AN ACT CLARIFYING THE AUTHORITY AND DUTIES OF INDUSTRIAL COMMISSION FRAUD INVESTIGATORS AND MAKING TECHNICAL, CONFORMING, AND OTHER CHANGES TO THE WORKERS' COMPENSATION LAWS OF NORTH CAROLINA.
Enacts new GS 97-79.1, Authority of Industrial Commission fraud investigator; inspection of records, directing the Industrial Commission (Commission) to establish a Criminal Investigation Unit (Unit) to operate as a law enforcement agency in enforcing GS Chapter 97. Requires members of the unit to serve as fraud investigators and be sworn law enforcement officers, appointed and certified by the NC Criminal Justice Education and Training Standards Commission.
Sets out the authority of the above sworn officers, including making arrests and taking investigatory and enforcement actions for felonies and misdemeanors, as well as to charge for infractions for violations of the laws of North Carolina, with primary responsibility being the enforcement of the Workers' Compensation Act.
Requires insurance companies, agents, or brokers to furnish copies of specified records to the fraud investigators for inspection by the Commissioner of the Industrial Commission as demanded. Refusal to submit or exhibit the records is considered a Class 1 misdemeanor.
Amends GS 143-166.13, adding the above sworn law enforcement officers to the list of officers that qualify for the Salary Continuation Plan.
Amends GS 97-88.2(b) making conforming and clarifying changes reflecting the establishment of the unit.
Amends GS 97-73(d) to provide that the Commission can set a reasonable fee for reviewing the safety rules for an employer.
Amends GS 97-87(c)(5), providing that notice of appeal of a Commission decision in regards to awards can request a de novo evidentiary hearing before the Commission (was, before the full Commission).
Amends GS 97-87(c)(7) concerning notice of appeals after the Commission provides for an award that requires periodic payments requiring that the Commission, if an appeal is issued pursuant to GS 97-87(c)(5), conduct an evidentiary hearing within 90 days of the filing of the response or when the response is due, if no response is filed (previously, only stated 90 days of the filing of the response).
Amends GS 97-92(d) making technical changes.
Amends GS 97-101, concerning the collection of fines and penalties, deleting language that provided that all fines and penalties collected by the Commission must become part of the specified maintenance fund.
Amends GS 97-26.2, concerning the reimbursement for prescription drugs, prescribed over-the-counter drugs, and professional pharmaceutical services, making several technical and clarifying changes to provisions that provide reimbursement allowances and limitations. Adds language to provide that this section also apply to prescribed over-the-counter drugs. Adds language limiting reimbursement for Schedule IV controlled substances. Provides that only an initial health care provider providing the employee's initial treatment following injury can seek reimbursement for dispensing controlled substances as described in this section; subsequent dispensing of controlled substances by another health care provider are not eligible for reimbursement.
Amends GS 97-200(a), concerning claims administration, to provide that a self-insurer cannot not use a claims adjuster unless the adjuster is licensed under GS 58-33-26 (was, is licensed under GS 58-33-25).