04 NCAC 10D .0107 INFORMATION FOR EMPLOYEE
(a) Following the onset of an injury, the employer or MCO shall provide to the employee a printed explanation of the system being utilized for his care, suitable for sharing with emergency, "out-of-network", and referral physicians, that shall be filed with any Form 19 submitted to the Commission; provided, that electronic filers may otherwise notify the Commission of the identity of the MCO. This statement shall include the following information:
(1) the offices to contact concerning medical treatment for the injury, including a telephone number;
(2) if known at that time, the employee's chosen treating physician, including a phone number for seeking medical assistance outside normal business hours if the injury might cause such a need;
(3) the applicable methods for choosing and changing treating physicians and resolving disputes concerning physicians or treatment pursuant to G.S. 97-25.2;
(4) that the MCO can provide access to licensed physicians of all specialties;
(5) the employer's obligation to pay for treatment for which the employee is referred to the MCO, whether or not the employer admits liability for the injury per G.S. 97-90(e);
(6) the employee's duty to cooperate in treatment, and right to secure treatment at his or her own expense that does not interfere with the treating physician's treatment; and
(7) the Commission's File Number, if known when filed.
(b) Providers may include identifying billing information on the statement.
History Note: Authority G.S. 97-25.2;
Eff. January 1, 1996;
Amended Eff. July 1, 2014.