Current through Register Vol. 39, No. 6, September 16, 2024
(a) The
Commission shall not approve a compromise settlement agreement unless it
contains the following:
(1) The employee
knowingly and intentionally waives the right to further benefits under the
Workers' Compensation Act for the injury that is the subject of this
agreement.
(2) The parties'
agreement, if any, as to the payment of the costs due to the Commission
pursuant to
11 NCAC
23E .0203, and any mediation costs pursuant
to 11
NCAC 23G .0107. If there is no agreement as
to the payment of some or all of these costs, the compromise settlement
agreement shall include the credits, including the amounts, to be applied by
the employer or carrier against the settlement proceeds.
(3) An affirmative statement that no rights
other than those arising under the provisions of the Workers' Compensation Act
are compromised or released by this agreement.
(4) Whether the employee has, or has not,
returned to work.
(5) If the
employee has returned to work, whether the employee is earning the same or
greater average weekly wage.
(6) If
the employee has returned to work at a lower average weekly wage, a description
of the specific job or position, the name of the employer, and the average
weekly wage earned. This Subparagraph does not apply if the employee is
represented by counsel or if the employee certifies that partial wage loss due
to an injury or occupational disease is not being claimed.
(7) If the employee has not returned to work,
a summary of the employee's age, educational level, past vocational training,
past work experience, and any emotional, mental, or physical impairment that
predates the current injury or occupational disease. This Subparagraph does not
apply if:
(A) it places an unreasonable burden
upon the parties;
(B) the employee
is represented by counsel; or
(C)
the employee certifies that total wage loss due to an injury or occupational
disease is not being claimed.
(b) No compromise settlement agreement shall
be considered by the Commission unless the following requirements are met:
(1) The relevant medical, vocational, and
rehabilitation reports known to exist, including those pertinent to the
employee's future earning capacity, are submitted with the agreement to the
Commission by the employer, carrier, administrator, or the attorney for the
employer.
(2) The employee, the
employee's attorney of record, if any, and an attorney of record or other
representative who has been given the authority to sign for the employer,
carrier and administrator, have signed the agreement.
(3) In a claim where liability is admitted or
otherwise has been established, the employer, carrier, or administrator has
undertaken to pay all medical expenses for the compensable injury to the date
of the settlement agreement.
(4) In
a claim in which the employer, carrier, or administrator has not agreed to pay
all medical expenses of the employee related to the injury up to the date of
the settlement agreement, the settlement agreement contains a list of all known
medical expenses of the employee related to the injury to the date of the
settlement agreement. This list of known medical expenses shall include:
(A) All expenses that have been paid by the
employer, carrier, or administrator;
(B) All expenses that the employer, carrier,
or administrator disputes;
(C) All
expenses that have been paid by the employee;
(D) All expenses that have been paid by a
health benefit plan;
(E) All unpaid
expenses that will be paid by the employer, carrier, or administrator;
and
(F) All unpaid expenses that
will be paid by the employee.
(5) The settlement agreement provides that a
party who has agreed to pay a disputed unpaid medical expense will notify the
unpaid health care provider in writing of the party's responsibility to pay the
unpaid medical expense. Other unpaid health care providers will be notified in
writing of the completion of the settlement by the party specified in the
settlement agreement:
(A) when the employee or
the employee's attorney has notified the unpaid health care provider in writing
under G.S. 97-90(e) not
to pursue a private claim against the employee for the costs of medical
treatment; or
(B) when the unpaid
health care provider has notified the employee or the employee's attorney in
writing of its claim for payment for the costs of medical treatment and has
requested notice of a settlement.
(6) Any obligation of any party to pay an
unpaid disputed medical expense pursuant to a settlement agreement does not
require payment of any medical expense in excess of the maximum allowed under
G.S.
97-26.
(7) The settlement agreement contains a
finding that the positions of the parties to the agreement are reasonable as to
the payment of medical expenses.
(c) When a settlement has been reached, the
written agreement shall be submitted to the Commission upon execution in
accordance with Rule .0108 of this Subchapter. All compromise settlement
agreements shall be distributed for review in accordance with Paragraphs (a)
through (c) of Rule .0609 of this Subchapter. Any changes or addenda to the
agreement submitted to the Commission shall be served upon the opposing party
contemporaneously with submission to the Commission.
(d) The employer, carrier, or administrator
shall furnish an executed copy of the agreement to the employee's attorney of
record or the employee, if unrepresented.
(e) An employee's attorney who seeks fees in
connection with a compromise settlement agreement shall submit a copy of the
fee agreement with the employee. Further, if the employee's attorney is aware
of a fee being claimed by a prior attorney for the employee, the employee's
attorney shall advise the Commission at the time of the submission of a
compromise settlement agreement whether an agreement has been reached with the
prior attorney regarding a division of the fee and, if so, the division
proposed.
Authority
G.S.
97-17;
97-80(a);
97-82;
Eff. January 1,
1990;
Amended Eff. February 1, 2016; November 1, 2014; August 1,
2006; June 1, 2000; March 15, 1995;
Recodified from
04 NCAC
10A .0502 Eff. June 1, 2018;
Amended Eff. January 1, 2019.
