# Title 92 — Workforce Safety and Insurance

## Article 92-01 — General Administration

## Chapter 92-01-02 — Rules of Procedure - North Dakota Workers' Compensation Act

to Submit Payroll Reports
This State

Athletic Trainers
Review
### § 92-01-02-01. Definitions.

Repealed effective January 1, 2026.
### § 92-01-02-02. Claims - Forms.

Repealed effective July 1, 2006.

### § 92-01-02-02.1. Temporary partial disability benefits.

If, after a compensable injury, an injured employee cannot return to full-time employment, or returns
to work at a wage less than that earned at the time of the injured employee's first or recurrent disability,
the injured employee is eligible for a temporary partial disability benefit. Pursuant to North Dakota
Century Code section 65-05-10, the temporary partial disability rate is to be fixed by the organization.
1. An injured employee may earn up to ten percent of the injured employee's average weekly
wage without the organization reducing temporary total disability benefits; however, all
postinjury wages, from any source, must be reported to the organization to determine whether
a reduction is required.
2. If an injured employee is receiving temporary partial disability benefits under North Dakota
Century Code section 65-05-10, the injured employee shall submit documentation of paystubs
or income earned every pay period. If the organization does not receive this documentation,
the organization may not pay temporary partial disability benefits. If the organization does not
receive this documentation for a period in excess of ninety days, the organization shall
discontinue temporary partial disability benefits.
History: Effective June 1, 1990; amended effective April 1, 1997; February 1, 1998; July 1, 2006;
April 1, 2020; January 1, 2022; January 1, 2026.
General Authority: NDCC 65-02-08, 65-05-10
Law Implemented: NDCC 65-02-08, 65-05-09
### § 92-01-02-02.2. Additional twenty-five percent rehabilitation allowance benefit payment.

Repealed effective January 1, 1996.
### § 92-01-02-02.3. First report of injury.

Repealed effective January 1, 2026.
### § 92-01-02-02.4. Treating health care provider's opinion.

Repealed effective January 1, 2026.
### § 92-01-02-02.5. Contributing cause of mental or psychological condition defined.

Repealed effective January 1, 2026.
### § 92-01-02-02.6. Verification of disability.

If an injured employee's disability benefits are discontinued under subsection 6 of North Dakota
Century Code section 65-05-08.1, and verification of disability is not received within one hundred
twenty days from the date disability benefits are discontinued, the organization may not pay any further
disability or vocational rehabilitation benefits, unless the injured employee meets the requirements of a
reapplication as found in North Dakota Century Code section 65-05-08.
History: Effective April 1, 2020.
General Authority: NDCC 65-02-08
Law Implemented: NDCC 65-05-08.1
### § 92-01-02-03. Informal hearing.

Repealed effective April 1, 1997.

### § 92-01-02-04. Rehearing - Formal hearing.

Repealed effective April 1, 1997.
### § 92-01-02-05. Notice of formal hearing - Specification of issues.

Repealed effective April 1, 1997.
### § 92-01-02-06. Evidence.

Repealed effective April 1, 1997.
### § 92-01-02-07. Subpoena - Depositions.

Repealed effective April 1, 1997.
### § 92-01-02-08. Information not presented at a formal hearing.

Repealed effective April 1, 1997.
### § 92-01-02-09. Decision.

Repealed effective April 1, 1997.
### § 92-01-02-10. Appeal.

Repealed effective April 1, 1997.
### § 92-01-02-11. Attorneys.

Any party has a right to be represented by an attorney at any stage in the proceedings regarding a
claim. An attorney who represents an injured employee in a proceeding regarding a claim shall file a
notice of legal representation signed by the injured employee prior to or together with the attorney's first
communication with the organization. The notice of legal representation remains in effect for five years
from the date it is signed by the injured employee or until revoked by the injured employee, whichever
occurs first.
History: Amended effective June 1, 1990; April 1, 1997; April 1, 2008; July 1, 2017; April 1, 2020.
General Authority: NDCC 65-02-08, 65-10-03
Law Implemented: NDCC 65-02-08, 65-10-03
### § 92-01-02-11.1. Attorney's fees.

Upon receipt of a certificate of program completion from the decision review office, fees for legal
services provided by employees' attorneys and legal assistants working under the direction of
employees' attorneys must be paid if an administrative order reducing or denying benefits is submitted
to administrative hearing, district court, or supreme court and the employee prevails; or if a managed
care decision is submitted to binding dispute resolution and the employee prevails subject to the
following:
1. The organization shall pay attorneys at two hundred five dollars per hour for all actual and
reasonable time other than travel time. The organization shall pay attorney travel time at
one hundred three dollars per hour.

