In April, the NC Senate and House introduced bills to reform the Workers’ Compensation Act. The bill introduced in each chamber was identical and entitled “Protect and Put North Carolina Back to Work.” Pro-employer and pro-employee groups have since negotiated the language of the bill and submitted a compromised draft to House committees. The bill was approved by the House Select Committee on Tort Reform in late May and put to a vote on the house floor on June 1, 2011. The bill passed the House 110-3. The bill now heads to the Senate where it is expected to pass. Governor Perdue has indicated she will likely sign any bill which has been favorably negotiated by both sides.
Below is a synopsis of the major proposed changes to the Workers’ Compensation Act. Please be aware this article is not exhaustive, nor can it anticipate how particular language in the bill will be interpreted by the Commission or the Courts. Also, please be aware this bill is not yet law. Please note each individual section has a specific effective date if the bill is passed. Sections 4, 5, 6, 7, and 9 apply to claims pending on or after the effective date the bill is passed. Sections 2, 3, 10, 11, 12, 13, 14, 15, and 20 apply to claims arising on or after the effective date the bill is passed.
Attendant care services are added to the definition of medical compensation, but the services are only considered such if a health care provider authorized by the employer or commission prescribes the service.
The bill proposes a statutory definition of “suitable employment.” Prior to reaching maximum medical improvement (MMI), suitable employment would include any available employment that is within the claimant’s work restrictions. The employment is appropriate if it is within the employee’s work restrictions and includes rehabilitative or other noncompetitive employment which is approved by the employee’s authorized health care provider.
Once a claimant reaches MMI, suitable employment would be defined as employment which the employee is capable of performing considering the employee’s:
The proposed definition suitable employment does not include mention of wages.
The bill proposes that no compensation shall be allowed under the Act for an injury by accident or occupational disease if the employer is able to prove that either at the time of hire, at the time of receiving notice of the removal of conditions from a conditional offer of employment, or during the course of a post-offer medical examination:
The bill proposes an additional subsection to the Act specifically stating that parties can reach separate contemporaneous agreements resolving issues not covered by the Act. This proposed change would allow the parties to reach agreement on resignation and release of employment in conjunction with the resolution of a workers’ compensation claim. However, the separate agreement must be in a separate document.
Changes in this section are two fold and summarized below.
(1) The bill codifies the procedure for an employee to request and obtain a second opinion examination. The employee may submit a written request to the employer to which the employer may agree. After 14 days, should the employer deny the request or the parties cannot, in good faith, agree on a second opinion physician the employee may request the commission order a second opinion examination. The employer shall pay for any examination.
The employer is entitled to all “relevant medical information.” Relevant medical information is defined as any medical record, report, or information that is (1) restricted to the particular evaluation, diagnosis, or treatment of the injury or disease for which compensation is sought; (2) reasonably related to the injury or disease for which the employee claims compensation; or (3) related to an assessment of the employee’s ability to return to work as a result of the particular injury or disease. This entitles an employer to:
(a) The bill proposes that an Independent Medical Examination (IME) may be conducted in either an accepted or denied claim. Further, in the case of an IME, the proposed provisions of N.C.G.S. §97-25.6 do not apply and an employer may openly communicate either orally or in writing with an independent medical examiner chosen by the employer regardless of whether the examiner physically examined the employee. If a physical examination occurred, the employer must produce the examiner’s report to the employee within 10 business days of receipt. Should the employee refuse to submit to an IME an order compelling compliance to submit the IME is not necessary to suspend benefits. The employer may immediately seek to suspend benefits by order of the Commission.
(b) The bill also proposes specific language that if the employee is dissatisfied with the assignment of a permanent partial disability (PPD) rating the employee is entitled to another examination solely on the percentage of the PPD rating. The Industrial Commission must either disregard or give less weight to the opinions of a physician who conducts and examination for a second opinion on the rating.
