a Proposed Order is required with the submission of a Motion. If you are not represented by an attorney, then this requirement may be waived. See North Carolina Industrial Commission Rule 609. In addition, a Proposed Order is helpful with a response to a Motion.

I am not represented by an attorney. How do I obtain relief on an issue I have in my claim?

If the claim is denied, a Form 33 to request a hearing is required on most issues. If an issue has arisen in your accepted workers’ compensation claim that you believe requires a ruling by the Commission, you may submit your request to the Executive Secretary’s Office in writing.

Frequently Asked Questions from Insurance Carriers

The following are answers to some of the most commonly asked questions from insurers about North Carolina Workers’ Compensation.

How can I use EDI to send information to the Industrial Commission?

The NC Industrial Commission has established a method of reporting workers' compensation claims electronically using EDI (Electronic Data Interchange). First Reports of Injury and Subsequent Reports of Injury may be submitted electronically. Reporting of Medical Billing can also be submitted electronically. To find out more about EDI, please go to http://www.ncicedi.info. For more information specific to the Industrial Commission and EDI, you can view or download a more detailed FAQ by clicking here. For questions not answered here or for support with EDI, you may send an E-Mail to ncicedi@ic.nc.gov.

I am an adjuster for an insurer. Is there a form I should use to deny a workers’ compensation claim?

Yes. Pursuant to N.C. Gen. Stat. §97-18(c) and (d), a Form 61 must be filed with the N.C. Industrial Commission and a copy sent to the employee or the employee’s attorney of record, if any, and also to all known medical service providers. The adjuster should provide a detailed statement describing the grounds for denying compensability or liability either on the Form 61 or on an attached letter.

I am an out-of-state medical provider. Am I required to accept medical rates as established by the N.C. Medical Fee Schedule when I treat patients for a N.C. claim?

No. You are allowed to bill charges in full or based on a prior agreement if one has been established. If one has not been established, expect reimbursement pursuant to your state’s fee schedule.

Do I need permission to suspend or terminate Temporary Total benefits under workers’ compensation?

Yes, unless there has been a return to work as explained in the paragraph below. A Form 24 must be filed with the N.C. Industrial Commission and sent to the employee or the employee’s attorney of record, if any, and payments may be stopped only after a decision by the Commission.

You may terminate Temporary Total benefits [N.C. Gen. Stat. §97-29] when an employee has returned to work for the same or different employer subject to Trial-Return to Work provisions [N.C. Gen. Stat. §97-32.1] or when the employer contests a claim pursuant to Payment Without Prejudice [N.C. Gen. Stat. §97-18(d)] within ninety (90) days (unless an extension has been granted by the Industrial Commission).

Otherwise, you should submit a Form 24 - Application to Terminate or Suspend Payments of Compensation pursuant to N.C. Gen. Stat. §97-18.1, to the Industrial Commission. The Industrial Commission shall approve or deny the Form 24. You should receive approval from the Industrial Commission prior to the termination of compensation benefits. If payments are suspended prematurely, and the Special Deputy Commissioner disallows the Form 24 request, the insurer must pay full retroactive benefits to the employee.

Are there any penalties if payment of compensation benefits are not paid within fourteen (14) days after it has become due when the injured worker is being paid ongoing compensation?

Yes. Pursuant to N.C. Gen. Stat. §97-18(g), there shall be added to such unpaid installment an amount equal to ten per cent (10%), which shall be paid at the same time as, but in addition to, such installment, unless such nonpayment is excused by the Industrial Commission after a showing by the employer that owing to conditions over which he had no control such installment could not be paid within the period prescribed for payment.

Which forms should I submit to the Industrial Commission when a claimant has returned to work?

You should use the Form 28 - Return to Work Report, when the claimant has returned to work with no working restrictions, or the Form 28-T - Notice of Termination of Compensation by Reason of Trial-Return to Work Pursuant to N.C. Gen. Stat. §97-18.1(b) and §97-32.1, when the claimant has working restrictions.

Do the forms have to be color-coded?

Because we scan all forms and documents and convert them to electronic files, at this time, the Industrial Commission is using white paper for all forms and correspondence. This makes them easier to scan.

Do insurers and self-insurers have to send medical bills to the Industrial Commission?