2. The organization may pay legal assistants and third-year law students or law school graduates
who are not licensed attorneys who are practicing under the North Dakota senior practice rule
acting under the supervision of employees' attorneys up to one hundred twenty-five dollars per
hour for all actual and reasonable time other than travel time. The organization shall pay travel
time at sixty-three dollars per hour. A "legal assistant" means a person with a bachelor's
degree, associate's degree, or correspondence degree in a legal assistant or paralegal
program from an accredited college or university or other accredited agency, or a legal
assistant certified by the national association of legal assistants or the national federation of
paralegal associations. The term also may include a person employed as a paralegal or legal
assistant who has a bachelor's degree in any field and experience working as a paralegal or
legal assistant.
3. Total fees paid by the organization for all legal services in connection with a dispute regarding
an administrative order is an amount equal to twenty percent of the additional amount
awarded except for an order litigating the initial determination of compensability. Awards
include those arrived at by a mutually agreed upon settlement. Total fees paid under an
administrative order may not exceed the following:
a. Four thousand seven hundred four dollars, plus reasonable costs incurred, following
issuance of an administrative order under North Dakota Century Code chapter 28-32
reducing or denying benefits, for services provided if a hearing request is resolved by
settlement or amendment of the administrative order before the hearing is called to order.
b. Seven thousand four hundred fifty-five dollars, plus reasonable costs incurred, if the
hearing request is resolved by settlement or amendment of the administrative order after
the hearing is called to order but before a written decision is issued by the administrative
law judge; or the employee prevails after the hearing is called to order by the
administrative law judge.
c. Eight thousand two hundred ninety-five dollars, plus reasonable costs incurred, if the
employee's district court appeal is settled prior to submission of briefs. Eleven thousand
seventy-eight dollars, plus reasonable costs incurred, if the employee prevails after
hearing by the district court.
d. Thirteen thousand two hundred eighty-three dollars, plus reasonable costs incurred, if the
employee's North Dakota supreme court appeal is settled prior to hearing. Fourteen
thousand five hundred ninety-five dollars, plus reasonable costs incurred, if the employee
prevails after hearing by the supreme court.
e. Two thousand two hundred five dollars, plus reasonable costs incurred, if the employee
requests binding dispute resolution and prevails.
f. Should a settlement or order amendment offered during the DRO process be accepted
after the DRO certificate of completion has been issued, no attorney's fees are payable.
This contemplates not only identical offers and order amendments but those which are
substantially similar.
4. The maximum fees specified in subdivisions a, b, c, and d of subsection 3 include all fees paid
by the organization to one or more attorneys, legal assistants, law students, and law
graduates representing the employee in connection with the same dispute regarding an
administrative order at all stages in the proceedings. A "dispute regarding an administrative
order" includes all proceedings subsequent to an administrative order, including hearing,
judicial appeal, remand, an order resulting from remand, and multiple matters or proceedings
consolidated or considered in a single proceeding.
5. All time must be recorded in increments of no more than six minutes (one-tenth of an hour).

6. If the organization is obligated to pay the employee's attorney's fees, the attorney shall submit
to the organization a final statement upon resolution of the matter. All statements must show
the name of the employee, claim number, date of the statement, the issue, date of each
service or charge, itemization and a reasonable description of the legal work performed for
each service or charge, time and amount billed for each item, and total time and amounts
billed. The employee's attorney shall sign the fee statement. The organization may deny fees
and costs that are determined to be excessive or frivolous.
7. The following costs must be reimbursed:
a. Actual postage, if postage exceeds three dollars per parcel.
b. Actual toll charges for long-distance telephone calls.
c. Copying charges, at ten cents per page.
d. Mileage and other expenses for reasonable and necessary travel. Mileage and other
travel expenses, including per diem, must be paid in the amounts that are paid state
officials as provided by North Dakota Century Code sections 44-08-04 and 54-06-09.
Out-of-state travel expenses may be reimbursed if approval for such travel is given, in
advance, by the organization.
e. Other reasonable and necessary costs, not to exceed one hundred fifty dollars. Other
reasonable and necessary costs in excess of one hundred fifty dollars may be
reimbursed upon agreement, in advance, by the organization. Costs for typing and
clerical or office services may not be reimbursed.
8. The following costs may not be reimbursed:
a. Facsimile charges.
b. Express mail.
c. Additional copies of transcripts.
d. Costs incurred to obtain medical records.
e. Online computer-assisted legal research.
f. Copy charges for documents provided by the organization.
The organization shall reimburse court reporters for mileage and other expenses, for reasonable and
necessary travel, in the amounts that are paid state officials as provided by North Dakota Century Code
sections 44-08-04 and 54-06-09.
History: Effective June 1, 1990; amended effective November 1, 1991; January 1, 1994; January 1,
1996; May 1, 2000; May 1, 2002; July 1, 2004; July 1, 2006; April 1, 2008; April 1, 2009; July 1, 2010;
April 1, 2012; April 1, 2014; April 1, 2016; January 1, 2018; April 1, 2020; January 1, 2022; January 1,
2024; January 1, 2026.
General Authority: NDCC 65-02-08
Law Implemented: NDCC 65-02-08, 65-10-03

### § 92-01-02-11.2. Attorney time statements.

An attorney representing a claimant shall submit to the organization, at least once a month, a
statement of the time spent representing that claimant during that month. The statement must include
the name and claim number of the claimant represented, the type of work performed, which attorney or
legal assistant performed the work, and the dates each service was performed. The organization may
not pay fees which were not included on a monthly statement submitted as required by this section.
History: Effective April 1, 1997.
General Authority: NDCC 65-02-08
Law Implemented: NDCC 65-02-08
### § 92-01-02-12. Mileage and per diem for travel to and from medical treatment.

Workforce safety and insurance recognizes payment for travel and lodging to and from medical
treatment if reasonable and necessary. These expenses will be paid according to North Dakota Century
Code section 65-05-28. The number of miles actually traveled is rebuttably presumed to be the least
number of miles listed by Google Maps between the start and end points of travel.
History: Effective August 1, 1988; amended effective April 1, 1997; July 1, 2010; April 1, 2012; April 1,
2014; July 1, 2017; January 1, 2024.
General Authority: NDCC 65-02-08
Law Implemented: NDCC 65-02-08, 65-05-28
### § 92-01-02-13. Merger, transfer, or sale of business.