(b) The bill proposes a 500-week cap on temporary total disability benefits. The employee is entitled to total disability benefits within this cap so long as they prove by a preponderance of the evidence (greater than 50% chance that the proposition is true) that the employee is unable to earn the same wages he/she had earned before the injury or either in the same or other employee. The employee remains eligible for medical benefits as required past the cap. There are two exceptions to the cap:
(c) The employee may make an application with the Commission to exceed 500 weeks of benefits so long as (1) 425 weeks have passed since the first date of disability, (2) the employee proves by a preponderance of the evidence that he/she has sustained a total loss of wage-earning capacity. If the Commission approves the application benefits cannot be terminated on appeal except by determination of the Full Commission or an appellate court.
(d) Permanent and total disability is defined in this section. Medical compensation would still be paid by the employer during the lifetime of the employee. A presumption of permanent and total disability would arise only if the employee sustained:
The current bill proposes modifying the allowance of temporary partial disability benefits to 500 weeks to be consistent with §97-29. The 500 week cap runs for any benefits received for TPD or TTD.
The bill proposes language which would allow an employer to directly contact the employee about returning to suitable employment as defined by §97-2(22).
Orders suspending benefits based on refusal of suitable employment are required to outline the requirements for employee to end the suspension and reinstate benefits.
(a) The bill proposes that an employer may engage vocational rehabilitation services prior to or after MMI. An injured employee may also request vocational retraining where he/she (1) has not returned to work or (2) has returned to work earning less than 75% of pre-injury wages and receiving TPD. The 75% wage rule only applies to entitlement to vocational rehabilitation services not suitability of employment. Retraining may include education in NC community college or university so long as the education is reasonably likely to substantially increase the employee’s wage-earning capacity.
(b)-(g) The bill outlines the scope and procedure of vocational rehabilitation services and the guidelines for the initial vocational assessment and employer’s ability to terminate services if they are found not to be beneficial.
The bill proposes that where the death results proximately from the injury, payments to the decedent’s beneficiaries would increase from 400 weeks to 500 weeks to conform to §97-29.. The bill also proposes increasing burial expenses from $3,500.00 to $10,000.00 when death results proximately from the compensable injury.
The bill provides that the Commission is to decide the case and issue findings of fact based upon the preponderance of the evidence in view of the entire record.
While not currently in the proposed legislation, it is anticipated that the bill will include a proposal to decrease the number of Commissioners from seven to six. The Commissioners would be appointed for terms of six years and no Commissioner could serve more than two terms. Further, the bill proposes that two of the Commissioners be identified as having an affiliation with employers and two Commissioners be identified as having an affiliation with employees. The appointment of Commissioners would be subject to confirmation by both houses of the legislature.
In April, the senate and house introduced bills to reform the Workers’ Compensation Act. The bill introduced in each chamber was identical and entitled “Protect and Put North Carolina Back to Work.” Pro-employer and pro-employee groups have since negotiated the language of the bill and submitted a compromised draft to House committees. The bill was approved by the House Select Committee on Tort Reform in late May and put to a vote on the house floor on June 1, 2011. The bill passed the House 110-3. The bill now heads to the Senate where it is expected to pass. Governor Purdue has indicated she will likely sign any bill which has been favorably negotiated by both sides.
Below is a synopsis of the major changes to the Workers’ Compensation Act the bill proposes. Please be aware this article is not exhaustive, nor can it anticipate how particular language in the bill will be interpreted by the Commission or the Courts. Also, please be aware this bill is not yet law. Please note each individual section has a specific effective date if the bill is passed. Below, each section specifies the effective date.
Proposed Statutory Changes Quick Links:
1. Definition change for “medical compensation” and addition of “suitable employment.”
2. No entitlement to benefits when the claimant willfully misrepresented at or around the time of hiring regarding his/her physical condition.
3. Validation of separate Release and Resignation Agreements.
4. Procedure for Plaintiff to request a change to the authorized treating physician.
5. Commission’s treatment of unauthorized physicians’ opinions.
6. Employer’s right to medical records, written communication, and oral communication from the employee’s physicians and appropriate procedure to obtain/communicate each.
