If the employer grants permission to seek medical treatment from a chiropractor, the employee is entitled to 20 visits if medically necessary. If additional visits are needed, the chiropractor should request this authorization from the employer.

Supplies and durable medical equipment are paid pursuant to the Medical Fee Schedule. If a custom-made orthotic or prosthetic is not contained in the Commission schedule, these items should be paid per agreement between provider and payer.

No. You are allowed to bill charges in full or based on a prior agreement if one has been established. If one has not been established, expect reimbursement pursuant to your state’s fee schedule.

The NC Industrial Commission has established a method of reporting workers' compensation claims electronically using EDI (Electronic Data Interchange). First Reports of Injury and Subsequent Reports of Injury may be submitted electronically. Reporting of Medical Billing can also be submitted electronically. To find out more about EDI, please go to https://www.ncicedi.info. For more information specific to the Industrial Commission and EDI, you can view or download a more detailed FAQ by clicking here. For questions not answered here or for support with EDI, you may send an E-Mail to ncicedi@ic.nc.gov.

If the parties request the approval of a selected mediator after the appointment of another mediator by the Commission, and the substitution of mediators is allowed, the Commission will generally require the parties to pay the administration fee owed to the mediator initially appointed by the Commission.

If the claim is denied, a Form 33 to request a hearing is required on most issues. If an issue has arisen in your accepted workers’ compensation claim that you believe requires a ruling by the Commission, you may submit your request to the Executive Secretary’s Office in writing.

To be appointed by the Industrial Commission, a mediator must be certified by the North Carolina Dispute Resolution Commission to mediate cases in North Carolina’s superior courts through the court’s mediated settlement conference program. The mediator also must have a Declaration of Interest and Qualifications form on file with the Commission. The declaration must state that the mediator, if an attorney, is a member in good standing of the North Carolina State Bar; that the declarant agrees to accept and perform mediations of disputes before the Commission with reasonable frequency when called upon for the fees and at the rates of payment specified by the Commission.

You may file a written request as a motion to dockets@ic.nc.gov if you wish to have an administrative review of the issue. Include supporting documentation. You may file a Form 33 Request for Hearing for review by a Deputy Commissioner at an evidentiary hearing.

Yes. Pursuant to N.C. Gen. Stat. §97-18(c) and (d), a Form 61 must be filed with the N.C. Industrial Commission and a copy sent to the employee or the employee’s attorney of record, if any, and also to all known medical service providers. The adjuster should provide a detailed statement describing the grounds for denying compensability or liability either on the Form 61 or on an attached letter.

If a claim is denied by the insurance company or self-insurer, the employee may request a hearing before the Industrial Commission by submitting a Form 33, Request for Hearing.

North Carolina law requires that workers’ compensation coverage be in place to cover certain trucking owner/operators, even if the operator is deemed to be an independent contractor. If the owner-operator does not have workers’ compensation insurance coverage, the motor carrier must provide workers’ compensation coverage. The workers’ compensation coverage must be in place regardless of whether the principal contractor, intermediate contractor, or subcontractor regularly employs three or more employees. A motor carrier employer is not liable for the workplace injuries suffered by an independent contractor who is: 1) individually licensed by the U.S. Department of Transportation and 2) personally operates the vehicle. (N.C. Gen. Stat. § 97-19.1)

After the Compromise Settlement Agreement package is received by the Commission from the defendants and reviewed by the Executive Secretary’s Office for fairness and equitableness to the parties and compliance with all statutory and rule provisions, an Order approving the CSA may be issued. Once the notice of the Order is received by the defendants, the defendants must issue payment to the plaintiff within 10 days. Therefore, the payment is due within 10 days from notice of the Order. If the payment is not issued within 14 days after the date the payment was due (24 days total from receipt of the notice), then the payment is subject to a 10% late payment penalty.

Yes, unless there has been a return to work as explained in the paragraph below. A Form 24 must be filed with the N.C. Industrial Commission and sent to the employee or the employee’s attorney of record, if any, and payments may be stopped only after a decision by the Commission.

The following are answers to some of the most commonly asked questions from insurers about North Carolina Workers’ Compensation.