No, they do not. Insurers and self-insurers may pay all medical bills, including hospital bills, without submitting them to the Industrial Commission for approval.

Mediation FAQs

What are the settlement rates at IC mediation conferences?

Settlement rates at IC mediation conferences have historically been at or above 70%, and at or above 75% when settlements of cases at or before scheduled mediation conferences are included.

Does the Commission order all workers’ compensation cases to mediation?

Under the automatic referral procedures commenced during the 1996-97 fiscal year, whenever a party files a request for hearing in a workers’ compensation claim, the Docket Section sends an Order for Mediated Settlement Conference to all parties along with the Commission's acknowledgment letter. The only cases that are not automatically referred to mediation are claims against the state brought by prison inmates, which are excluded by law, expedited medical motions and administrative appeals. In addition, cases involving injured workers who are not represented by counsel are generally mediated only if all parties agree to mediate, and cases involving non-insured employers are generally mediated only if all parties agree to mediate and the Deputy Commissioner responsible for the adjudication of non-insured cases approves the parties’ request to refer such cases to mediation.

How are mediators selected or appointed?

The parties have the right to select a mediator certified by the Dispute Resolution Commission on their own and may do so within the time periods specified by the ICSMC Rules. If the parties do not have a specific mediator in mind, they can select one from a list of mediators available on the Commission's web site or from the Dispute Resolution Coordinator's office. If the parties want to select a mediator, but need more time, an extension of the selection deadline may be requested from the Dispute Resolution Coordinator (Deputy Commissioner John Schafer). Requests for extensions of time to select a mediator and to complete mediation are liberally granted when there is no objection to such requests. If the parties have agreed or have been ordered to mediate, and cannot agree on the selection of a mediator, the Commission will appoint a mediator from its list of mediators eligible for appointment.

How does a person become eligible to be appointed by the Commission?

To be appointed by the Industrial Commission, a mediator must be certified by the North Carolina Dispute Resolution Commission to mediate cases in North Carolina’s superior courts through the court’s mediated settlement conference program. The mediator also must have a Declaration of Interest and Qualifications form on file with the Commission. The declaration must state that the mediator, if an attorney, is a member in good standing of the North Carolina State Bar; that the declarant agrees to accept and perform mediations of disputes before the Commission with reasonable frequency when called upon for the fees and at the rates of payment specified by the Commission.

Can any party submit suggestions concerning the appointment of a mediator?

Yes, if a party sends a letter to the opposing party and to the Dispute Resolution Coordinator suggesting one or more mediators for consideration, and the Dispute Resolution Coordinator receives no response to the suggestion(s) from the opposing party, then the Dispute Resolution Coordinator usually appoints a mediator suggested by a party. However, if the opposing party objects to a suggested mediator, that mediator generally will not be appointed. To be eligible for appointment when not selected by the parties, the suggested mediator must be on the Commission’s list of mediators available for appointment, and must have agreed to travel to the county where the case is pending. Certain mediators are not on the Commission’s list because they do not accept the appointed rate, or otherwise set compensation terms that are different from the Commission's terms. Those mediators may nevertheless be selected by the parties since a selected mediator may charge any amount that is agreed upon by the parties.

Can a mediation conference be postponed after it has been scheduled?

After a mediation conference is scheduled to convene on a specific date, it may not be postponed unless the requesting party first notifies all other parties of the grounds for the requested postponement, or without the consent and approval of the mediator or the Dispute Resolution Coordinator.

What are the current mediation fees in IC cases?

When the mediator is agreed to by the parties, compensation will be as agreed upon between the parties and the mediator. If the mediator is not agreed to by the parties, and is then appointed by the Commission, the mediator will be paid by the parties at the rate of $150.00 per hour for mediation services at the conference. In addition, the parties will pay to the mediator a one time, per case administrative fee of $150.00. The mediator’s administrative fee will be paid in full unless, within 10 days after the date that the mediator has been appointed, written notice is given to the mediator and the Dispute Resolution Coordinator that the issues for which a request for hearing had been filed have been fully resolved or the hearing request has been withdrawn. In cases involving appointed mediators postponement fees are set at $300.00 if a mediation conference is postponed without good cause within seven days of a scheduled conference, and $150.00 if a mediation conference is postponed more than seven calendar days prior to the scheduled date.

