Note: The following constitutes the proposed
changes in this Rule. Added language appears in bold italic script, and
proposed deletions are indicated by strikeout. The changes will not go
into effect until further notice by the Industrial Commission.
Rule 408
Additional Medical Compensation
(1) The Industrial Commission may enter an order as contemplated by N.C. Gen. Stat. § 97-25.1 providing for additional medical compensation on its own motion or pursuant to a stipulation of the parties or by approval of an agreement of the parties for additional medical compensation reflected in a Form 21 or a Form 26.
(2) If the parties have not reached an agreement regarding additional medical compensation, an employee may file a claim with the Industrial Commission for an order pursuant to the terms of N.C. Gen. Stat. § 97-25.1, for payment of additional medical compensation within two (2) years of the date of the last payment of medical or indemnity compensation, whichever shall last occur. The claim may be made on a Form 18M or by written request to the Industrial Commission. The filing of this claim tolls the time limit contained in this paragraph and in N.C. Gen. Stat. § 97-25.1. The original and one copy of the claim must be filed with the Industrial Commission’s Office of the Executive Secretary, one copy must be provided to the employer or carrier/administrator, and one copy must be provided to the attorney of record, if any.
(3) Upon receipt of the claim, the Industrial Commission will notify the employer or carrier/administrator that the claim has been received by providing a copy of a Form 18M or a written claim. The employer or carrier/administrator shall, within 30 days, send to the Industrial Commission and to the employee and the employee’s attorney of record, if any, a written statement as to whether the employee’s request is accepted or denied. If the request is denied, the employer or carrier/administrator shall state in writing the grounds for the denial and shall attach any supporting documentation to the statement of denial.
(4) In cases where the employee’s right to additional medical
compensation is contested, the Form 18M, Request for Additional Medical
Compensation, shall be treated as a Motion to the Executive Secretary for future medical
compensation. Defendants shall have 30 days to respond thereto. An administrative ruling
shall thereafter be made subject to the right of either party to appeal such
administrative decision by filing a Form 33, Request for Hearing, pursuant to the time
limitations contained in Rule 602. An appeal of the Administrative Decision shall have the
effect of staying the decision, provided that the stay may be dissolved in the discretion
of the Commission for good cause shown. a request that a claim be assigned
for hearing may be filed with the Industrial Commission on a Form 33.
(5) This Rule applies to injuries by accident occurring on or after July 5, 1994.
(6) This Rule is effective March 15, 1995.
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