11 NCAC 23A .104 – Employer’s Requirement to file Form 19:
New rule requires a Form 19 when an employee is absent from work for more than one (1) day because of the injury OR employee’s medical expenses are greater than $4,000.00 (previously $2,000.00). Note– Defendants are still required to send a Form 18 to the employee when a Form 19 is filed).
11 NCAC 23A .408 – Application for or Stipulation to Additional Medical Compensation:
New rule allows an employee to file a Form 33 hearing request when requesting additional medical compensation beyond the two-year limitation period for medical compensation. Employees still have the option of filing a Form 18M or a written request.
11 NCAC 23A .0409 – Claims for Death Benefits:
New rule clarifies the old rule re: death claims. Defendants must conduct an investigation to determine (previously “make a good faith effort to discover”) the names and addresses of potential beneficiaries under 97-38 and identify them on a Form 29. The Form 29 must be filed within 45 days of notification of death or alleged work-related death.
New rule provides that defendants may file a Form 61 to deny employee’s claim for death benefits on compensability grounds. (Note – Form 61 must be sent to all known potential beneficiaries and their counsel, along with any providers who have requested bill payment.)
New rule requires defendants to submit the following documents with a Form 30 or a proposed Opinion and Award regarding payment of death benefits (when no dispute re: beneficiaries or other issues):
- AWW stipulation
- Affidavits regarding dependents
- Death certificate
- Form 29
- Form 42 (for any minor or incompetent beneficiary)
- Proof of beneficiary status (e.g., marriage license, divorce/birth certificates)
- Funeral bill or stipulation as to payment of funeral bill
- Form 30D
- Affidavit or itemized statement in support of any attorney fee request
In the alternative, a hearing can be requested for determination of beneficiaries and/or any other issues which may exist.
11 NCAC 23A .0501 – Agreements for Prompt Payment of Compensation:
New rule requires submission of a written job description with a Form 26A when an employee has returned to work for the employer of injury with permanent work restrictions.
New rule requires that agreements for payment of permanent disability (such as a Form 26A) be submitted to the IC for approval within twenty (20) days of receipt by defendants.
11 NCAC 23A .0903 – Employee’s Obligation to Report Earnings:
New rule provides that, if compensation is suspended (after a Form 24) due to an employee’s failure to timely complete and return a Form 90, defendants can continue to suspend benefits if the Form 90, once received, shows benefits are no longer owed. For example, if the completed Form 90 shows earnings equal to or greater than employee’s pre-injury wages, defendants do not have to reinstate benefits and refile a Form 24. If the completed Form 90 does not report earnings, or shows that employee is earning less than his pre-injury wages, defendants have to reinstate TTD or TPD.