14B NCAC 09 .0302          PROCESSING AND PAYMENT OF CLAIMS

(a)  An application for a claim will be accepted only when submitted on an approved form and a determination is made by the Director that the application is complete.

(b)  Claims will be processed in the order in which the completed applications are received, deliverable by United States mail.  In any consideration of competing claims, with respect to priority order of processing, the filed date stamped on the claim shall be controlling.

(c)  Every claim filed is subject to investigation by the Director. Failure of the claimant to cooperate in the investigation may result in a denial of the claim or a reduction in the amount awarded.

(d)  The Director or the commission may reopen the investigation of any claim.

(e)  The Director will determine, from information supplied in the application and verified by investigation, the amount of an award to be paid, if any, for each claim.  Awards which must be made by the Commission will be docketed by the Director for consideration by the Commission.  The Director shall notify the Commission of all awards made or denied.

(f)  The Director shall make a recommendation for all awards that require approval by the Commission. After reaching a decision to recommend that the Commission approve an award, the Director shall require the claimant to submit current collateral source information.  After receipt of such information, the Director shall notify the claimant of the recommended award amount and the date on which the claim will be considered by the Commission.

(g)  All awards requiring approval by the Commission shall be docketed upon the Commission's agenda by the Director.  The report of investigation and recommendation of the Director for each claim to be considered shall be provided the Commission in advance of the meeting.  The Commission shall decide whether to approve an award. If the award is approved, the Commission shall determine an amount.  Any award made by the Commission may be reduced, prior to payment, by the Director to the extent the award is or will be recouped from a collateral source.

(h)  The Director shall mail a written statement of the award decision to the claimant along with the check for the award, if any, within 15 days of the Director's or the Commission's decision or verification of current collateral source information, whichever occurs last.  This written statement shall notify the claimant: whether this check is a partial or complete payment of the award; of any payments made directly to a service provider; and of appeal rights.

(i)  Claims will be docketed for determination of payment in an order determined by the Director.

(j)  All payments of compensation must be made in strict accordance with the award issued by the Director or the Commission.

(k)  A claimant who fails to cooperate with or supply requested information to the Director or who supplies inaccurate or incomplete information may have the claim denied or the award reduced, in the discretion of the Director or the Commission.

(l)  The claimant shall be required to inform the director at any time before or after the award of any action brought to recover damages for the criminally injurious conduct that is the basis of any claim or award and the availability of any collateral source.  The failure to provide such information may be considered as fraud, allowing the Director or the Commission to reduce or deny an award or to recover monies previously paid.

(m)  All notifications and payments or other documents transmitted by mailing will be sent to the address submitted by the claimant.  The claimant must notify the Director in writing of any change of address.

 

History Note:        Authority G.S. 15B-6; 15B-7; 15B-8; 15B-10; 15B-11; S.L. 1987, c. 819, s. 35;

Temporary Rule Eff. November 24, 1987 For a Period of 171 Days to Expire on May 13, 1988;

Eff. April 1, 1988;

Transferred from 14A NCAC 11 .0502 Eff. June 1, 2013.