(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;

Recodified from 04 NCAC 10D .0107 Eff. June 1, 2018.