GENERAL ASSEMBLY OF NORTH CAROLINA

SESSION 1993

S	1 

SENATE BILL 1032

Short Title:  Workers' Comp/Med Cost Controls.	(Public)
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Sponsors: Senator Sands.
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Referred to:  Manufacturing and Labor.
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May 4, 1993

A BILL TO BE ENTITLED
AN ACT TO CONTROL MEDICAL COSTS UNDER THE WORKERS' COMPENSATION ACT BY LIMITING THE EMPLOYER'S LIABILITY FOR MEDICAL COMPENSATION TO SCHEDULES OF FEES ESTABLISHED BY THE INDUSTRIAL COMMISSION.
The General Assembly of North Carolina enacts:
Section 1.  G.S. 97-26 reads as rewritten:
"§ 97-26. Liability for medical treatment limited to fees schedules; malpractice of physician.
(a)	The pecuniary liability of the employer for medical compensation shall be limited to the fees contained in the schedules established in accordance with G.S. 97-90.
(b)	The employer shall not be liable in damages for malpractice by a physician or surgeon furnished by him pursuant to the provisions of this section, but the consequences of any such malpractice shall be deemed part of the injury resulting from the accident, and shall be compensated for as such."
Sec. 2.  G.S. 97-90 reads as rewritten:
"§ 97-90.  Legal and medical fees to be approved by Commission; misdemeanor to receive fees unapproved by Commission, or to solicit employment in adjusting claims; agreement for fee or compensation.
(a)	Fees for attorneys under this Article shall be subject to the approval of the Commission.  Fees for medical compensation shall be limited to maximum medical fee schedules.  The schedules shall be established and published, or incorporated by reference, by the Commission and may be changed pursuant to subsection (e) of this section.  The Commission shall not establish fees for physicians or hospitals that are at a rate less than those fees for the same service contained in the fee schedules in effect under the Medicare program at the time the service is rendered. No physician or hospital or other medical facilities shall be entitled to collect fees from an employer or insurance carrier until he has made the reports required by the Industrial Commission in connection with the case.  Unless otherwise provided by the rules, schedules, or orders of the Commission, a request for a specific prior approval to charge shall be submitted to the Commission for each such fee or charge.
(b)	Any person (i) who receives any fee, other consideration, or any gratuity on account of services so rendered, unless such consideration or gratuity is approved by the Commission or such court, or (ii) who makes it a business to solicit employment for a lawyer or for himself in respect of any claim or award for compensation, shall be guilty of a misdemeanor, and upon conviction thereof shall, for each offense, be punished by a fine of not more than five hundred dollars ($500.00) or by imprisonment not to exceed one year, or by both such fine and imprisonment.
(c)	If an attorney has an agreement for fee or compensation under this Article, he shall file a copy or memorandum thereof with the hearing officer or Commission prior to the conclusion of the hearing.  If the agreement is not considered unreasonable, the hearing officer or Commission shall approve it at the time of rendering decision.  If the agreement is found to be unreasonable by the hearing officer or Commission, the reasons therefor shall be given and what is considered to be reasonable fee allowed.  If within five days after receipt of notice of such fee allowance, the attorney shall file notice of appeal to the full Commission, the full Commission shall hear the matter and determine whether or not the attorney's agreement as to a fee or the fee allowed is unreasonable.  If the full Commission is of the opinion that such agreement or fee allowance is unreasonable and so finds, then the attorney may, by filing written notice of appeal within 10 days after receipt of such action by the full Commission, appeal to the resident judge of the superior court or the judge holding the courts of the district of or in the county in which the cause of action arose or in which the claimant resides; and upon such appeal said judge shall consider the matter and determine in his discretion the reasonableness of said agreement or fix the fee and direct an order to the Commission following his determination therein.  The Commission shall, within 20 days after receipt of notice of appeal from its action concerning said agreement or allowance, transmit its findings and reasons as to its action concerning such agreement or allowance to the judge of the superior court designated in the notice of appeal.  In all other cases where there is no agreement for fee or compensation, the attorney or claimant may, by filing written notice of appeal within five days after receipt of notice of action of the full Commission with respect to attorneys' fees, appeal to the resident judge of the superior court or the judge holding the courts of the district of the county in which the cause arose or in which the claimant resides; and upon such appeal said judge shall consider the matter of such fee and determine in his discretion the attorneys' fees to be allowed in the cause.  The Commission shall, within 20 days after notice of appeal has been filed, transmit its findings and reasons as to its action concerning such fee or compensation to the judge of the superior court designated in the notice of appeal; provided that the Commission shall in no event have any jurisdiction over any attorneys' fees in any third-party action.
(d)	Provided, that nothing contained in this section shall prevent the collection of such reasonable fees of physicians and charges for hospitalization as may be recovered in an action, or embraced in settlement of a claim, against a third-party tort-feasor as described in G.S. 97-10.2.
(e)	The Commission shall continuously receive reasonable comment from interested parties concerning the advisability of altering the fees in the schedules established pursuant to subsection (a) of this section.  At any time the Commission determines it is reasonable to do so, the Commission may alter fees for specific services, appliances, treatments, or diagnostic groups.  At least every two years, the Commission shall review the maximum medical fees schedule and determine whether it is appropriate to make comprehensive changes to this schedule.  The Commission shall hold at least one day of public hearings no less than 15 days prior to adopting comprehensive changes to the maximum medical fees schedule.  The Commission shall maintain a list of interested parties, including those providers, potential payors, and persons or firms representing interests of employees to whom it shall give notice, by regular mail, of public hearings and any proposals prepared by the Commission or its delegee for publication prior to a public hearing.  Comprehensive changes to the fees shall be approved by the Commission no later than June 1 of the year in which the Commission considers the comprehensive changes but shall not become effective until January 1 following such approval."
Sec. 3.  This act becomes effective January 1, 1994.