1. Definitions. In this section:
a. "Business entity" means any form of business organization, including proprietorships,
partnerships, limited partnerships, cooperatives, limited liability companies, and
corporations.
b. "Constituent business" means a business entity or entities of which a surviving entity is
composed. The constituent business may also be referred to as the "predecessor entity"
or "seller".
c. "Surviving entity" means the business entity resulting from a merger, transfer, or sale of
business assets from one or more constituent businesses. The surviving entity may also
be referred to as "successor entity" or "buyer".
2. Experience rating. The surviving entity resulting from a merger, transfer, or sale of business
assets must be assigned an experience rating derived from the combined premium, payroll,
and loss history of all the employer accounts involved in the merger, transfer, or sale. The
employer accounts of the constituent businesses shall merge or transfer into the surviving
entity. The organization may change the experience rating of the surviving entity.
If the organization determines a business entity is a continuation or extension of an already
existing business entity and not a surviving entity composed of one or more constituent
businesses, and the existing business entity is already experience-rated, the experience rate
of the existing business entity must transfer to its continuation or extension. Future experience
rates must be calculated using the combined premium, payroll and loss history from the
existing business entity and its continuations or extensions.
3. Compensation coverage.
a. The organization may transfer compensation coverage of any constituent business to the
surviving entity. The organization may require the surviving entity to provide information

on the constituent businesses of which it is comprised and its owners, officers, directors,
partners, and managers. If the organization determines a surviving entity is merely a
continuation of the constituent business or businesses, the organization may transfer any
liability to the surviving entity or decline coverage until any delinquency is resolved.
b. Factors the organization may consider in determining if a surviving entity is a mere
continuation of a constituent business include:
(1) Whether there is continuity of the constituent business in the surviving entity as
shown by retention of key personnel, assets, liabilities, customers, contracts, and
general business operations.
(2) Whether the surviving entity continues to use the same business location .
(3) Whether employees transferred from the constituent business to the surviving entity.
(4) Whether the surviving entity holds itself out as the effective continuation of the
constituent business.
c. The organization shall calculate premium based on actual payroll, subject to the payroll
cap, for the relevant period of time. The organization may prorate the payroll cap based
on one-twelfth of the statutory payroll cap per month per employee at the beginning of
the relevant period of time.
History: Effective June 1, 1990; amended effective January 1, 1992; April 1, 1997; May 1, 2002; July 1,
2004; July 1, 2010; January 1, 2026.
General Authority: NDCC 65-02-08
Law Implemented: NDCC 65-04-01
### § 92-01-02-13.1. General contractors.

For purposes of application of North Dakota Century Code section 65-04-26.2, the relationship
between a general contractor and subcontractor may be identified by the organization in any industry.
History: Effective January 1, 2018.
General Authority: NDCC 65-02-08, 65-04-26.2
Law Implemented: NDCC 65-04-26.2
### § 92-01-02-14. Procedure for penalizing employers accounts for failure to pay premium or

failure to submit payroll reports.
1. The organization shall bill each employer for premiums as provided by North Dakota Century
Code chapter 65-04. If an employer has an open account with the organization, the
organization may send to the employer a payroll report on which the employer shall submit
payroll expenditures for the preceding payroll reporting period. The employer shall provide on
the payroll report all information requested by the organization, including the name, social
security number, rate classification, and gross payroll for each employee. The employer shall
submit an electronic report of payroll information in a format approved by the organization.
The report must be received by the organization by the last day of the month following the
expiration date of the employer's payroll reporting period. The organization shall consider an
unsigned or incomplete submission a failure or refusal to furnish the report.
2. The organization shall send the first billing statement to the employer by regular mail to the
employer's last-known address or by electronic transmission. The first billing statement must
identify the amount due from the employer. The statement must explain the installment
payment option. The payment due date for an employer's account is thirty days from the date

of billing indicated on the billing statement. If a previous delinquency exists on the employer
account, the billing statement indicates a past-due status.
3. If the organization does not receive full payment or the minimum installment payment
indicated on the billing statement, on or before the payment due date, the organization shall
send a second billing statement.
4. If the minimum installment payment remains unpaid thirty days after the organization sends
the second billing statement to the employer, the organization shall notify the employer by
regular mail to the employer's last-known address or by electronic transmission that:
a. The employer is in default and may be assessed a penalty of two hundred fifty dollars
plus two percent of the amount of premium, penalties, and interest in default;
b. The employer's account has been referred to the collections unit of the policyholder
services department; and
c. Workforce safety and insurance may cancel the employer's account.
5. The organization may extend coverage if the organization and the employer have agreed in
writing to a payment schedule on a delinquent account. If the employer defaults on the agreed
payment schedule, that employer is not insured.
6. If the employer's payroll report is not timely received by the organization, the organization
shall notify the employer, by electronic transmission or regular mail addressed to the
last-known address of the employer of the employer's failure to submit the payroll report. The
notification must indicate that the organization may assess a penalty of up to five thousand
dollars against the employer's account.
7. If the payroll report is not received by the due date provided by letter from the organization to
the employer, the organization shall assess a penalty of fifty dollars. A second fifty-dollar
penalty is assessed against the employer if the payroll report remains unsubmitted after an
additional fifteen days. The organization shall notify the employer of the penalty by electronic
transmission or regular mail addressed to the employer's last-known address.
8. At any time after sixty days following the expiration of the employer's payroll period, when the
employer has failed to submit a payroll report, the organization may bill the employer
consistent with North Dakota Century Code section 65-04-19. An employer whose premium
has been calculated under this subsection may submit actual wages on an employer payroll
report for the period billed and the organization shall adjust the employer's account unless the
organization determines the information submitted by the employer is unreliable or inaccurate.
9. The organization may cancel an employer's account which has failed to pay premium owing or
failed to submit a payroll report.
10. If the organization receives an employer payroll report more than sixty days after the
expiration of the employer's payroll period, the employer's billing statement may show a
past-due premium billing due date. Any employer account billed without benefit of the
employer payroll report may show a past-due billing due date.
11. If the employer does not have an open account with the organization, the organization shall
send the employer an application for coverage by regular mail or by electronic transmission.
The organization shall notify the employer of the penalties provided by North Dakota Century
Code chapter 65-04 and this section.
12. Upon receipt of an incomplete or unsigned payroll report, the employer shall submit the
completed payroll report within fifteen days of the organization's request. The organization

shall consider an unsigned or incomplete submission to be a failure or refusal to furnish the
report. If the payroll report is not timely received by the organization, the organization may
assess a penalty of up to five thousand dollars and shall notify the employer that the employer
is uninsured.
History: Effective June 1, 1990; amended effective January 1, 1994; January 1, 1996; May 1, 2002;
March 1, 2003; July 1, 2006; April 1, 2009; July 1, 2010; April 1, 2016; January 1, 2018; April 1, 2020;
January 1, 2022.
General Authority: NDCC 65-02-08, 65-04-06, 65-04-19, 65-04-33
Law Implemented: NDCC 65-04-33
### § 92-01-02-15. Altering payroll reporting periods for employers.

