section .0600 – claims administration and procedures

 

04 NCAC 10A .0601          EMPLOYER'S OBLIGATIONS UPON NOTICE; DENIAL OF LIABILiTY; and Sanctions

(a)  Upon the employee's filing of a claim for compensation with the Commission, the Commission may order sanctions pursuant to G.S. 97-18(j) against the employer or its insurance carrier if it does not, within 30 days following notice from the Commission of the filing of the claim, or 90 days when a disease is alleged to be from exposure to chemicals, fumes, or other materials or substances in the workplace, do one of the following:

(1)           File a Form 60 Employer's Admission of Employee's Right to Compensation to notify the Commission and the employee in writing that the employer is admitting the employee's right to compensation and, if applicable, satisfy the requirements for payment of compensation under G.S. 97-18(b);

(2)           File a Form 61 Denial of Workers' Compensation Claim to notify the Commission and the employee that the employer denies the employee's right to compensation consistent with G.S. 97-18(c);

(3)           File a Form 63 Notice to Employee of Payment of Compensation Without Prejudice consistent with G.S. 97-18(d).

For purposes of this Rule, sanctions ordered pursuant to G.S. 97-18(j) shall not prohibit the employer or its insurance carrier from contesting the compensability of and its liability for the claim.

Requests for extensions of time to comply with G.S. 97-18(j) shall be addressed to the Claims Administration Section.

(b)  When liability in any case is denied, the employer or insurance carrier shall provide a detailed statement of the basis of denial that shall be set forth in a letter of denial or Form 61 Denial of Workers' Compensation Claim, and that shall be sent to the employee's attorney of record or the employee, if unrepresented, all known health care providers who have submitted bills and provided medical records to the employer or carrier, and the Commission.

 

History Note:        Authority G.S. 97-18; 97-80(a); 97-81(a);

Eff. January 1, 1990;

Amended Eff. November 1, 2014; August 1, 2006; June 1, 2000.