7. Rules regarding Independent Medical Examinations.
8. 500 week cap on temporary total disability benefits and exceptions.
9. 500 week cap on temporary partial disability benefits.
10. Offers of suitable employment and refusal of suitable employment.
11. Vocational rehabilitation. Permissive use and required procedure.
12. Changes to death and burial benefits.
13. The Commission’s legal standard of proof.
14. Proposed changes not yet in the new bill.
Definitions
N.C.G.S. §97-2 (19) Medical Compensation (Section 2)
Attendant care services are added to the definition of medical compensation, but the services are only considered such if a health care provider authorized by the employer or commission prescribes the service.
N.C.G.S. §97-2 (22) Suitable Employment
The bill proposes a statutory definition of “suitable employment.” Prior to reaching maximum medical improvement (MMI), suitable employment would include any available employment that is within the claimant’s work restrictions. The employment is appropriate if it is within the employee’s work restrictions and includes rehabilitative or other noncompetitive employment which is approved by the employee’s authorized health care provider.
Once a claimant reaches MMI, suitable employment would be defined as employment which the employee is capable of performing considering the employee’s:
1. preexisting and injury-related physical and mental limitations,
2. education,
3. vocational skills,
4. experience,
5. and is located within a 50-mile radius of the employee’s residence at the time of injury or the employee’s current residence if the employee had a legitimate reason to relocate since the date of injury.
The proposed definition for medical compensation and suitable employment after MMI would eliminate consideration of a claimant’s pre-injury wages.
N.C.G.S. §97-12.1 Willful Misrepresentation in Applying for Employment (Section 3)
The bill proposes that no compensation shall be allowed under the Act for an injury by accident or occupational disease if the employer is able to prove that either at the time of hire, at the time of receiving notice of the removal of conditions from a conditional offer of employment, or during the course of a post-offer medical examination:
1. the employee knowingly and willfully made a false representation as to the employee’s physical condition;
2. the employer relied upon one or more false representations by the employee and said reliance was a substantial factor in the employer’s decision to hire the employee; and
3. there was a causal connection between the false representation and the employee’s injury or occupational disease.
I
N.C.G.S. §97-17 (e) Resignation and Release of Employment (Section 4)
The bill proposes an additional subsection to the Act specifically stating that parties can reach separate contemporaneous agreements resolving issues not covered by the Act. This proposed change would allow the parties to reach agreement on resignation and release of employment in conjunction with the resolution of a workers’ compensation claim. However, the separate agreement must be in a separate document.
N.C.G.S. §97-25 Change of Authorized Treating Physician (Section 6)
Changes in this section are two fold and summarized below.
(1) The bill codifies the procedure for an employee to request and obtain a second opinion examination. The employee may submit a written request to the employer to which the employer may agree. After 14 days, should the employer deny the request or the parties cannot, in good faith, agree on a second opinion physician the employee may request the commission order a second opinion examination. The employer shall pay for any examination.
(2) This section has significant changes to the original proposed legislation. The revised bill proposes that, in order to change an authorized treating physician, the claimant must establish by a preponderance of the evidence that the change is reasonably necessary. Furthermore, the proposed bill provides that the Industrial Commission may disregard any opinions of unauthorized health care providers who evaluated, diagnosed, or treated the claimant before the claimant’s request to change health care provider being filed with the Industrial Commission.
- The employee’s burden of proof between the first and second drafts of the legislation has changed. Under “preponderance of the evidence” the employee is only required to show there is greater than 50 percent chance that the proposition is true that a second opinion is necessary.
- The disregard of unauthorized heath care providers has changed from “shall” vs. “may” in the first draft versus the second. Under the latest proposed bill the commission can either disregard unauthorized medical opinions or may still rely on the evidence.