N.C. Gen. Stat. § 97-18(i) states "If any bill for services rendered under N.C. Gen. Stat. § 97-25 by any provider of health care is not paid within 60 days after it has been approved by the Commission and returned to the responsible party, or within 60 days after it was properly submitted, in accordance with the provisions of this Article, to an insurer or managed care organization responsible for direct reimbursement pursuant to N.C. Gen. Stat. § 97-26(g), there shall be added to such unpaid bill an amount equal to ten per centum (10%) thereof, which shall be paid at the same time as, but in addition to, such medical bill, unless such late payment is excused by the Commission."

When the mediator is agreed to by the parties, compensation will be as agreed upon between the parties and the mediator. If the mediator is not agreed to by the parties, and is then appointed by the Commission, the mediator will be paid by the parties at the rate of $150.00 per hour for mediation services at the conference. In addition, the parties will pay to the mediator a one time, per case administrative fee of $150.00. The mediator’s administrative fee will be paid in full unless, within 10 days after the date that the mediator has been appointed, written notice is given to the mediator and the Dispute Resolution Coordinator that the issues for which a request for hearing had been filed have been fully resolved or the hearing request has been withdrawn. In cases involving appointed mediators postponement fees are set at $300.00 if a mediation conference is postponed without good cause within seven days of a scheduled conference, and $150.00 if a mediation conference is postponed more than seven calendar days prior to the scheduled date.

The employer or its insurance company, subject to any Commission orders, provides and directs medical treatment. The employee may petition the Commission to change physicians or approve a physician of employee’s selection when good grounds are shown. However, payment by the employer or carrier is not guaranteed unless written permission to change physicians is obtained from the employer, carrier, or Commission before the treatment is rendered.

After a mediation conference is scheduled to convene on a specific date, it may not be postponed unless the requesting party first notifies all other parties of the grounds for the requested postponement, or without the consent and approval of the mediator or the Dispute Resolution Coordinator.

Under the automatic referral procedures commenced during the 1996-97 fiscal year, whenever a party files a request for hearing in a workers’ compensation claim, the Clerk’s Office sends an Order for Mediated Settlement Conference to all parties along with the Commission's acknowledgment letter. The only cases that are not automatically referred to mediation are claims against the state brought by prison inmates, which are excluded by law, expedited medical motions and administrative appeals. In addition, cases involving injured workers who are not represented by counsel are generally mediated only if all parties agree to mediate, and cases involving non-insured employers are generally mediated only if all parties agree to mediate and the Deputy Commissioner responsible for the adjudication of non-insured cases approves the parties’ request to refer such cases to mediation.

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You should use the Form 28 - Return to Work Report, when the claimant has returned to work with no working restrictions, or the Form 28-T - Notice of Termination of Compensation by Reason of Trial-Return to Work Pursuant to N.C. Gen. Stat. §97-18.1(b) and §97-32.1, when the claimant has working restrictions.

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After calling the representative of the carrier/administrator to attempt to resolve the issue regarding failure to receive weekly payments, file a motion or written request with the Executive Secretary’s Office to request a 10% late payment penalty. Attach documentation that shows information stated in the request and supports the request.

Total loss or partial loss of use of a member of the body or inability to earn the same wages in any employment as earned at the time of injury.

The Industrial Commission sends out an acknowledgement letter when a Form 18 is processed that contains information about the insurance carrier. However, if you have not yet received an acknowledgement letter and you need this information, you may contact the Industrial Commission. It is not required that you provide insurance carrier information when completing a Form 18 if you do not have that information.

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All mediators conducting mediation conferences pursuant to the ICMSC Rules must adhere to the Standards of Professional Conduct for Mediators adopted by the North Carolina Dispute Resolution Commission.

A medical provider will be reimbursed based on the NCIC Medical Fee Schedule or any contract agreed to with the payor. In the absence of a contract or medical fee schedule provision, a medical provider will be reimbursed according to the usual, customary, and reasonable charge for the service rendered.

The employee should report the lack of workers’ compensation insurance or approved self-insurance to the NCIC Criminal Investigations & Employee Classification Division and, if injured, should file a Form 18 and Form 33 with the Commission.

No. Workers have a right to a private examination by their doctors. We do encourage the worker to allow the provider to meet with both the worker and the doctor immediately following the examination when the doctor discusses his/her findings and makes his/her recommendations for treatment. This will allow everyone to be aware of and understand treatment plans and expectations. Click here for the Rules governing the use of Rehabilitation Professionals in Workers’ Compensation cases.

