When an Employer Tries to Terminate Workers' Comp Benefits
Once the right to North Carolina workers’ compensation payments has been established, the employer may not terminate these benefits without the specific approval by order of the North Carolina Industrial Commission. (An exception to this rule is when the employee returns to work. This return to work involves a different set of rules and return to work documents.)
Aside from a return to work by the employee, the employer who wishes to stop payment of workers’ compensation benefits must petition the Industrial Commission for approval.
This petition must be on a form prescribed by the Industrial Commission and a copy must be given to the employee and the employee’s attorney.
This form shall contain the reasons for the proposed termination or suspension of compensation. It must be supported by available documentation and it must inform the employee of the employee’s rights to contest the termination or suspension by filing an objection in writing with the Industrial Commission within 14 days of the date the employer’s notice is filed with the Industrial Commission.
If the employee fails to object to the petition to terminate benefits within the time provided the Industrial Commission may, and most probably will, terminate or suspend the compensation to the employee.
If the employee files a timely objection to the petition to terminate benefits, the Industrial Commission shall conduct an informal hearing by telephone with the parties or their lawyers.
If either party objects to conducting the hearing by telephone, the Industrial Commission may, but does not have to, conduct the hearing in person in Raleigh or at another location selected by the Industrial Commission.
At this informal hearing the parties are given an opportunity to state their position and to submit documentary evidence.
The hearing must be conducted within 25 days of the receipt by the Industrial Commission of the employer’s petition to terminate benefits.
The Industrial Commission is required to issue a decision on the employer’s application for termination of compensation within five days after the informal hearing.
The commission may approve or disapprove of the application or if it is unable to reach a decision, may schedule a formal hearing before a deputy hearing officer of the Industrial Commission.
Only in the event that the employer’s application to suspend payments is approved may compensation be terminated.
If the commission was unable to reach a decision, the employee’s compensation shall continue until a decision is reached by the Industrial Commission after the formal hearing.
If the employer’s application to terminate or suspend benefits is allowed after the informal telephone hearing, the employer may, at that point, stop paying workers’ compensation payments.
Even if there is an appeal from the ruling, the employer does not have to continue making payments pending the appeal.
If the Industrial Commission denies the employer’s decision to terminate benefits after the informal telephone hearing, the employer must continue paying workers’ compensation payments to the employee. This is true even if there is an appeal and request for a formal hearing.
The Industrial Commission’s decision in the informal hearing is not binding on either party and either party may appeal and ask for a formal hearing before a deputy commissioner.
Upon the appeal a new hearing is conducted from scratch without any factor in the informal hearing playing a part in the formal hearing. All evidence is presented anew at the formal hearing.
If after a formal hearing the employer’s request to terminate benefits is allowed, the employer may terminate benefits effective from the date the employer first filed the petition to terminate. At this point the employer will be entitled to a credit for the overpayment which will have accrued during the hearing and appeal process.