N.C. Industrial Commission Rules for
Utilization of Rehabilitation Professionals
in Workers' Compensation Claims

III. Definitions; Description of Rehabilitation Services.

1. RPs are case managers and coordinators of medical rehabilitation services and/or vocational rehabilitation services, including but not limited to, state, private, or carrier based, whether on site, telephonic, or in or out of state. RPs do not include direct care providers, e.g., physical therapists, occupational therapists, or speech therapists.
    
2. The "parties" are the worker, the worker's attorney, the employer, the workers’ compensation carrier (including claims administrator, third party administrator), and the employer or carrier's attorney(s).
    
3. "Physician" means medical doctor, chiropractor, other physician, and, where the context requires, other health care providers.
    
4. "Medical rehabilitation" refers to the planning and coordination of health care services. The goal of medical rehabilitation is to assist in the restoration of injured workers as nearly as possible to the workers' pre-injury level of physical function. Medical case management may include but is not limited to case assessment, including a personal interview with the injured worker; development, implementation and coordination of a care plan with health care providers and with the worker and family; evaluation of treatment results; planning for community re-entry; return to work with the employer of injury and/or referral for further vocational rehabilitation services.
    
5. "Vocational Rehabilitation" refers to the delivery and coordination of services under an individualized plan, with the goal of assisting injured workers to return to suitable employment.
    
1. Specific vocational rehabilitation services may include, but are not limited to: vocational assessment, vocational exploration, counseling, job analysis, job modification, job development and placement, labor market survey, vocational or psychometric testing, analysis of transferable skills, work adjustment counseling, job-seeking skills training, on-the-job training and retraining, and follow-up after re-employment.
    
2. The vocational assessment is based on the RP’s evaluation of the worker’s social, medical, and vocational standing, along with other information significant to employment potential and on a face-to-face interview between the worker and the RP, to determine whether the worker can benefit from vocational rehabilitation services, and, if so, to identify the specific type and sequence of appropriate services. It should include an evaluation of the worker's expectations in the rehabilitation process, an evaluation of any specific requests by the worker for medical treatment or vocational training, and a statement of the RP's conclusion regarding the worker's need for rehabilitation services, benefits expected from services, and a description of the proposed rehabilitation plan.
    
3. Job placement activities may be commenced after completion of a vocational assessment and formulation of an individualized plan for vocational services which specifies its goals and the priority for return-to-work options in each case. Placement shall only be directed toward prospective employers offering the opportunity for suitable employment, as defined herein.
6. "Return to work" means placement of the injured worker into suitable employment, as defined herein. Return-to-work options generally should be considered in the following priority:
    
1. Current job, current employer
    
2. New job, current employer
    
3. On-the-job training, current employer
    
4. New job, new employer
    
5. On-the-job training, new employer
    
6. Formal vocational training to prepare worker for job with current or new employer.
    
7. Due to the high risk of small business failure, self-employment should be considered only when its feasibility is documented with reference to worker's aptitudes and training, adequate capitalization, and market conditions.
7. "Suitable employment" means employment in the local labor market or self-employment which is reasonably attainable and which offers an opportunity to restore the worker as soon as possible and as nearly as practicable to pre-injury wage, while giving due consideration to the worker's qualifications (age, education, work experience, physical and mental capacities), impairment, vocational interests, and aptitudes. No one factor shall be considered solely in determining suitable employment.

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