This segment in the Cost Containment Strategies Blog Series will focus on the fourth initial investigation cost containment strategy- utilizing Rule 607(a) of the Workers’ Compensation Rules of the North Carolina Industrial Commission and Discovery.
These tools help secure additional information about the following:
- The claimant’s relevant pre-existing medical history/condition;
- The alleged injury or condition at the center of the workers’ compensation claim; and
- The claimant’s return to work efforts- if applicable.
Rule 607(a) of the Workers’ Compensation Rules
Rule 607(a) of the Workers’ Compensation Rules of the North Carolina Industrial Commission provides:
Upon written request, any party shall provide to the requesting party without cost, a copy of all medical, vocational and rehabilitation reports, employment records, Commission forms, and written communications with health care providers in its possession, within 30 days of the request, unless objection is made within that time period. The duty to respond exists whether or not a request for hearing has been filed and is a continuing one, and any such reports and records that come into the possession of a party after receipt of a request pursuant to this Rule shall be provided to the requesting party within 15 days from the party’s receipt of these reports and records.
Rule 607(a) allows a claims adjuster to request relevant documentation concerning medical, vocational and rehabilitation reports from the claimant/claimant’s attorney in both accepted and denied claims to determine what treatment the claimant has received to date and what treatment is being recommended.
Importantly, Rule 607(a) allows a claims adjuster to secure written communications with health care providers from the claimant/claimant’s attorney as well.
Rule 607(a) requires that the party of whom the request is made disclose the documentation listed in the Rule without cost. In addition, Rule 607(a) requires the production of newly received documentation within 15 days of receipt, as the production obligation is a continuing one. Either party may make a Rule 607(a) request at any time- there does not have to be litigation/a Hearing Request pending.
An additional useful tool that a claims adjuster may want to utilize once defense counsel is assigned is serving Discovery, which is governed by N.C.G.S. §97-80(f) and Rule 605 of the Workers’ Compensation Rules of the North Carolina Industrial Commission.
N.C.G.S. §97-80(f) provides as follows:
The Commission may by rule provide for and limit the use of interrogatories and other forms of discovery, including production of books, papers, records, and other tangible things, and it may provide reasonable sanctions for failure to comply with a Commission order compelling discovery.
Rule 605 of the Workers’ Compensation Rules of the North Carolina Industrial Commission provides detailed regulations concerning:
What can be served:
- Up to 30 Interrogatories, including subparts;
- Requests for Production of Documents; and/or
- Additional methods of Discovery as provided by the North Carolina Rules of Civil Procedure if agreed upon by the parties or approved by the Industrial Commission.
When they can be served:
- Interrogatories- any time after the filing of a Form 18; Form 33 or acceptance of liability for the claim by the employer UNTIL Hearing;
- After Hearing- only if allowed by the Deputy Commissioner per Rule 606 of the Workers’ Compensation Rules of the North Carolina Industrial Commission
- Requests for Production of Documents- until 35 days prior to the date of the hearing.
Of importance, Interrogatories and Requests for Production of Documents must relate to matters that are not privileged, that are relevant to an issue in dispute, or that the requesting party reasonably believes may later become disputed.
Practice Tip – When preparing Interrogatories and Requests for Production of Documents, it is vital to ensure the requests are narrowly tailored to meet these requirements. Ask questions reasonably designed to reveal additional information concerning important claim issues on a case by case basis. Likewise, when served with Discovery from the other party, it is important to make sure their Discovery requests meet these requirements as well.
Questions? Please contact Jennifer directly at (919) 863-8846 or email@example.com.