N.C.G.S. §97-25.6 Reasonable Access to Medical Information (Section 7)
The bill proposes several changes outlined below:
The employer is entitled to all “relevant medical information.” Relevant medical information is defined as any medica record, report, or information that is (1) restricted to the particular evaluation, diagnosis, or treatment of the injury or disease for which compensation is sought; (2) reasonably related to the injury or disease for which the employee claims compensation; or (3) related to an assessment of the employee’s ability to return to work as a result of the particular injury or disease. This entitles an employer to:
Medical Records
1. An employer may obtain medical records without express authorization in accepted claims.
2. In a denied claim where the employer seeks medical records the employer shall provide the employee with immediate written notice of the request for medical records. The employer is required to provide the employee with a copy of any records received within 30 days of receipt.
Written Communications
1. An employer may communicate with an employee’s authorized health care provider in writing. No authorization from the employee is necessary for the following information so long as the employer provides contemporaneous notice to the employee: (a) The diagnosis of the employee’s condition; (b) appropriate course of treatment; anticipated time that the employee will be out of work; (c) causation and relation of the employee’s condition to employment; (d) work restrictions; (e) the kind of work which the employee may be eligible; (f) the anticipated time the employee will be restricted; and (h) permanent impairment resulting from the condition.
i. Any response from the provider must be forwarded to the employee within 10 business days of receipt.
Oral Communications
1. Employers will be allowed to communicate orally with medical providers to obtain relevant medical information not contained in the medical records, available in written communications, or not otherwise available so long as (1) the employer provides prior notice of the purpose of the intended oral communication and provides the employee an opportunity to participate in the oral communication and (2) the employer provides the employee a summary of the communication within 10 business days of the communication if the employee did not participate.
2. The employer may communicate with providers regarding administrative matters.
Employer May Submit Information to a Heath Care Provider
1. Employers will be allowed to submit additional relevant medical information not already contained in the employee’s medical records to a medical provider. In such instances the employer may communicate the information so long as they (1) notify the employee of the communication, (2) the employee shall have 10 business days from postmark, email, or fax date to consent or object to the proposed communication, (2a.) if consented the employer may send the communication, (2b.) if the employee objects, he/she may request a protective order and the employer must refrain from communicating with the provider until the Commission rules on the employee’s request. The Commission will weigh whether the information is pertinent to fair and swift administration to the resolution of the claim.
N.C.G.S. §97-27 – Independent Medical Evaluations (Section 9)
(a) The bill proposes that an Independent Medical Examination (IME) may be conducted in either an accepted or denied claim. Further, in the case of an IME, the proposed provisions of N.C.G.S. §97-25.6 do not apply and an employer may openly communicate either orally or in writing with an independent medical examiner chosen by the employer regardless of whether the examiner physically examined the employee. If a physical examination occurred, the employer must produce the examiner’s report to the employee within 10 business days of receipt. Should the employee refuse to submit to an IME an order compelling compliance to submit the IME is not necessary to suspend benefits. The employer may immediately seek to suspend benefits by order of the Commission.
(b) The bill also proposes specific language that if the employee is dissatisfied with the assignment of a permanent partial disability (PPD) rating the employee is entitled to another examination solely on the percentage of the PPD rating. The Industrial Commission must either disregard or give less weight to the opinions of a physician who conducts and examination for a second opinion on the rating.
N.C.G.S. §97-29 500-Week Cap on Temporary Total Disability Benefits (Section 10)
(b) The bill proposes a 500-week cap on temporary total disability benefits. The employee is entitled to total disability benefits within this cap so long as they prove by a preponderance of the evidence (greater than 50% chance that the proposition is true) that the employee is unable to earn the same wages he/she had earned before the injury or either in the same or other employee. The employee remains eligible for medical benefits as required past the cap. There are two exceptions to the cap:
(c) The employee may make an application with the Commission to exceed 500 weeks of benefits so long as (1) 425 weeks have passed since the first date of disability, (2) the employee proves by a preponderance of the evidence that he/she has sustained a total loss of wage-earning capacity. If the Commission approves the application benefits cannot be terminated on appeal except by determination of the Full Commission or an appellate court.
If the employee is receiving full retirement under the Social Security Act and after the age of retirement, the employer may reduce extended compensation by 100% of retirement benefits. This applies to any employee who has begun to receive social security retirement after the specified age of retirement, P&T or otherwise. Only applies to primary benefits paid pursuant to Section 202(a).
