97-25.4. Utilization guidelines for medical treatment.
(a) The Commission may adopt utilization rules and guidelines, consistent with this Article, for medical care and medical rehabilitation services, other than those services provided by managed care organizations pursuant to G.S. 97-25.2, including, but not limited to, necessary palliative care, physical therapy treatment, psychological therapy, chiropractic services, medical rehabilitation services, and attendant care. The Commission's rules and guidelines shall ensure that injured employees are provided the services and care intended by this Article and that medical costs are adequately contained. In developing the rules and guidelines, the Commission may consider, among other factors, the practice guidelines adopted by the boards and associations representing medical and rehabilitation professionals.
(b) Palliative care rules or guidelines adopted by the Commission may require that the provider (i) supply to the employer a treatment plan, including a schedule of measurable objectives, a projected termination date for treatment, and an estimated cost of services, and (ii) obtain preauthorization from the employer, not inconsistent with the provisions of G.S. 97-25.3. (1993 (Reg. Sess., 1994), c. 679, s. 2.4.)
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.