The organization may alter an employer's payroll reporting period to conform with regular quarter
endings (March thirty-first, June thirtieth, September thirtieth, December thirty-first) in cases where an
employer's payroll reporting period would not normally coincide with a quarter's end.
History: Effective June 1, 1990; amended effective July 1, 2010.
General Authority: NDCC 65-02-08, 65-04-33
Law Implemented: NDCC 65-04-33
### § 92-01-02-16. Expiration date change.

The organization may change the expiration date on the employer's account. The organization shall
calculate premium based on actual taxable payroll for each employee up to the statutory payroll cap,
prorated for the actual number of days in the adjusted payroll period.
History: Effective June 1, 1990; amended effective January 1, 1994; April 1, 1997; May 1, 2002; July 1,
2010.
General Authority: NDCC 65-02-08
Law Implemented: NDCC 65-04-01
### § 92-01-02-17. Reporting payroll for period of noncompliance.

If the noncompliance period of a new account is less than twelve months, the organization must
prorate the payroll based on one-twelfth of the statutory payroll cap per employee, per month, for the
period of time involved. If the payroll is less than one-twelfth of the statutory payroll cap per employee,
per month, the full month is reportable. An account in noncompliance is uninsured until a completed
application for workers' compensation insurance coverage is received by the organization and the
premium is paid.
History: Effective June 1, 1990; amended effective January 1, 1994; January 1, 1996; May 1, 2002;
July 1, 2004; July 1, 2006; April 1, 2020.
General Authority: NDCC 65-02-08
Law Implemented: NDCC 65-09-01
### § 92-01-02-18. Experience rating system.

The following system is established for the experience rating of risks of employers contributing to
the fund:
1. Definitions. In this section, unless the context otherwise requires:
a. "Three-year losses" means the total sum of ratable losses accrued on claims occurring
during the first three of the four years immediately preceding the premium year being
rated.

b. "Three-year payroll" means the total sum of limited payroll reported for the first three of
the four years immediately preceding the premium year being rated.
c. "Three-year premium" means the total sum of earned premium for the first three of the
four years immediately preceding the premium year being rated.
d. "Manual premium" means the actual premium, prior to any experience rating, for the
premium year immediately preceding the premium year being rated for claims
experience.
2. An employer's account is not eligible for an experience rating until the account has completed
three consecutive payroll periods and has developed aggregate manual premiums of at least
fifteen thousand dollars for the rating period used in developing the experience modification
factor.
3. For accounts with ratable manual premium of fifteen thousand dollars or more:
a. The experience rating must be applied prior to the inception of each premium year for all
eligible accounts. A claim is deemed to occur in the premium year in which the injury date
occurs.
b. The experience modification factor (EMF) to be applied to the current estimated portion
of an employer's payroll report is computed as follows:
(1) Calculate the actual primary losses (A ), which consist of the sum of those
p
three-year losses, comprising the first fifteen thousand dollars of each individual
claim.
(2) Calculate the actual excess losses (A ), which consist of the sum of those
e
three-year losses in excess of the first fifteen thousand dollars of losses of each
individual claim, limited to the maximum loss amount contained in the most recent
edition of North Dakota workforce safety and insurance rating plan values which is
hereby adopted by reference and incorporated within this subsection as though set
out in full.
(3) Calculate the total expected losses (E), which are determined by adding the
t
products of the actual payroll for each year of the three-year payroll times the class
expected loss rate for each year. The class expected loss rates, taking into
consideration the hazards and risks of various occupations, must be those
contained in the most recent edition of North Dakota workforce safety and insurance
rating plan values, which is hereby adopted by reference and incorporated within
this subsection as though set out in full.
(4) Calculate the expected excess losses (E ), which are determined by adding the
e
products of the actual payroll for each year of the three-year payroll times the class
expected excess loss rates. The class expected excess loss rates, taking into
consideration the hazards and risks of various occupations, must be those
contained in the most recent edition of North Dakota workforce safety and insurance
rating plan values, which is hereby adopted by reference and incorporated within
this subsection as though set out in full.
(5) Calculate the "credibility factor" (Z) based on the formula that is contained in the
most recent edition of North Dakota workforce safety and insurance rating plan
values, which is hereby adopted by reference and incorporated within this
subsection as though set out in full.
(6) The experience modification factor is then calculated as follows:

(a) Calculate the "ballast amount" (B) which is contained in the most recent edition
of North Dakota workforce safety and insurance rating plan values, which is
hereby adopted by reference and incorporated within this subsection as though
set out in full.
(b) Add the actual primary losses to the product of the actual excess losses times
the credibility factor.
(c) To this sum add the product of the expected excess losses times the difference
between one dollar and the credibility factor.
(d) To this sum add the ballast amount (B).
(e) Divide this total sum by the sum of the total expected losses plus the ballast
amount (B).
The resulting quotient is the experience modification factor to be applied in
calculating the estimated premium for the current payroll year.
(7) The formula for the above-mentioned calculation is as follows:
4. Small account credit or debit program. Accounts that fall below the eligibility standard for
experience rating outlined in subsection 2 are subject to the small account credit or debit
program. The rating period and ratable losses used to determine eligibility for the small
account credit or debit program are the same as those used for the experience rating program
outlined above. The amount of the credit or debit will be determined annually in conjunction
with the development of rating plan values for the prospective coverage period.
5. The organization shall include any modification to the North Dakota workforce safety and
insurance rating plan values in its ratemaking process pursuant to North Dakota Century Code
section 65-04-01.
History: Effective June 1, 1990; amended effective July 1, 1993; July 1, 1994; April 1, 1997; July 1,
2001; July 1, 2006; July 1, 2009; July 1, 2010; July 1, 2016.
General Authority: NDCC 65-02-08, 65-04-17
Law Implemented: NDCC 65-04-01
### § 92-01-02-18.1. Application of discount to experience rate for employers establishing