The preferred method is through e-mail directly with the contact person for the subject matter on which the motion is filed. See staff contact list and e-mail addresses.

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Medical providers are to follow the American Medical Association’s CPT guidelines. See Rule 11 NCAC 23J .0102(d) for payment

The employer or its insurance company, subject to any Commission orders, provides and directs medical treatment. The employee may petition the Commission to change physicians or approve a physician of employee’s selection when good grounds are shown. However, payment by the employer or carrier is not guaranteed unless written permission to change physicians is obtained from the employer, carrier, or Commission before the treatment is rendered.

Motions related to the ICMSC Rules should always be addressed to the Dispute Resolution Coordinator, but all other motions (including motions related to discovery, Form 24 matters and medical issues) should be addressed to the Industrial Commission's Executive Secretary, unless the case has already been assigned to a Deputy Commissioner or a Full Commission panel, or the motion is otherwise subject to the Commission’s expedited medical motions procedures.

The following is a list of Frequently Asked Questions (FAQs) that we receive by phone and E-mail. They are arranged by Category, with the most common questions at the top. You may use the links to the right of this box to go directly to a list of FAQs related to the subject you are searching for.

The employee may obtain the necessary treatment from a physician or hospital of his own choice, but must promptly request the Commission’s approval.

When liability for payment of compensation is denied, the Commission, claimant, his or her attorney (if any), and all known providers of health care shall be promptly notified of the reason for such denial. The denial Form 61 shall not be worded in general terms, but must detail the exact reason for the denial of liability.

A provider of medical compensation shall submit its statement for services within 75 days of the rendition of the service or if treatment is longer, within 30 days after the end of the month during which multiple treatments were provided, or within such other reasonable period of time as allowed by the Industrial Commission. However, in cases where liability is initially denied but subsequently admitted or determined by the Industrial Commission, the time for submission of medical bills shall run from the time the health care provider received notice of the admission or determination of liability.

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The Commission, based on the impairment ratings of physicians or evidence of consideration of wage earning capacity.

Yes. Pursuant to N.C. Gen. Stat. §97-18(g), there shall be added to such unpaid installment an amount equal to ten per cent (10%), which shall be paid at the same time as, but in addition to, such installment, unless such nonpayment is excused by the Industrial Commission after a showing by the employer that owing to conditions over which he had no control such installment could not be paid within the period prescribed for payment.

The mediator must file a report of mediator with the Dispute Resolution Coordinator in all cases, even if no conference is held. The mediator should not attach a copy of the parties' memorandum of agreement to the report.

The Employee should file a claim (Form 18 or 18B) within two years of the accident with the Industrial Commission.

Since you have reached the medical improvement expected following your injury, if your employer or carrier does not offer vocational assistance to you, we would refer you to the N.C. Division of Vocational Rehabilitation for reemployment, counseling, and guidance.

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Defendants may terminate Temporary Total benefits [N.C. Gen. Stat. §97-29] when an employee has returned to work for the same or different employer subject to Trial-Return to Work provisions [N.C. Gen. Stat. §97-32.1] or when the employer contests a claim pursuant to Payment Without Prejudice [N.C. Gen. Stat. §97-18(d)] within ninety (90) days (unless an extension has been granted by the Industrial Commission).

Medical Rehabilitation Nurses Section N.C. Industrial Commission 1236 Mail Service Center Raleigh, North Carolina 27699-1236

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Settlement rates at IC mediation conferences have historically been at or above 70%, and at or above 75% when settlements of cases at or before scheduled mediation conferences are included.

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Only if an office visit is not charged. When an injection is given during an office visit service provided by a physician, the cost of administering the injection is included in the payment for the office visit.

The NC Industrial Commission has established a method of reporting workers' compensation claims electronically using EDI (Electronic Data Interchange). First Reports of Injury may be submitted electronically. Reporting of Medical Billing can also be submitted electronically. To find out more about EDI, please go to https://www.ncicedi.info. For more information specific to the Industrial Commission and EDI, you can view or download a more detailed FAQ by clicking here. For questions not answered here or for support with EDI, you may send an E-Mail to ncicedi@ic.nc.gov.

No, they do not. Insurers and self-insurers may pay all medical bills, including hospital bills, without submitting them to the Industrial Commission for approval.

