If you’re dealing with a worker’s compensation claim due to a workplace injury, you’ve likely heard about the North Carolina Industrial Commission (“NCIC”). You may be wondering what NCIC does and how it is involved in your worker’s compensation claim. We’re here to answer those questions.
What is the North Carolina Industrial Commission?
NCIC is a state agency responsible for administering the North Carolina Worker’s Compensation Act. The Commission is comprised of six commissioners, with one commissioner designated by the Governor of North Carolina to serve as the chairman. The chairman acts as the Commission’s CEO and chief judicial officer and is responsible for selecting deputy commissioners and the Executive Secretary.
There are ten sections in NCIC: Docket; Statistics; Safety Education; Claims; Information Technology; Workers’ Compensation Nurses; Office of the Executive Secretary; Medical Fees; File Center; and Fraud Investigations.
What does the North Carolina Industrial Commission do?
As a broad description, NCIC administers North Carolina worker’s compensation claims and decides worker’s compensation disputes. It also offers a mediation program, provides safety training for employers, and investigates employers’ insurance status.
The Commission also plays an active role in medical benefits related to worker’s compensation claims, including requests for a second opinion, a change in treating physician, and appeals for denied treatments. The Medical Fees section of the Commission sets the reimbursement rates for medical services, reviews medical bills, and resolves any disputes that arise between physicians or medical providers and the worker’s compensation insurance companies over medical costs.
What decisions and disputes does the North Carolina Industrial Commission handle?
The Commission’s Executive Secretary makes initial administrative decisions on many matters, such as access to medical treatments and termination of disability benefits or wage replacement payments. The Executive Secretary also makes decisions regarding settlements and any third-party agreements.
Most worker’s compensation disputes are brought before a deputy commissioner who serves as the judge in the matter. Worker’s compensation disputes do not have juries. If a party appeals the decision of the deputy commissioner, the appeal goes on to a panel of three commissioners. Further appeals go to the North Carolina Court of Appeals, and, if more escalation is needed, up to the North Carolina Supreme Court.
Does my worker’s compensation claim have to go through the North Carolina Industrial Commission?
Yes. Worker’s compensation claims in North Carolina must be filed with the NCIC. The Commission has jurisdiction over North Carolina worker’s compensation claims, and that jurisdiction is not optional. If a worker’s compensation claim is settled without the Commission, that settlement will be considered void.
Why does the North Carolina Industrial Commission deny claims?
Many injured workers are frustrated to find out that the Commission has denied their claim. There are many reasons that a claim may be denied. The most common include:
- Errors or omissions on the claim form
- Missing filing deadlines
- Failure to follow NCIC procedures
- Failure to follow a physician’s treatment instructions
- Questions about the nature of the injury or if it was a workplace injury
No matter the reason for the denial, you have an opportunity to appeal, and it’s generally advisable to take advantage of that opportunity.
How does the North Carolina Industrial Commission handle appeals?
An appeal with NCIC involved several steps, forms, and deadlines. Missing deadlines and making mistakes can be detrimental to your claim, so it’s beneficial to have an experienced worker’s compensation on your side to guide you through the process.
What follows is an overview of the steps involved with an NCIC appeal.
Filing a request for a hearing
If your claim was denied, the first thing to do is file a request for a hearing, which will escalate the dispute to a deputy commissioner. If you are working with a workers’ compensation attorney, you will have a mediation with the insurance company and their legal counsel to attempt to settle the dispute. If the dispute is resolved at the mediation, it generally means you will be paid a lump sum. There is no obligation to come to an agreement at this mediation. If you cannot agree on a settlement, your dispute will move forward with a hearing.
Participating in the hearing
If your dispute goes to a hearing, it will be before a deputy commissioner. The deputy commission will fill the role of judge, determining any rights you may have to benefits for your workplace injury. During the hearing, the injured employee will share testimony about the injury, and then the employee will be subject to questioning from the other party. Both sides will have the opportunity to present their own witness testimony for the deputy commissioner to consider in making their decision. Each attorney will have time to prepare written arguments for the deputy commissioner’s review. In most cases, you’ll also need to get expert testimony from your physician. The deputy commissioner has six months to make a decision, and most will take at least three months. When a decision is made, you’ll receive a written opinion and award, noting why the requested benefits have not been awarded.
Appealing the deputy commissioner’s decision
If you disagree with the decision rendered by the deputy commissioner, you can appeal that decision to a panel of three commissioners. If two of the commissioners disagree with the deputy commissioner’s decision, the decision can be reversed. During this appeal, you (or your attorney) will have 20 minutes to argue your case. There is no time limit for this appeal, but the commissioners’ decision usually takes six months. While not frequently needed, there are two more levels of appeal.
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How can Horton & Mendez help you?
Navigating your worker’s compensation claim and the NCIC procedures can be challenging. Missing deadlines, incorrectly filling out forms, or missing opportunities for appeal can be detrimental to your case and result in you missing out on benefits to which you’re entitled. Our experienced team of attorneys at Horton & Mendez can help you get the maximum benefits available to you. Contact us today for a free case review.