Which party is responsible for paying the mediation fees?

Unless otherwise agreed to by the parties or ordered by the Commission, costs of the mediated settlement conference are allocated to the parties as follows: one share by plaintiff(s); one share by the workers’ compensation defendant-employer or its insurer, or if more than one employer or carrier is involved, or if there is a dispute between employer(s) or carrier(s), one share by each separately represented entity; one share by participating third-party tort defendants or their carrier, or if there are conflicting interests among them, one share from each such defendant or group of defendants having shared interests; and one share by the defendant State agency in a State Tort Claims Act case. Parties obligated to pay a share of the costs will be responsible for equal shares; provided, however, that in workers’ compensation claims the defendant will pay the plaintiff’s share, as well as its own, and the defendant will be reimbursed for the plaintiff’s share when the case is concluded from benefits that may be determined to be due to the plaintiff, and the defendant may withhold funds from any award for this purpose.

Are the parties obligated to pay a fee if they request a substitution of mediators after the Commission has already appointed someone to mediate the case?

If the parties request the approval of a selected mediator after the appointment of another mediator by the Commission, and the substitution of mediators is allowed, the Commission will generally require the parties to pay the administration fee owed to the mediator initially appointed by the Commission.

Is the mediator required to file a report of mediator in all cases?

The mediator must file a report of mediator with the Dispute Resolution Coordinator in all cases, even if no conference is held. The mediator should not attach a copy of the parties' memorandum of agreement to the report.

Other than the ICMSC Rules are there any standards of conduct applicable to mediators who are mediating IC cases?

All mediators conducting mediation conferences pursuant to the ICMSC Rules must adhere to the Standards of Professional Conduct for Mediators adopted by the North Carolina Dispute Resolution Commission.

To what person should a party address motions while a case is in the process of being mediated?

Motions related to the ICMSC Rules should always be addressed to the Dispute Resolution Coordinator, but all other motions (including motions related to discovery, Form 24 matters and medical issues) should be addressed to the Industrial Commission's Executive Secretary, unless the case has already been assigned to a Deputy Commissioner or a Full Commission panel, or the motion is otherwise subject to the Commission’s expedited medical motions procedures.

Medical Fees FAQs

When can reimbursement for sick travel be collected?

If employees travel 20 miles or more round trip for medical treatment in workers’ compensation cases, they are entitled to collect for mileage at the rate of 25 cents a mile for travel prior to June 1, 2000; 31 cents a mile for travel between June 1, 2000 and January 17, 2006; 44.5 cents a mile for travel between January 18 and December 31, 2006; 48.5 cents a mile for travel between January 1 and December 31, 2007; 50.5 cents a mile for travel between January 1 and June 30, 2008; 58.5 cents a mile for travel between July 1 and December 31, 2008; 55 cents a mile for travel during 2009; 50 cents a mile for travel during 2010; 51 cents a mile for travel between January 1 and June 30, 2011; 55.5 cents a mile for travel between July 1, 2011 and December 31, 2012; and 56.5 cents a mile for travel after January 1, 2013.

Note: The Industrial Commission has given the self-insurers and insurance carriers permission to pay drug and travel expenses directly to the employee without approval from the Commission.

Where do I mail my completed travel form (25T)

Mail to the workers compensation insurance carrier or self-insured employer.

What are the rules for chiropractic treatment?

If the employer grants permission to seek medical treatment from a chiropractor, the employee is entitled to 20 visits if medically necessary. If additional visits are needed, the chiropractor should request this authorization from the employer

Who provides and directs medical treatment?

The employer or its insurance company, subject to any Commission orders, provides and directs medical treatment. The employee may petition the Commission to change physicians or approve a physician of employee’s selection when good grounds are shown. However, payment by the employer or carrier is not guaranteed unless written permission to change physicians is obtained from the employer, carrier, or Commission before the treatment is rendered.

How long does it normally take for medical bill approval?

Medical Fees has to wait for the insurance carrier to send the bill. Once it is received, bills are approved on a daily basis. After approval, Medical Fees sends the insurance carrier or self-insured a medical bill analysis, stating the approved amount.