(d) Permanent and total disability is defined in this section. Medical compensation would still be paid by the employer during the lifetime of the employee. A presumption of permanent and total disability would arise only if the employee sustained:
1. the loss of both hands, both arms, both feet, both legs, or both eyes;
2. a spinal injury involving severe paralysis of both arms, both legs, or the trunk;
3. a severe brain or closed-head injury as evidenced by severe and permanent (i) sensory or motor disturbances, (ii) communication disturbances, (iii) complex integrated disturbances of cerebral function, or (iv) neurological disorders; or
4. second-degree or third-degree burns of 33 percent or more of the total body surface unless the employer can show that the employee is capable of returning to suitable employment.
(f) The bill also proposes codifying the holding in Collins vs Motor Speedway and provide that after reaching MMI, a claimant can only collect Temporary Partial Disability (or Temporary Total Disability if recovering those benefits) or Permanent Partial Disability, but not both.
N.C.G.S. §97-30 500-Week Cap on Temporary Partial Disability Benefits (Section 11)
The current bill proposes modifying the allowance of temporary partial disability benefits to 500 weeks to be consistent with §97-29. The 500 week cap runs for any benefits received for TPD or TTD.
N.C.G.S. §97-32 Refusal to Return to Work (Section 12)
The bill proposes language which would allow an employer to directly contact the employee about returning to suitable employment as defined by §97-2(22).
Orders suspending benefits based on refusal of suitable employment are required to outline the requirements for employee to end the suspension and reinstate benefits.
§97-32.2 Vocational Rehabilitation (Section 13)
(a) The bill proposes that an employer may engage vocational rehabilitation services prior to or after MMI. An injured employee may also request vocational retraining where he/she (1) has not returned to work or (2) has returned to work earning less than 75% of pre-injury wages and receiving TPD. The 75% wage rule only applies to entitlement to vocational rehabilitation services not suitability of employment. Retraining may include education in NC community college or university so long as the education is reasonably likely to substantially increase the employee’s wage-earning capacity.
(b)-(g) The bill outlines the scope and procedure of vocational rehabilitation services and the guidelines for the initial vocational assessment and employer’s ability to terminate services if they are found not to be beneficial.
N.C.G.S. §97-38 & 97-40 Death Benefits and Burial Benefits (Section 14 & 15)
The bill proposes that where the death results proximately from the injury, payments to the decedent’s beneficiaries would increase from 400 weeks to 500 weeks to conform to §97-29.. The bill also proposes increasing burial expenses from $3,500.00 to $10,000.00 when death results proximately from the compensable injury.
N.C.G.S. §97-84 Preponderance of the Evidence (Section 20)
The bill provides that the Commission is to decide the case and issue findings of fact based upon the preponderance of the evidence in view of the entire record.
In April, the senate and house introduced bills to reform the Workers’ Compensation Act. The bill introduced in each chamber was identical and entitled “Protect and Put North Carolina Back to Work.” Pro-employer and pro-employee groups have since negotiated the language of the bill and submitted a compromised draft to House committees. The bill was approved by the House Select Committee on Tort Reform in late May and put to a vote on the house floor on June 1, 2011. The bill passed the House 110-3. The bill now heads to the Senate where it is expected to pass. Governor Purdue has indicated she will likely sign any bill which has been favorably negotiated by both sides.
Below is a synopsis of the major changes to the Workers’ Compensation Act the bill proposes. Please be aware this article is not exhaustive, nor can it anticipate how particular language in the bill will be interpreted by the Commission or the Courts. Also, please be aware this bill is not yet law. Please note each individual section has a specific effective date if the bill is passed. Below, each section specifies the effective date.
Proposed Statutory Changes Quick Links:
- Definition change for “medical compensation” and addition of “suitable employment.”
- No entitlement to benefits when the claimant willfully misrepresented at or around the time of hiring regarding his/her physical condition.
- Validation of separate Release and Resignation Agreements.
