Proposed Revisions to Workers' Compensation Rules
of the North Carolina Industrial Commission

 

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.


Article VI. Contested Cases

Rule 601

Denial of Liability

If the employer or insurance carrier decides to deny denies liability in any case, a detailed statement of the basis of denial must be set forth in a letter of denial or Form 61, which shall be sent to the plaintiff, or his attorney currently of record, if any, and the Industrial Commission.

The detailed statement of the basis of denial shall set forth a statement of the facts, as alleged by the employer, concerning the injury or any other matter in dispute; a statement identifying the source, by name or date and type of document, of the facts alleged by the employer; and a statement explaining why the facts, as alleged by the employer, do not entitle the employee to workers’ compensation benefits.

Upon notice of a claim, the employer must admit or deny such statement compensation to the Commission within fourteen days after the employer has written or actual notice of the injury or death, or commence payment without prejudice pursuant to N.C. Gen. Stat. 97-18(d). If, after 90 days from the date of filing of a Form 18, or if no Form 18 is filed, the filing of a Form 33, an employer has neither admitted the claim, filed the notice of denial of the claim with the Commission, or initiated compensation payments without prejudice pursuant to N.C. Gen. Stat. 97-18(d), the employer shall be assessed a $500.00 sanction pursuant to Rule 802, in addition to any other sanctions available under the Act. shall be provided within 45 days of receipt of Form 18, Form 18B, or Form 33, and in any case, within twenty-one (21) days from the date that a determination is made to deny the claim, or upon order of the Industrial Commission. Requests for waivers of this Rule or extensions may be addressed to the Commission’s Claims Department. Defendant is not obligated to repeat grounds for denial previously given. (Amended effective January 1, 1992.)


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