operations in this state.
If an employer who is beginning operations in this state can prove that for similar operations in
another jurisdiction the employer received an experience-rate-based discount on workers'
compensation premiums in that jurisdiction, the organization may discount that employer's premium in
this state. The employer must be setting up a permanent operation and the discount must be part of an
economic development package. The discount will be applied after one year. Premium discounts for the
employer's second through fourth years of operation in this state will be retrospectively based on the
employer's most recent out-of-state experience rate. Premiums for the employer's fifth year of operation
in this state will be based on the applicable experience rating programs in this state. The out-of-state
employer discount may not exceed the maximum allowable discount under the organization's
experience rating plans. An employer who self-insured in another jurisdiction is not eligible for the
discount.

History: Effective April 1, 1997; amended effective May 1, 2002; July 1, 2006.
General Authority: NDCC 65-02-08
Law Implemented: NDCC 65-04-01, 65-04-17
### § 92-01-02-19. Employer relief after third-party recovery.

Upon third-party recovery pursuant to North Dakota Century Code section 65-01-09 in claims which
have been accepted by the organization and when the employer's experience rating has been affected,
relief will be given to the employer from the date of injury to the balance of the experience rating period.
Relief will be given to the extent of the actual net recovery made by or on behalf of the organization,
after deduction from the gross recovery of the costs and attorney fees allowable under North Dakota
Century Code section 65-01-09.
"Relief will be given" indicates that the amount of money recovered by the organization in a
third-party action will be deducted from the amount charged against the employer's experience rating.
This may result in a decreased premium for policy periods impacted by the revised experience rates.
An account that has been canceled is not entitled to relief under this section.
Relief will also be given to the extent of the employer reimbursement paid by the employer
pursuant to North Dakota Century Code section 65-04-04.4, provided that the net recovery made by or
on behalf of the organization is equal to or exceeds the total chargeable expenditures made by the
organization on the claim plus the reimbursement made by the employer. An employer who has not
timely paid reimbursement under North Dakota Century Code section 65-04-04.4 forfeits any right to
relief for that reimbursement.
History: Effective June 1, 1990; amended effective January 1, 1996; May 1, 2002; July 1, 2004;
April 1, 2020.
General Authority: NDCC 65-02-08
Law Implemented: NDCC 65-01-09, 65-04-04.3, 65-04-04.4, 65-04-17
### § 92-01-02-20. Classification of employments - Premium rates.

Classifications and premium rates must be those classifications contained in the documents
entitled "Classification Manual" and "Workforce Safety and Insurance Rates". When classifying
employment or assigning a premium rate, the organization must use the edition of the manuals in effect
during the policy period in which the premium is incurred. Rate classifications are assigned by the
organization. Rate classifications of any employer may be modified by the organization at any time.
Premium rates must be adjusted annually as recommended by the organization's actuaries based upon
the criteria found in North Dakota Century Code section 65-04-01.
History: Effective June 1, 1990; amended effective July 1, 1990; July 1, 1991; July 1, 1992; July 1,
1993; July 1, 1994; July 1, 1996; May 1, 2002; July 1, 2006; April 1, 2020.
General Authority: NDCC 65-02-08, 65-04-01
Law Implemented: NDCC 65-04-01
### § 92-01-02-21. Employee staffing arrangements.

Repealed pursuant to North Dakota Century Code section 28-32-18.1, effective July 16, 2003.
### § 92-01-02-22. Out-of-state injuries.

An employee may be deemed to regularly work at or from an employment principally localized in
this state as defined in North Dakota Century Code sections 65-08-01 and 65-08.1-01 if the employee's
out-of-state injury is sustained under circumstances in which the employee has worked outside this
state for a period of not more than thirty consecutive calendar days.

History: Effective July 1, 1991; amended effective January 1, 1994.
General Authority: NDCC 65-02-08
Law Implemented: NDCC 65-08.1-02, 65-08.1-05
### § 92-01-02-22.1. Out-of-country injuries.

The organization may, at its sole discretion, extend workers' compensation coverage by written
agreement to North Dakota employers for their employees hired in North Dakota and working outside
the United States for a limited period of time, provided the workers' compensation system of the foreign
country is not applicable to the employer and the employer provides sufficient documentation in
advance of the foreign exposure of its inability to obtain any coverage in the private insurance market.
History: Effective April 1, 2008.
General Authority: NDCC 65-02-08
Law Implemented: NDCC 65-08-01(1)(d)
### § 92-01-02-22.2. Out-of-state coverage for law enforcement training.

The organization may, at its sole discretion, extend workers' compensation coverage by written
agreement to North Dakota employers for their employees engaged in law enforcement training outside
the state for a limited period of time, provided the North Dakota employer provides documentation that
the workers' compensation system of that state is not applicable to the employer.
History: Effective October 1, 2011.
General Authority: NDCC 65-02-08
Law Implemented: NDCC 65-08-01(1)(a), 65-02-13.1
### § 92-01-02-23. Interest rate - Installment payment of premiums.

