What Is A Form 25C In A North Carolina Workers’ Compensation Case?

Father and Daughter Surfing the WebA Form 25C in Workers’ Compensation is an Authorization for Rehabilitation Professional to Obtain Medical Records of Current Treatment.  When you have been injured on a job and you have started your Workers’ Compensation case, you will be assigned to a physician picked by the insurance company representing the company in which you work(ed) for.  At this point you and the doctor will begin treatment to get you improved medically to the maximum potential (your MMI, maximum medical improvement).   If your physician feels like you need to be seen by a specialist in order to reach your MMI then the physician will send written recommendation and authorization for the specialist to treat you.

At this point, this is where a Form 25C comes in to play.  A Form 25C in Workers’ Compensation is an Authorization for Rehabilitation Professional to Obtain Medical Records of Current Treatment and is filed with the North Carolina Industrial Commission.  This gives permission for the treating specialist to obtain your medical records of treatment resulting from your work related injury to assess your current health situation.

What happens if you do not feel like you should have to see a specialist?  If you wish to continue with your case, unfortunately there is not much choice!  Your refusal to sign this form upon the request of the rehabilitation professional can result in being deemed as “noncompliant” with rehabilitation and the North Carolina Industrial Commission can suspend your benefits.  It is very important throughout your Workers’ Compensation case that you comply with all rules and regulations of the North Carolina Industrial Commission.

Like all other facets of the law, Workers’ Compensation is very complicated and best handled by an experienced attorney.  It is strongly advised that if you think you may have a workers’ compensation case that you consult an attorney.

What Is A Form 23 in North Carolina Workers' Compensation?

Construction Worker Injured at Work in North CarolinaNorth Carolina Industrial Commission Form 23 is the Application to Reinstate Payment of Disability Compensation. The NCIC requires this form to be used when payment from the employer to the employee in a workers’ compensation case has stopped, and the employee wants to reestablish a payment schedule with their employer. The form has two sections; one must be completed by the employee, and the other must be completed by the employer.

In the section to be filled out by the employee, you must record the nature of your original injury and the history of the case so far. This includes payments already received and which forms have been filed to establish original compensation. You must also state the reason you are seeking further payments from your employer.

The section that is to be completed by the employer can be filled out in one of two ways—If the request to reinstate payments is not being contested, then the employer must record the amount of the new payments and the date on which they will resume. If the employer does choose to contest the employee’s request for new payments then they must state their reason on this form. The employer must also provide a contact phone number so that the North Carolina Industrial Commission may conduct and informal phone interview to discuss why they have declined to reinstate payment.

What Is A Form 28 In North Carolina Workers’ Compensation?

ChecklistA Form 28 in a workers’ compensation case is a Return to Work Form.  This form is usually completed by your employer or their workers’ compensation insurance company and states that under the Workers’ Compensation Act, an employee can return to work.  What it means is that you as the employee have reached your maximum level of improvement medically, and your treating physician has stated you can return back to your old position (or something similar). This form is only if you are okay to return to work like normal, and this is not a trial return to work, it also means that you meet one of the exclusions contained in North Carolina Industrial Commission Rule 404A(7).

What does that mean for you?  This means that since you have been given the “OK” to go back to work, you will no longer receive your disability compensation.  If your doctor is still “iffy” on sending you back to work at 100% of your capacity, you are entitled to return on a trial basis which is not to exceed 9 months; unless you have been released by your doctor for unrestricted work in which your trial return may be limited to only 45 days.  During this trial period, you may be entitled to partial disability compensation if you earn less in wages now than before your injury.  This is only if this is caused by your on-the-job injury.  If this is the case a separate form (Form 28T) must be filled out.

Will the Insurance Company Provide me with Transportation in a Worker’s Comp Claim?

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Yes, the insurance company can provide you with transportation to receive medical care that is approved by the insurance company or the North Carolina Industrial Commission. Usually you must provide your own transportation, but the insurance company will reimburse you the expenses.  However, if your injury makes it difficult to drive to and from your medical treatment then the insurance company may be compelled to provide you with transportation by the Industrial Commission.

Doing Workers' Compensation Research on a ComputerCurrently the North Carolina law requires the worker’s compensation to reimburse you $0.565 per mile as of January 2013. This amount may change as the cost of gasoline changes.  To be reimbursed, your trip must be more than 20 miles round trip. Normally you will not be reimbursed for medication and supplies on a separate trip in which you did not receive medical care.  These medications and supplies must be purchased on the same trip you are receiving your medical care.

