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 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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