1. On March thirty-first of each year, the organization shall establish the interest rate to be
charged to accounts with policy periods renewing between July first and June thirtieth of the
following year, which elect to pay premium by installments. For the purposes of North Dakota
Century Code sections 65-04-20 and 65-04-33, the interest rate is the base rate posted by the
Bank of North Dakota plus two and one-half percent. The interest rate may not be lower than
six percent.
2. Premium subject to installments is limited to the premium for the advance premium only. Prior
period premium deficiencies must be paid in full within the original premium due date. All
payments made by an employer are applied to the oldest balance first. The organization may
apply alternative installment options.
3. Default of any installment payment causes the entire premium balance to be due immediately.
History: Effective November 1, 1991; amended effective January 1, 1996; May 1, 2002; April 1, 2014;
April 1, 2020.
General Authority: NDCC 65-02-08, 65-04-20
Law Implemented: NDCC 65-04-20, 65-04-24
### § 92-01-02-23.1. Payment by credit card.

The organization, in its sole discretion, may accept payment by credit card for premiums,
assessments, penalties, interest, reimbursements, or any other payment that is due the organization.
History: Effective January 1, 1996; amended effective April 1, 1997; April 1, 2020.
General Authority: NDCC 65-02-08
Law Implemented: NDCC 54-06-08.2

### § 92-01-02-23.2. Employers to provide security instrument.

The organization may require an employer to provide a bond, letter of credit, cash deposit, or other
security instrument approved by the organization to guarantee payment of workers' compensation
premium. The required security instrument is in addition to any other required installment payment
obligations.
1. A security instrument or cash deposit may be required when:
a. The employer does not have a permanent place of business in this state;
b. The employer is not a resident of this state;
c. The employer does not have a payment history or previously underwritten account with
the organization; or
d. The employer has a previous delinquency with the organization.
2. The security required by an employer may be the amount of premium calculated for the
applicable premium year. The security amount may be adjusted by the organization based on
changes in premium and anticipated payroll. The organization may consider all aspects of an
employer's account, including premium, rate classifications, and premium and assessment
delinquencies to determine the security required.
3. Failure to provide a security instrument as required by the organization results in the employer
being deemed uninsured and in default.
4. The organization may permit withdrawal of the security if the employer has made all premium
and assessment payments timely for two policy periods and complied with all requirements of
the organization.
5. Once an employer account is in a closed status, and any balance due on the account is paid,
the security instrument will be released.
History: Effective January 1, 2018.
General Authority: NDCC 65-02-08, 65-04-22
Law Implemented: NDCC 65-04-22
### § 92-01-02-24. Rehabilitation services.

1. If an employment opportunity suited to an employee's education, experience, and marketable
skills is identified within thirty-five miles [56.33 kilometers] from the employee's home, the
appropriate priority option must be identified as return to related occupation in the local job
pool under subdivision e of subsection 4 of North Dakota Century Code section 65-05.1-01,
and relocation expense under subsection 3 of North Dakota Century Code section
2. The organization may award services to move an employee's household where the employee
has actually located work under subdivision f of subsection 2 of North Dakota Century Code
section 65-05.1-06.1 or under subsection 3 of North Dakota Century Code section
employer, and the employee's destination. A relocation award must be the actual cost of
moving the household to the location where work has been obtained. A minimum of two bids
detailing the costs of relocation must be submitted to the organization for approval prior to
incurring the cost. The organization shall pay per diem expenses, as set forth under
subsection 2 of North Dakota Century Code section 65-05-28, for the employee only.
Reimbursement for mileage expenses may not be paid for more than one motor vehicle.

3. If the rehabilitation award is for retraining, the organization shall pay the actual cost of books,
tuition, and school supplies required by the school. The school shall provide documentation of
the costs necessary for completion of the program in which the employee is enrolled.
Reimbursable school costs may not exceed those charged to other students participating in
the same program. The award for school supplies may not exceed twenty-five dollars per
quarter or fifty dollars per semester unless the employee obtains prior approval of the
organization by showing that the expenses are reasonable and necessary. A rehabilitation
award for retraining may include tutoring assistance to employees who require tutoring to
maintain a passing grade. Payment of tutoring services must be authorized when these
services are not available as part of the training program. The award for tutoring services may
not exceed the usual and customary rate established by the school. Expenses such as
association dues or subscriptions may be reimbursed only if that expense is a course
requirement.
4. An award for retraining which includes an additional rehabilitation allowance as provided in
subdivision b of subsection 2 of North Dakota Century Code section 65-05.1-06.1 may
continue while the employee is actually enrolled or participating in the training program.
5. An award of a specified number of weeks of training means training must be completed during
the specified period of weeks, and rehabilitation benefits may be paid for the specified number
of weeks of training.
6. The organization may reimburse an employee's travel and personal expenses for attendance
at an adult learning center or skill enhancement program at the request of the employee and
upon the approval of the organization. All claims for reimbursement must be supported by the
original vendor receipt, when appropriate, and must be submitted within one year of the date
the expense was incurred. The organization shall reimburse these expenses at the rates in
effect on the date of travel or the date the expense was incurred at which state employees are
paid per diem and mileage, or reimburse the actual cost of meals and lodging plus mileage,
whichever is less. The calculation for reimbursement for travel by motor vehicle must be
calculated using miles actually and necessarily traveled. The number of miles actually traveled
is rebuttably presumed to be the least number of miles listed by Google Maps between the
start and end points of travel. The organization may not reimburse mileage or travel expenses
if the distance traveled is less than fifty miles [80.47 kilometers] one way, unless the total
mileage in a calendar month equals or exceeds two hundred miles [321.87 kilometers].
7. The organization may pay for retraining equipment required by an institution of higher
education, an institution of technical education, or an adult learning center institution
specializing in a skill enhancement program on behalf of a student attending that institution.
The organization may pay for equipment to enhance the employability skills of an injured
employee absent a determination of a retraining program. The organization will award an
injured employee one thousand two hundred dollars for the purchase of computer, warranty,
software, maintenance, and internet access. Securing and maintaining these items are the
injured employee's responsibility. Failure to maintain or secure these items does not constitute
good cause for noncompliance with vocational rehabilitation. Improper maintenance of the
equipment does not constitute good cause for noncompliance with vocational rehabilitation.
8. The organization may provide certain selected services to assist an injured employee and the
injured employee's family with coping and financial strategies while in the recovery process.
The recovery process includes the medical recovery, the ability to return to gainful
employment, and the need for financial stability. The services may include up to six sessions
with a contracted behavioral health professional and up to four sessions with a contracted
financial services professional. Injured employee participation in these sessions is voluntary.
The granting or denial of contemplated services is not appealable, and costs of the program
will be made against the general fund.