Special consideration will be provided to persons that are unable to drive to receive their medical treatments. The worker’s compensation insurance company, on the orders of the Industrial Commission, may provide special transportation for those injured workers, such as a special van for wheel chairs, etc.

In the event you must stay overnight for your medical care, certain expenses are covered.  These are normally hotel rooms up to $45 per day.  You may receive up to $28 per day for food. You can also be reimbursed for parking and cab expense for your medical treatment.  However, you must provide actual receipts as proof of your expenses that will be reimbursed to you.

To be reimbursed for your travel expenses, you must complete, sign, and submit North Carolina Industrial Commission Form 25T and your receipts to the worker’s compensation insurance company for reimbursement. Be sure and keep a copy of the form and your receipts for your own records.

What Is A Form 24 In A North Carolina Workers’ Compensation Case?

Workers' Compensation Doctor Looking at X-RayWhen you receive your workers’ compensation benefits, you have been evaluated by a doctor as to what limitations you may have when you go back to work.  Let’s say that you have hurt your arm, and the doctor limits you to “light duty” work, and perhaps sets a limit to the weight that you can carry or the movements that you can make, but you are able to work under certain circumstances.  You go into work and decide that you can’t and/or do not want to work and you stop showing up. Your refusal to do your legally obligated job under the workers’ compensation law can prompt your employer to try to terminate or suspend your workers’ compensation payment.

When your employer does not feel like they should still have to continue to pay your workers’ compensation benefits they can file a Form 24 which is an Application to Terminate or Suspend Payment of Compensation (G.S 97-18.1).  Your employer will fill this out which explains why they feel your workers’ compensation payments should be suspended or terminated. At this point, the date that they mail it, you have 17 days to fill out your response and send it back. Typically there will be an informal hearing in which the Deputy Commissioner will hear both sides of the story (normally by a telephone conference) and will make a ruling based upon their findings and the consideration of the doctor’s opinion.

You have the right to appeal the decision to the full commission if you do not agree with the Deputy Commissioners decision, although in most cases, once the decision has been made it is not likely to be overturned. They key is, however, is to ensure that you follow the steps laid out by your doctor. If you do not agree with the restrictions or with something set out as part of your restrictions you should discuss that with your workers’ compensation attorney instead of just not following the doctor’s orders.

Are Travel Expenses Covered Under Workers Compensation?

Travel Expenses for Workers' Compensation | Form 25TGenerally speaking, mileage to go to and from treatment is covered under workers’ compensation if the client travels 20 miles or more roundtrip.  The current mileage reimbursement rate is $.565 per mile, but it is subject to change in accordance to the Internal Revenue Service guidelines.  If the Internal Revenue Service alters the mileage rates, whether they increase or decrease, the Industrial Commission will act in accordance to their updated rates.

What form should I fill out?

Clients are going to fill out a Form 25T which can be accessed on the NC Industrial Commission website. The form itself is simple to complete but it’s important to stay on top of documenting your mileage to and from treatment.  You may consider keeping a journal close by so you can document the date, where you are traveling, arrival and departure time, and mileage reading before and after appointment.  It’s a good idea to have it documented on both the Form 25T and your journal, since you will be submitting the form to the insurance carrier.  You may also consider making a copy of the Form 25T for your records.

How do I turn in my Form 25T?

The form will be submitted to the insurance carrier so it typically depends on what form of communication is already in place.  When you fill out your form for the first time and are ready to submit, it’s probably a good idea to send it to your workers’ compensation attorney first.  Your attorney can review the form and make sure everything is filled out before sending it to the insurance carrier.  While your attorney is reviewing the form, touch base with him or her and let them know you would like to verify how to submit it to the insurance carrier.  After the first couple of times, you should be able to complete the form and send it to the insurance carrier on your own.

When do I receive my reimbursement check?

Most clients will receive a reimbursement check from the insurance carrier within a couple of weeks.  It is essential clients are staying on top of filling out their forms on a weekly basis and submitting them in a timely manner.  If you have questions about mileage reimbursement for treatment, Form 25T, etc. you should consult with your workers compensation attorney.