- Procedure for Plaintiff to request a change to the authorized treating physician.
- Commission’s treatment of unauthorized physicians’ opinions.
- Employer’s right to medical records, written communication, and oral communication from the employee’s physicians and appropriate procedure to obtain/communicate each.
- Rules regarding Independent Medical Examinations.
- 500 week cap on temporary total disability benefits and exceptions.
- 500 week cap on temporary partial disability benefits.
- Offers of suitable employment and refusal of suitable employment.
- Vocational rehabilitation. Permissive use and required procedure.
- Changes to death and burial benefits.
- The Commission’s legal standard of proof.
- Proposed changes not yet in the new bill.
Definitions
N.C.G.S. §97-2 (19) Medical Compensation (Section 2)
Attendant care services are added to the definition of medical compensation, but the services are only considered such if a health care provider authorized by the employer or commission prescribes the service.
N.C.G.S. §97-2 (22) Suitable Employment
The bill proposes a statutory definition of “suitable employment.” Prior to reaching maximum medical improvement (MMI), suitable employment would include any available employment that is within the claimant’s work restrictions. The employment is appropriate if it is within the employee’s work restrictions and includes rehabilitative or other noncompetitive employment which is approved by the employee’s authorized health care provider.
Once a claimant reaches MMI, suitable employment would be defined as employment which the employee is capable of performing considering the employee’s:
- preexisting and injury-related physical and mental limitations,
- education,
- vocational skills,
- experience,
- and is located within a 50-mile radius of the employee’s residence at the time of injury or the employee’s current residence if the employee had a legitimate reason to relocate since the date of injury.
The proposed definition for medical compensation and suitable employment after MMI would eliminate consideration of a claimant’s pre-injury wages.
N.C.G.S. §97-12.1 Willful Misrepresentation in Applying for Employment (Section 3)
The bill proposes that no compensation shall be allowed under the Act for an injury by accident or occupational disease if the employer is able to prove that either at the time of hire, at the time of receiving notice of the removal of conditions from a conditional offer of employment, or during the course of a post-offer medical examination:
- the employee knowingly and willfully made a false representation as to the employee’s physical condition;
- the employer relied upon one or more false representations by the employee and said reliance was a substantial factor in the employer’s decision to hire the employee; and
- there was a causal connection between the false representation and the employee’s injury or occupational disease.
N.C.G.S. §97-17 (e) Resignation and Release of Employment (Section 4)
The bill proposes an additional subsection to the Act specifically stating that parties can reach separate contemporaneous agreements resolving issues not covered by the Act. This proposed change would allow the parties to reach agreement on resignation and release of employment in conjunction with the resolution of a workers’ compensation claim. However, the separate agreement must be in a separate document.
N.C.G.S. §97-25 Change of Authorized Treating Physician (Section 6)
Changes in this section are two fold and summarized below.
(1) The bill codifies the procedure for an employee to request and obtain a second opinion examination. The employee may submit a written request to the employer to which the employer may agree. After 14 days, should the employer deny the request or the parties cannot, in good faith, agree on a second opinion physician the employee may request the commission order a second opinion examination. The employer shall pay for any examination.
(2) This section has significant changes to the original proposed legislation. The revised bill proposes that, in order to change an authorized treating physician, the claimant must establish by a preponderance of the evidence that the change is reasonably necessary. Furthermore, the proposed bill provides that the Industrial Commission may disregard any opinions of unauthorized health care providers who evaluated, diagnosed, or treated the claimant before the claimant’s request to change health care provider being filed with the Industrial Commission.
- The employee’s burden of proof between the first and second drafts of the legislation has changed. Under “preponderance of the evidence” the employee is only required to show there is greater than 50 percent chance that the proposition is true that a second opinion is necessary.
- The disregard of unauthorized heath care providers has changed from “shall” vs. “may” in the first draft versus the second. Under the latest proposed bill the commission can either disregard unauthorized medical opinions or may still rely on the evidence.