History: Effective November 1, 1991; amended effective January 1, 1996; April 1, 1997; February 1,
1998; May 1, 2002; July 1, 2006; July 1, 2010; April 1, 2012; April 1, 2016; July 1, 2017; January 1,
2022; January 1, 2024; January 1, 2026.
General Authority: NDCC 65-02-08
Law Implemented: NDCC 65-05.1-01(2), 65-05.1-02, 65-05.1-06.3
### § 92-01-02-25. Permanent impairment evaluations and disputes.

1. Definitions:
a. Amputations and loss as used in subsection 11 of North Dakota Century Code section
65-05-12.2.
"Amputation of a thumb" means disarticulation at the metacarpal phalangeal joint.
"Amputation of the second or distal phalanx of the thumb" means disarticulation at or
proximal to the interphalangeal joint.
"Amputation of the first finger" means disarticulation at the metacarpal phalangeal joint.
"Amputation of the middle or second phalanx of the first finger" means disarticulation at
or proximal to the proximal interphalangeal joint.
"Amputation of the third or distal phalanx of the first finger" means disarticulation at or
proximal to the distal interphalangeal joint.
"Amputation of the second finger" means disarticulation at the metacarpal phalangeal
joint.
"Amputation of the middle or second phalanx of the second finger" means disarticulation
at or proximal to the proximal interphalangeal joint.
"Amputation of the third or distal phalanx of the second finger" means disarticulation at or
proximal to the distal interphalangeal joint.
"Amputation of the third finger" means disarticulation at the metacarpal phalangeal joint.
"Amputation of the middle or second phalanx of the third finger" means disarticulation at
or proximal to the proximal interphalangeal joint.
"Amputation of the fourth finger" means disartriculation at the metacarpal phalangeal
joint.
"Amputation of the middle or second phalanx of the fourth finger" means disarticulation at
or proximal to the proximal interphalangeal joint.
"Amputation of the leg at the hip" means disarticulation at or distal to the hip joint
(separation of the head of the femur from the acetabulum).
"Amputation of the leg at or above the knee" means disarticulation at or proximal to the
knee joint (separation of the femur from the tibia).
"Amputation of the leg at or above the ankle" means disarticulation at or proximal to the
ankle joint (separation of the tibia from the talus).
"Amputation of a great toe" means disarticulation at the metatarsal phalangeal joint.
"Amputation of the second or distal phalanx of the great toe" means disarticulation at or
proximal to the interphalangeal joint.

"Amputation of any other toe" means disarticulation at the metatarsal phalangeal joint.
"Loss of an eye" means enucleation of the eye.
b. "Maximum medical improvement" means the injured employee's recovery has
progressed to the point where substantial further improvement is unlikely, based on
reasonable medical probability and clinical findings indicate the medical condition is
stable.
c. "Medical dispute" means an employee has reached maximum medical improvement in
connection with a work injury and has been evaluated for permanent impairment, and
there is a disagreement between health care providers arising from the physical
evaluation that affects the amount of the award. The dispute to be reviewed must clearly
summarize the underlying medical condition. It does not include disputes regarding
proper interpretation or application of the American medical association guides to the
evaluation of permanent impairment, sixth edition. It does not include disputes arising
from an impairment percentage rating or an impairment opinion given by a health care
provider when the health care provider is not trained in the American medical association
guides to the evaluation of permanent impairment, sixth edition, and when the health
care provider's impairment percentage rating or impairment opinion do not meet the
requirements of subsection 5 of North Dakota Century Code section 65-05-12.2.
d. "Potentially eligible for an impairment award" means the medical evidence in the claim
file indicates an injured employee has reached maximum medical improvement and has
a permanent impairment caused by the work injury that will likely result in a monetary
impairment award.
e. "Treating health care provider" means an allied health care professional who has
physically examined or provided direct care or treatment to the injured employee.
2. Permanent impairment evaluations must be performed in accordance with the American
medical association guides to the evaluation of permanent impairment, sixth edition, and
modified by this section. All permanent impairment reports must include the opinion of the
health care provider on the cause of the impairment and must contain an apportionment if the
impairment is caused by both work-related and non-work-related injuries or conditions.
3. The organization shall schedule an evaluation with a health care provider who has the training
and experience necessary to conduct an evaluation of permanent impairment and apply the
American medical association guides to the evaluation of permanent impairment, sixth edition.
The organization may not use nor consider a permanent impairment evaluation conducted by
the employee's treating health care provider or any health care provider who has treated the
injured employee for the work-related injury. In the event of a medical dispute, the organization
will identify qualified specialists and submit all objective medical documentation regarding the
dispute to specialists who have the knowledge, training, and experience in the application of
the American medical association guides to the evaluation of permanent impairment, sixth
edition.
4. Upon receiving a permanent impairment rating report from the health care provider, the
organization shall audit the report and shall issue a decision awarding or denying permanent
impairment benefits.
a. Pain impairment ratings. A permanent impairment award may not be made upon a rating
solely under chapter 3 of the sixth edition.
b. Mental and behavioral disorders are not independently compensable and are
encompassed within the rating for physical impairment.