Where should a medical provider send the bill for payment?

The bill, along with the medical records, should be sent certified mail, return receipt requested, to the employer, self-insured employer, or the workers’ compensation insurance carrier. Keep the receipt as proof of mailing.

How can I use EDI to send information to the Industrial Commission?

The NC Industrial Commission has established a method of reporting workers' compensation claims electronically using EDI (Electronic Data Interchange). Reporting of Medical Billing can now be submitted electronically. First Reports of Injury and Subsequent Reports of Injury may also be submitted electronically. To find out more about EDI, please go to http://www.ncicedi.info. For more information specific to the Industrial Commission and EDI, you can view or download a more detailed FAQ by clicking here. For questions not answered here or for support with EDI, you may send an E-Mail to ncicedi@ic.nc.gov.

How long does a medical provider have to submit a bill?

A provider of medical compensation shall submit its statement for services within 75 days of the rendition of the service or if treatment is longer, within 30 days after the end of the month during which multiple treatments were provided, or within such other reasonable period of time as allowed by the Industrial Commission. However, in cases where liability is initially denied but subsequently admitted or determined by the Industrial Commission, the time for submission of medical bills shall run from the time the health care provider received notice of the admission or determination of liability.

How long should a medical provider have to wait for reimbursement?

G.S. §97-18(i) states "If any bill for services rendered under G.S. §97-25 by any provider of health care is not paid within 60 days after it has been approved by the Commission and returned to the responsible party, or within 60 days after it was properly submitted, in accordance with the provisions of this Article, to an insurer or managed care organization responsible for direct reimbursement pursuant to G.S. §97-26(g), there shall be added to such unpaid bill an amount equal to ten per centum (10%) thereof, which shall be paid at the same time as, but in addition to, such medical bill, unless such late payment is excused by the Commission."

What does a medical provider do if they feel medical reimbursement is incorrect?

Attempt should be made to resolve dispute with payer. Unresolved disputes should be submitted to the North Carolina Industrial Commission Medical Fees Section with a carbon copy to the payer. Submitted information should include the following:

  • A cover letter on company letterhead explaining the dispute
  • Copies of bill(s)
  • Copies of medical reports related to the dispute
  • Copy of the payer’s previous explanation of payment
  • Copy of the certified mail return receipt confirmation
  • Any additional documentation felt to be related to the issue

Will a medical provider receive 100% reimbursement for every bill?

No. They will be reimbursed as follows:

Beginning July 27, 2009, for service dates on and after that date, the following inpatient hospital billing band and outpatient and ambulatory surgical center reimbursement rates shall come into effect:

  • The lower end cap of the DRG band for reimbursement of inpatient hospital bills will be adjusted from 77.07% to 75% of charges for hospitals other than critical access hospitals. (Critical access hospitals are defined by federal law and are the smallest hospitals in the State, located in rural areas.)
  • The reimbursement rate for outpatient hospital bills will be adjusted from 95% of charges to 79% of charges for hospitals other than critical access hospitals. For critical access hospitals, the outpatient reimbursement rate will be reduced from 95% to 87% of charges.
  • The reimbursement rate for ambulatory surgical centers will be adjusted from 100% of charges to 79% of charges.

Prior to July 27, 2009:

  • Outpatient hospital claims will be reimbursed at 95% of charges.
  • Ambulatory surgical services will be reimbursed at 100%.
  • Inpatient bills will be calculated by the North Carolina Industrial Commission’s reimbursement methodology with continuation of the end caps at 77.07% and 100%. These percentages officially became effective July 15, 2002 and will continue through the year 2002 and thereafter until the Commission adopts a new reimbursement methodology.
  • Contracts with payors could subject providers to different reimbursement procedures other than described above.

How would a physician bill an Independent Medical Evaluation?

The Commission has created special coding for review of medical records when an IME is conducted. Along with the special code, the provider may bill an office visit code if an examination is performed. Keep in mind that an IME may involve the examination portion, but always includes a comprehensive review of records, and a full report (reference Section 16). A second opinion on an impairment rating is not an Independent Medical Evaluation, as the rating is just one component of the IME. (CPT code 99456 would be appropriate for the second opinion rating only.)

