97-25.2. Managed care organizations.
The requirements of G.S. 97-25 may be satisfied by contracting with a managed care organization. Notwithstanding any other provision of this Article, if an employer or carrier contracts with a managed care organization for medical services pursuant to this Article, those employees who are covered by the contract with the managed care organization shall receive medical services for a condition for which the employer has accepted liability or authorized treatment under this Article in the manner prescribed by the contract and in accordance with the managed care organization's certificate of authority; provided that the contract complies with rules adopted by the Commission, consistent with this Article, governing managed care organizations. An employee must exhaust all dispute resolution procedures of a managed care organization before applying to the Commission for review of any issue related to medical services compensable under this Article. Once application to the Commission has been made, the employee shall be entitled to an examination by a duly qualified physician or surgeon in the same manner as provided by G.S. 97-27.
If an employee's medical services are provided through a managed care organization pursuant to this section, subject to the rules of the managed care organization, the employee shall select the attending physician from those physicians who are members of the managed care organization's panel, and may subsequently change attending physicians once within the group of physicians who are members of the managed care organization's panel without approval from the employer or insurer. Additional changes in the attending physician or any change to a physician or examination by a physician not a member of the insurer's managed care organization's panel shall only be made pursuant to the organization's contract or upon reasonable grounds by order of the Commission. (1993 (Reg. Sess., 1994), c. 679, s. 2.1.)
Structure North Carolina General Statutes
North Carolina General Statutes
Chapter 97 - Workers' Compensation Act
Article 1 - Workers' Compensation Act.
§ 97-1.1 - References to workmen's compensation.
§ 97-3 - Presumption that all employers and employees have come under provisions of Article.
§ 97-5 - Presumption as to contract of service.
§ 97-5.1 - Presumption that taxicab drivers are independent contractors.
§ 97-6 - No special contract can relieve an employer of obligations.
§ 97-7 - State or subdivision and employees thereof.
§ 97-8 - Prior injuries and deaths unaffected.
§ 97-9 - Employer to secure payment of compensation.
§ 97-10.1 - Other rights and remedies against employer excluded.
§ 97-10.3 - Minors illegally employed.
§ 97-11 - Employer not relieved of statutory duty.
§ 97-12.1 - Willful misrepresentation in applying for employment.
§ 97-13 - Exceptions from provisions of Article[Effective until January 1, 2023]
§ 97-17 - Settlements allowed in accordance with Article.
§ 97-18.1 - Termination or suspension of compensation benefits.
§ 97-20 - Priority of compensation claims against assets of employer.
§ 97-22 - Notice of accident to employer.
§ 97-24 - Right to compensation barred after two years; destruction of records.
§ 97-25 - Medical treatment and supplies.
§ 97-25.1 - Limitation of duration of medical compensation.
§ 97-25.2 - Managed care organizations.
§ 97-25.4 - Utilization guidelines for medical treatment.
§ 97-25.5 - Utilization guidelines for vocational and other rehabilitation.
§ 97-25.6 - Reasonable access to medical information.
§ 97-26 - Fees allowed for medical treatment; malpractice of physician.
§ 97-28 - Seven-day waiting period; exceptions.
§ 97-29 - Rates and duration of compensation for total incapacity.
§ 97-31 - Schedule of injuries; rate and period of compensation.
§ 97-31.1 - Effective date of legislative changes in benefits.
§ 97-32 - Refusal of injured employee to accept suitable employment as suspending compensation.
§ 97-32.1 - Trial return to work.
§ 97-32.2 - Vocational rehabilitation.
§ 97-33 - Prorating in event of earlier disability or injury.
§ 97-34 - Employee receiving an injury when being compensated for former injury.
§ 97-35 - How compensation paid for two injuries; employer liable only for subsequent injury.
§ 97-36 - Accidents taking place outside State; employees receiving compensation from another state.
§ 97-37 - Where injured employee dies before total compensation is paid.
§ 97-40.1 - Second Injury Fund.
§ 97-42 - Deduction of payments.
§ 97-42.1 - Credit for unemployment benefits.
§ 97-43 - Commission may prescribe monthly or quarterly payments.
§ 97-45 - Reducing to judgment outstanding liability of insurance carriers withdrawing from State.
§ 97-46 - Lump sum payments to trustee; receipt to discharge employer.
§ 97-47 - Change of condition; modification of award.
§ 97-47.1 - Payment without prejudice; limitations period.
§ 97-50 - Limitation as against minors or mentally incompetent.
§ 97-51 - Joint employment; liabilities.
§ 97-52 - Occupational disease made compensable; "accident" defined.
§ 97-54 - "Disablement" defined.
§ 97-55 - "Disability" defined.
§ 97-56 - Limitation on compensable diseases.
§ 97-58 - Time limit for filing claims.
§ 97-59 - Employer to pay for treatment.
§ 97-61 - Rewritten as §§ .1 to .7.
§ 97-61.1 - First examination of and report on employee having asbestosis or silicosis.
§ 97-61.2 - Filing of first report; right of hearing; effect of report as testimony.
§ 97-61.3 - Second examination and report.
§ 97-61.4 - Third examination and report.
§ 97-61.7 - Waiver of right to compensation as alternative to forced change of occupation.
§ 97-62 - "Silicosis" and "asbestosis" defined.
§ 97-63 - Period necessary for employee to be exposed.
§ 97-64 - General provisions of act to control as regards benefits.
§ 97-65 - Reduction of rate where tuberculosis develops.
§ 97-66 - Claim where benefits are discontinued.
§ 97-67 - Postmortem examinations; notice to next of kin and insurance carrier.
§ 97-68 - Controverted medical questions.
§ 97-69 - Examination by advisory medical committee; inspection of medical reports.
§ 97-70 - Report of committee to Industrial Commission.
§ 97-71 - Filing report; right of hearing on report.
§ 97-78.1 - Standards of judicial conduct to apply to commissioners and deputy commissioners.
§ 97-83 - Commission is to make award after hearing.
§ 97-83.1 - Facilities for hearings; security.
§ 97-84 - Determination of disputes by Commission or deputy.
§ 97-86 - Award conclusive as to facts; appeal; certified questions of law.
§ 97-86.1 - Payment of award pending appeal in certain cases.
§ 97-86.2 - Interest on awards after hearing.
§ 97-87 - Judgments on awards.
§ 97-88 - Expenses of appeals brought by insurers.
§ 97-88.1 - Attorney's fees at original hearing.
§ 97-88.2 - Penalty for fraud.
§ 97-88.3 - Penalty for health care providers.
§ 97-89 - Commission may appoint qualified physician to make necessary examinations; expenses; fees.
§ 97-91 - Commission to determine all questions.
§ 97-95 - Actions against employers failing to effect insurance or qualify as self-insurer.
§ 97-97 - Insurance policies must contain clause that notice to employer is notice to insurer, etc.