Q: What happens when the employer refuses to acknowledge the claim?
A: 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.
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.
Medical providers may bill the employee only after it has finally been determined that it is not a compensable workers’ compensation claim.
Q: How long does it normally take for medical bill approval?
A: Medical Fees has to wait for the insurance carrier to send the bill. Once it is received, bills are approved on a daily basis. After approval, Medical Fees sends the insurance carrier or self-insured a medical bill analysis, stating the approved amount.
Q: How long should a medical provider have to wait for reimbursement?
A: G.S. §97-18(i) states "If any bill for services rendered under G.S. §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 G.S. §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."