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If employees travel 20 miles or more round trip for medical treatment in workers’ compensation cases, they are entitled to collect for mileage at the rate of 67 cents per mile for travel beginning January 1, 2024. (This amount will stay in effect until the IRS issues a different standard mileage rate, which normally occurs annually). The mileage rates that employees who have traveled 20 miles or more round trip for medical treatment in workers’ compensation cases for travel that occurred before January 1, 2024 is as follows: 65.5 cents per mile for travel occurring in the year 2023; 62.5 cents per mile for travel occurring July 1, 2022 through December 31, 2022; 58.5 cents per mile for travel occurring January 1, 2022 through June 30, 2022; 56 cents per mile for travel occurring in the year 2021; 57.5 cents per mile for travel occurring in the year 2020; 58 cents per mile for travel occurring in the year 2019; 54.5 cents per mile for travel occurring in the year 2018; 53.5 cents per mile for travel occurring in the year 2017; 54 cents per mile for travel occurring in the year 2016; 57.5 cents per mile for travel occurring in the year 2015; 56 cents per mile for travel occurring in the year 2014; 56.5 cents per mile for travel occurring in the year 2013; 55.5 cents per mile for travel occurring July 1, 2011 through December 31, 2012; 51 cents per mile for travel occurring January 1, 2011 through June 30, 2011; 50 cents per mile for travel occurring in the year 2010; 55 cents per mile for travel occurring in the year 2009; 58.5 cents per mile for travel occurring July 1, 2008 through December 31, 2008; 50.5 cents per mile for travel occurring January 1, 2008 through June 30, 2008; 48.5 cents per mile for travel occurring in the year 2007; 44.5 cents per mile for travel occurring January 18, 2006 through December 31, 2006; 31 cents per mile for travel occurring June 1, 2000 through January 17, 2006; and 25 cents per mile for travel occurring prior to June 1, 2000.

No compensation is due for the first seven (7) days of lost time unless the disability exceeds 21 days. Therefore, the first check will not include payment for days 1-7. Payment for those days will be made should the disability continue beyond 21 days.

No, they do not. Insurers and self-insurers may pay all medical bills, including hospital bills, without submitting them to the Industrial Commission for approval.

File a response to the Form 24 Application with the Executive Secretary’s Office within 17 days of the date the Form 24 Application was mailed to you. It is helpful to attach documentation that shows information stated in the response and supports the response.

Yes. Also, please provide the address, and any other contact information you may have available (including e-mail addresses) for the opposing party.

The bill, along with the medical records, should be sent to the employer, self-insured employer, or the workers’ compensation insurance carrier. If a paper bill is sent, a medical provider may want to send it certified mail, return receipt requested, and to document the date of receipt.

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Otherwise, defendants may obtain counsel to submit a Form 24 - Application to Terminate or Suspend Payments of Compensation pursuant to N.C. Gen. Stat. §97-18.1, to the Industrial Commission. The Industrial Commission shall approve or deny the Form 24. You should receive approval from the Industrial Commission prior to the termination of compensation benefits. If payments are suspended prematurely, and the Special Deputy Commissioner disallows the Form 24 request, the insurer must pay full retroactive benefits to the employee.

Yes, a Proposed Order is required with the submission of a Motion. If you are not represented by an attorney, then this requirement may be waived. See North Carolina Industrial Commission Rule 609. In addition, a Proposed Order is helpful with a response to a Motion.

Because we scan all forms and documents and convert them to electronic files, at this time, the Industrial Commission is using white paper for all forms and correspondence. This makes them easier to scan.

Medical providers may bill the employee only after it has finally been determined that it is not a compensable workers’ compensation claim.

For class availability and registration, click here. If you have questions, call 919-807-2616 or e-mail 25N@ic.nc.gov.

This type claim means that there is no more than one day of lost time, no disfigurement or impairment, and no more than $4000.00 in medical expenses. The North Carolina Industrial Commission does not require the employer/carrier to submit the Form 19 for these claims, so there is no Industrial Commission file number created. The injured worker must file a Form 18 to create an I.C. file number in order to settle a dispute or request a hearing.

Attempts should be made to resolve the dispute with the payer. The procedure for resolving a dispute about a medical bill may be found in Rule 11 NCAC 23A .0614. or ncic/pages/MedProvDRP.pdf.

