Rule 601
Denial of Liability
If the employer or insurance carrier 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 of record, if any, all known health care providers which have submitted bills to the employer/carrier, 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 compensability of the claim to the Commission within 14 days after the employer has written or actual notice of the claim, 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 may be sanctioned pursuant to Rule 802, in addition to any other sanctions available under the Act. Requests for waivers of this Rule or extensions may be addressed to the Executive Secretary. Defendant is not obligated to repeat grounds for denial previously given.
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