Order Adopting Rules Relating to


A. Additions to the Chiropractic Fee Schedule (effective March 1, 2001) E. Establishment of Hospital Fees for Workers' Compensation Cases (effective January 1, 2001)
B. Adoption of a Durable Medical Equipment/Supply Fee Schedule (effective March 1, 2001) F. Reimbursement for Multiple Arthroscopic Procedures (effective March 1, 2001)
C. Deletion of Obsolete CPT Codes (effective March 1, 2001) G. Amendment of Industrial Commission Rule 104 (effective March 1, 2001)
D. Adoption of Fees for Physicians' Assistants (effective March 1, 2001)

Amendment of Industrial Commission Rule 104

Industrial Commission Rule 104 is amended to include the following statement at the end of the Rule: "In addition to providing the Form 19 to the employee, the employer shall also provide a blank Form 18 for use by the employee."

As so amended, Rule 104 reads as follows:

Rule 104
Employer’s Report of Injury

An employer shall immediately report to its carrier or administrator any injury or occupational disease, or allegation by an employee of an injury or occupational disease, sustained in the course of employment for which the attention of a physician is needed or actually sought. Within five days of knowledge of the injury or allegation, the employer or carrier/administrator or its successor in interest shall file with the Industrial Commission and provide a copy to the employee of a Form 19, Employer’s Report of Employee’s Injury to the Industrial Commission, if injury causes the employee to be absent from work for more than one day and the employee’s medical compensation is greater than an amount which is established periodically by the Industrial Commission in its Minutes. The employer may record the employee’s or another person’s description of the injury on the Form 19 without admitting the truth of the information.

In addition to providing the Form 19 to the employee, the employer shall also provide a blank Form 18 for use by the employee.


Go Back to January 16, 2001 Order Adopting These Rules

Return to N.C. Industrial Commission Home Page

Return to NCIC Alternate Home Page


N.C. Industrial Commission · 4319 Mail Service Center · Raleigh, NC 27699-4319
Webmaster:  (919) 807-2500 · Fax:  (919) 715-0282
Internet Address:  http://www.comp.state.nc.us/