Employees are entitled to reimbursement for travel expenses when the travel is medically necessary and the mileage is 20 or more miles, round trip, at the business standard mileage rate set by the Internal Revenue Service per mile of travel and the actual cost of any tolls paid. Employees are entitled to lodging and meal expenses, at the rate established for state employees by the North Carolina Director of Budget, when it is medically necessary that the employee stay overnight at a location away from the employee's usual place of residence. Employees are entitled to reimbursement for the costs of parking or a vehicle for hire, when the costs are medically necessary, at the actual costs of the expenses. The current reimbursement rates referenced in this Paragraph are contained in the Form 25T, Itemized Statement of Charges for Travel, which shall be used to claim travel expenses.

Note: The Industrial Commission has given the self-insurers and insurance carriers permission to pay drug and travel expenses directly to the employee without approval from the Commission.

The NC Industrial Commission has established a method of reporting workers' compensation claims electronically using EDI (Electronic Data Interchange). Reporting of Medical Billing can now be submitted electronically. First Reports of Injury and Subsequent Reports of Injury may also be submitted electronically. To find out more about EDI, please go to https://www.ncicedi.info. For more information specific to the Industrial Commission and EDI, you can view or download a more detailed FAQ by clicking here. For questions not answered here or for support with EDI, you may send an e-mail to ncicedi@ic.nc.gov.

Information regarding the workers’ compensation carrier for your employer may be obtained from the Industrial Commission in one of the following three manners:

Occupational Accident Insurance (“OAI”) is a separate form of insurance and is not a lawful substitute for workers’ compensation coverage. Unlike workers’ compensation insurance, OAI only covers specific injuries and pays limited benefits based upon the insurance contract. Like other accidental insurance, OAI is regulated by the North Carolina Department of Insurance. Although some owner-operators, contractors and motor carriers may choose to carry OAI, North Carolina law does not require that they do so. Any individual or company with questions regarding OAI may wish to contact their insurance carrier or agent.

Unless otherwise agreed to by the parties or ordered by the Commission, costs of the mediated settlement conference are allocated to the parties as follows: one share by plaintiff(s); one share by the workers’ compensation defendant-employer or its insurer, or if more than one employer or carrier is involved, or if there is a dispute between employer(s) or carrier(s), one share by each separately represented entity; one share by participating third-party tort defendants or their carrier, or if there are conflicting interests among them, one share from each such defendant or group of defendants having shared interests; and one share by the defendant State agency in a State Tort Claims Act case. Parties obligated to pay a share of the costs will be responsible for equal shares; provided, however, that in workers’ compensation claims the defendant will pay the plaintiff’s share, as well as its own, and the defendant will be reimbursed for the plaintiff’s share when the case is concluded from benefits that may be determined to be due to the plaintiff, and the defendant may withhold funds from any award for this purpose.

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No. You are allowed to bill charges in full or based on a prior agreement if one has been established. If one has not been established, expect reimbursement pursuant to your state’s fee schedule.

We have a referral form which provides us with important information when completed. You can get these forms by clicking here. These forms may also be requested by telephone at (919) 807-2616 or by letter request to the:

The parties have the right to select a mediator certified by the Dispute Resolution Commission on their own and may do so within the time periods specified by the ICSMC Rules. If the parties do not have a specific mediator in mind, they can select one from a list of mediators available on the Commission's web site or from the Dispute Resolution Coordinator's office. If the parties want to select a mediator, but need more time, an extension of the selection deadline may be requested from the Dispute Resolution Coordinator. Requests for extensions of time to select a mediator and to complete mediation are liberally granted when there is no objection to such requests. If the parties have agreed or have been ordered to mediate, and cannot agree on the selection of a mediator, the Commission will appoint a mediator from its list of mediators eligible for appointment.

Yes, if a party sends a letter to the opposing party and to the Dispute Resolution Coordinator suggesting one or more mediators for consideration, and the Dispute Resolution Coordinator receives no response to the suggestion(s) from the opposing party, then the Dispute Resolution Coordinator usually appoints a mediator suggested by a party. However, if the opposing party objects to a suggested mediator, that mediator generally will not be appointed. To be eligible for appointment when not selected by the parties, the suggested mediator must be on the Commission’s list of mediators available for appointment, and must have agreed to travel to the county where the case is pending. Certain mediators are not on the Commission’s list because they do not accept the appointed rate, or otherwise set compensation terms that are different from the Commission's terms. Those mediators may nevertheless be selected by the parties since a selected mediator may charge any amount that is agreed upon by the parties.