N.C.G.S. §97-25.6 Reasonable Access to Medical Information (Section 7)
The bill proposes several changes outlined below:
The employer is entitled to all “relevant medical information.” Relevant medical information is defined as any medica record, report, or information that is (1) restricted to the particular evaluation, diagnosis, or treatment of the injury or disease for which compensation is sought; (2) reasonably related to the injury or disease for which the employee claims compensation; or (3) related to an assessment of the employee’s ability to return to work as a result of the particular injury or disease. This entitles an employer to:
Medical Records
- An employer may obtain medical records without express authorization in accepted claims.
- In a denied claim where the employer seeks medical records the employer shall provide the employee with immediate written notice of the request for medical records. The employer is required to provide the employee with a copy of any records received within 30 days of receipt.
Written Communications
- An employer may communicate with an employee’s authorized health care provider in writing. No authorization from the employee is necessary for the following information so long as the employer provides contemporaneous notice to the employee: (a) The diagnosis of the employee’s condition; (b) appropriate course of treatment; anticipated time that the employee will be out of work; (c) causation and relation of the employee’s condition to employment; (d) work restrictions; (e) the kind of work which the employee may be eligible; (f) the anticipated time the employee will be restricted; and (h) permanent impairment resulting from the condition.
- i. Any response from the provider must be forwarded to the employee within 10 business days of receipt.
Oral Communications
- Employers will be allowed to communicate orally with medical providers to obtain relevant medical information not contained in the medical records, available in written communications, or not otherwise available so long as (1) the employer provides prior notice of the purpose of the intended oral communication and provides the employee an opportunity to participate in the oral communication and (2) the employer provides the employee a summary of the communication within 10 business days of the communication if the employee did not participate.
- The employer may communicate with providers regarding administrative matters.
Employer May Submit Information to a Heath Care Provider
- Employers will be allowed to submit additional relevant medical information not already contained in the employee’s medical records to a medical provider. In such instances the employer may communicate the information so long as they (1) notify the employee of the communication, (2) the employee shall have 10 business days from postmark, email, or fax date to consent or object to the proposed communication, (2a.) if consented the employer may send the communication, (2b.) if the employee objects, he/she may request a protective order and the employer must refrain from communicating with the provider until the Commission rules on the employee’s request. The Commission will weigh whether the information is pertinent to fair and swift administration to the resolution of the claim.
N.C.G.S. §97-27 – Independent Medical Evaluations (Section 9)
(a) The bill proposes that an Independent Medical Examination (IME) may be conducted in either an accepted or denied claim. Further, in the case of an IME, the proposed provisions of N.C.G.S. §97-25.6 do not apply and an employer may openly communicate either orally or in writing with an independent medical examiner chosen by the employer regardless of whether the examiner physically examined the employee. If a physical examination occurred, the employer must produce the examiner’s report to the employee within 10 business days of receipt. Should the employee refuse to submit to an IME an order compelling compliance to submit the IME is not necessary to suspend benefits. The employer may immediately seek to suspend benefits by order of the Commission.
(b) The bill also proposes specific language that if the employee is dissatisfied with the assignment of a permanent partial disability (PPD) rating the employee is entitled to another examination solely on the percentage of the PPD rating. The Industrial Commission must either disregard or give less weight to the opinions of a physician who conducts and examination for a second opinion on the rating.
N.C.G.S. §97-29 500-Week Cap on Temporary Total Disability Benefits (Section 10)
(b) The bill proposes a 500-week cap on temporary total disability benefits. The employee is entitled to total disability benefits within this cap so long as they prove by a preponderance of the evidence (greater than 50% chance that the proposition is true) that the employee is unable to earn the same wages he/she had earned before the injury or either in the same or other employee. The employee remains eligible for medical benefits as required past the cap. There are two exceptions to the cap:
(c) The employee may make an application with the Commission to exceed 500 weeks of benefits so long as (1) 425 weeks have passed since the first date of disability, (2) the employee proves by a preponderance of the evidence that he/she has sustained a total loss of wage-earning capacity. If the Commission approves the application benefits cannot be terminated on appeal except by determination of the Full Commission or an appellate court.