How are supplies paid?

The North Carolina Industrial Commission has adopted nearly 1100 HCPCS billing codes to describe supplies and equipment used in workers’ compensation treatment. However, the Commission has not yet incorporated into its fee schedule all of the HCPCS level codes for supplies and equipments. For example, none of the “J” codes have been adopted. If a supply is billed, and the code does not have a fee assigned in the Commission schedule, the provider is entitled to 20% above invoice cost.

The Commission will allow a provider to use CPT code 99070 when billing for supplies or equipment that are not designated in the Workers’ Compensation Medical Fee Schedule. The provider is entitled to cost plus 20%.

If a custom-made orthotic or prosthetic is not contained in the Commission schedule, these items should be paid per agreement between provider and payer.

How does a medical provider know if an assistant surgeon fee is allowed?

Medical providers are to follow the American Medical Association’s CPT guidelines. You may also see the On-line Fee Schedule by Clicking Here. You must click to accept the Disclaimer, then click the CPT/Codes, then the Assistant Surgeon Guide.

Can a medical provider bill for administering an intramuscular injection?

Only if an office visit is not charged. See the Medical Fee Schedule, Medicine Section for more information.

Can a medical provider expect separate reimbursement for electrodes in conjunction with nerve conductions studies?

No, the cost of the electrodes is built into the procedure’s reimbursement.

I am an out-of-state medical provider. Am I required to accept medical rates as established by the N.C. Medical Fee Schedule when I treat patients for a N.C. claim?

No. You are allowed to bill charges in full or based on a prior agreement if one has been established. If one has not been established, expect reimbursement pursuant to your state’s fee schedule.

Do insurers and self-insurers have to send medical bills to the Industrial Commission?

No, they do not. Insurers and self-insurers may pay all medical bills, including hospital bills, without submitting them to the Industrial Commission for approval.

What is a “medical only” claim?

This type claim means that there is no more than one day of lost time, no disfigurement or impairment, and no more than $2000.00 in medical expenses. The North Carolina Industrial Commission does not require the employer/carrier to submit the Form 19 for these claims, so there is no Industrial Commission file number created. The injured worker must file a Form 18 to create an I.C. file number in order to settle a dispute or request a hearing. Please e-mail completed forms to forms@ic.nc.gov.

Medical Rehabilitation Nurses FAQs

How can an injured worker be referred to the Medical Rehabilitation Nurses Section?

We have a referral form which provides us with important information when completed. You can get these forms by clicking here. These forms may also be requested by telephone at (919) 807-2616 or by letter request to the:

Medical Rehabilitation Nurses Section
N.C. Industrial Commission
4341 Mail Service Center
Raleigh, North Carolina 27699-4341

Referrals will be accepted from anyone.

I did not know that the Industrial Commission had Nurses. How much do their services cost?

Nurses have worked for the Industrial Commission since 1974, and their services have always been free.

Do I have to work for the State to qualify for assistance from the Medical Rehabilitation Nurses Section at the Industrial Commission?

No. Anyone covered by the North Carolina Workers’ Compensation Act is eligible for our services.

Do I have to allow my Rehabilitation Professional in the examining room while I am being examined by my doctor?

No. Workers have a right to a private examination by their doctors. We do encourage the worker to allow the provider to meet with both the worker and the doctor immediately following the examination when the doctor discusses his/her findings and makes his/her recommendations for treatment. This will allow everyone to be aware of and understand treatment plans and expectations. Click here for the Rules governing the use of Rehabilitation Professionals in Workers’ Compensation cases.

My doctor has told me that I can go back to work, but my employer does not have a job for me or my job is now too physically demanding. Can you help me?

Since you have reached the medical improvement expected following your injury, if your employer or carrier does not offer vocational assistance to you, we would refer you to the N.C. Division of Vocational Rehabilitation for reemployment, counseling, and guidance.

How can a Rehabilitation Professional enroll in the mandatory comprehensive course entitled Workers' Compensation Case Management in NC: A Basic Primer for Medical and Vocational Case Managers?

For class availability and registration, click here. If you have questions, contact Karen Smith at 919-807-2618 or via e-mail to karen.smith@ic.nc.gov.