If the employee is receiving full retirement under the Social Security Act and after the age of retirement, the employer may reduce extended compensation by 100% of retirement benefits. This applies to any employee who has begun to receive social security retirement after the specified age of retirement, P&T or otherwise. Only applies to primary benefits paid pursuant to Section 202(a).
(d) Permanent and total disability is defined in this section. Medical compensation would still be paid by the employer during the lifetime of the employee. A presumption of permanent and total disability would arise only if the employee sustained:
- the loss of both hands, both arms, both feet, both legs, or both eyes;
- a spinal injury involving severe paralysis of both arms, both legs, or the trunk;
- a severe brain or closed-head injury as evidenced by severe and permanent (i) sensory or motor disturbances, (ii) communication disturbances, (iii) complex integrated disturbances of cerebral function, or (iv) neurological disorders; or
- second-degree or third-degree burns of 33 percent or more of the total body surface unless the employer can show that the employee is capable of returning to suitable employment.
(f) The bill also proposes codifying the holding in Collins vs Motor Speedway and provide that after reaching MMI, a claimant can only collect Temporary Partial Disability (or Temporary Total Disability if recovering those benefits) or Permanent Partial Disability, but not both.
N.C.G.S. §97-30 500-Week Cap on Temporary Partial Disability Benefits (Section 11)
The current bill proposes modifying the allowance of temporary partial disability benefits to 500 weeks to be consistent with §97-29. The 500 week cap runs for any benefits received for TPD or TTD.
N.C.G.S. §97-32 Refusal to Return to Work (Section 12)
The bill proposes language which would allow an employer to directly contact the employee about returning to suitable employment as defined by §97-2(22).
Orders suspending benefits based on refusal of suitable employment are required to outline the requirements for employee to end the suspension and reinstate benefits.
§97-32.2 Vocational Rehabilitation (Section 13)
(a) The bill proposes that an employer may engage vocational rehabilitation services prior to or after MMI. An injured employee may also request vocational retraining where he/she (1) has not returned to work or (2) has returned to work earning less than 75% of pre-injury wages and receiving TPD. The 75% wage rule only applies to entitlement to vocational rehabilitation services not suitability of employment. Retraining may include education in NC community college or university so long as the education is reasonably likely to substantially increase the employee’s wage-earning capacity.
(b)-(g) The bill outlines the scope and procedure of vocational rehabilitation services and the guidelines for the initial vocational assessment and employer’s ability to terminate services if they are found not to be beneficial.
N.C.G.S. §97-38 & 97-40 Death Benefits and Burial Benefits (Section 14 & 15)
The bill proposes that where the death results proximately from the injury, payments to the decedent’s beneficiaries would increase from 400 weeks to 500 weeks to conform to §97-29.. The bill also proposes increasing burial expenses from $3,500.00 to $10,000.00 when death results proximately from the compensable injury.
N.C.G.S. §97-84 Preponderance of the Evidence (Section 20)
The bill provides that the Commission is to decide the case and issue findings of fact based upon the preponderance of the evidence in view of the entire record.
Appointment of Commissioners (Not Yet in the Proposed Bill)
While not currently in the proposed legislation, it is anticipated that the bill will include a proposal to decrease the number of Commissioners from seven to six. The Commissioners would be appointed for terms of six years and no Commissioner could serve more than two terms. Further, the bill proposes that two of the Commissioners be identified as having an affiliation with employers and two Commissioners be identified as having an affiliation with employees. The appointment of Commissioners would be subject to confirmation by both houses of the legislature.
Appointment of Commissioners (Not Yet in the Proposed Bill)
While not currently in the proposed legislation, it is anticipated that the bill will include a proposal to decrease the number of Commissioners from seven to six. The Commissioners would be appointed for terms of six years and no Commissioner could serve more than two terms. Further, the bill proposes that two of the Commissioners be identified as having an affiliation with employers and two Commissioners be identified as having an affiliation with employees. The appointment of Commissioners would be subject to confirmation by both houses of the legislature.