c. In chapters that include assessment of the functional history as one of the nonkey factors
to adjust the final impairment rating within a class by using a self-report tool, the
examining health care provider is to score the self-report tool and assess results for
consistency and credibility before adjusting the impairment rating higher or lower than the
default value. The evaluating health care provider must provide rationale for deciding that
functional test results are clinically consistent and credible.
d. A functional history grade modifier may be applied only to the single, highest
diagnosis-based impairment.
e. All permanent impairment reports must include an apportionment if the impairment is
caused by both work and non-work injuries or conditions.
5. Pollicization procedures will be rated as an impairment under subsection 11 of North Dakota
Century Code section 65-05-12.2, relating to scheduled injury, and may not be rated as a
whole body impairment, unless otherwise specified under subsection 11 of North Dakota
Century Code section 65-05-12.2.
History: Effective November 1, 1991; amended effective January 1, 1996; April 1, 1997; May 1, 1998;
May 1, 2000; May 1, 2002; July 1, 2004; July 1, 2006; April 1, 2009; July 1, 2010; April 1, 2012; July 1,
2017; January 1, 2018; April 1, 2020; January 1, 2024.
General Authority: NDCC 65-02-08
Law Implemented: NDCC 65-05-12.2
### § 92-01-02-26. Binding arbitration.

Repealed effective July 1, 2006.
### § 92-01-02-27. Medical and hospital fees - Reimbursement methods.

Maximum medical and hospital fees paid by the organization, including reimbursement for
pharmaceuticals and durable medical equipment, are determined in accordance with the most current
edition of the organization's fee schedule guidelines or the organization's formulary and medication
restrictions list. Reimbursement for services and procedures not addressed within the fee schedules or
lists will be determined on a "by report" basis, in which case a description of the nature, extent and
need for the procedure or service, including the time, skills, equipment, and any other pertinent facts
necessary to furnish the procedure or service, must be provided to the organization.
History: Effective January 1, 1992; amended effective January 1, 1994; October 1, 1998; January 1,
2000; May 1, 2002; April 1, 2020; January 1, 2026.
General Authority: NDCC 65-02-08
Law Implemented: NDCC 65-02-08
### § 92-01-02-28. Health care advisory board.

Repealed effective October 1, 1998.
### § 92-01-02-29. Medical services - Definitions.

The definitions found in North Dakota Century Code title 65 apply to terms contained in this title. In
addition, unless the context otherwise requires, for purposes of sections 92-01-02-27 through
92-01-02-48:
1. "Bill audit" means the review of medical bills and associated medical records by the
organization or the managed care vendor, including review for duplications, omissions, actual
delivery of billed services and items, accuracy of charges and associated coding, coding

documentation guidelines, coverage, concurrent billing for covered and noncovered services,
and application of fee schedules.
2. "Case management" means the ongoing coordination of medical services provided to an
injured employee, including:
a. Developing a treatment plan to provide appropriate medical services to an injured
employee.
b. Systematically monitoring the treatment rendered and the medical progress of the injured
employee.
c. Assessing whether alternative medical services are appropriate and delivered in a
cost-effective manner based upon acceptable medical standards.
d. Ensuring the injured employee is following the prescribed medical plan.
e. Formulating a plan for keeping the injured employee safely at work or expediting a safe
return to work.
3. "Consulting health care provider" means a licensed health care provider who examines an
injured employee, or the injured employee's medical record, at the request of the primary
health care provider to aid in diagnosis or treatment. A consulting health care provider, at the
request of the primary health care provider, may provide specialized treatment of the
compensable injury and give advice or an opinion regarding the treatment being rendered or
considered for an injured employee's injury.
4. "Debilitating side effects" means an adverse effect to a treatment or medication which in and
of itself precludes return to employment or participation in vocational rehabilitation services.
5. "Elective surgery" means surgery that may be required in the process of recovery from an
injury or illness but need not be done as an emergency to preserve life, function, or health.
Pain, of itself, does not constitute a surgical emergency.
6. "Emergency" means a medical condition that manifests itself by symptoms of sufficient
severity, which may include severe pain, to cause a prudent layperson possessing an average
knowledge of health and medicine to reasonably conclude that immediate medical treatment
is required to avoid serious impairment of a bodily function, or serious dysfunction of any body
part, or jeopardizing the person's life.
7. "Fee schedule" means the organization's rules and maximum payment amounts that govern
how health care providers are reimbursed.
8. "Functional capacity evaluation" means an objective, directly observed, measurement of an
injured employee's ability to perform a variety of physical tasks combined with subjective
analyses of abilities by the injured employee and the evaluator. A physical tolerance screening
and a Blankenship's functional evaluation are functional capacity evaluations.
9. "Improved pain control" means the effectiveness of a treatment or medication which results in
at least thirty percent reduction in pain scores.
10. "Increase in function" means the effectiveness of a treatment or medication which results in
either a resumption of activities of daily living, a return to employment, or participation in
vocational rehabilitation services.
11. "Managed care" means services performed by the organization or a managed care vendor,
including prior authorization or preservice reviews, disability management services, case

management services, ambulatory reviews, retrospective reviews, preadmission reviews, and
medical bill audit.
12. "Managed care vendor" means a vendor that is retained by the organization to provide
managed care services.
13. "Medical service" means a medical, surgical, chiropractic, psychological, dental, hospital,
nursing, ambulance, and other related or ancillary service, including physical and occupational
therapy, medications, durable medical equipment, and physical restoration and diagnostic
services, or a service outlined in section 92-01-02-30.
14. "Medical service provider" means an allied health care professional, hospital, medical clinic, or
vendor of medical services.
15. "Medically stationary" means the "date of maximum medical improvement" as defined in North
Dakota Century Code section 65-01-02 has been reached.
16. "Notice of nonpayment" means the form by which an injured employee is notified of charges
denied by the organization which are the injured employee's personal responsibility.
17. "Pharmacy services" means services rendered by a pharmacist in pharmaceutical care,
selection, counseling, dispensing, use, administration, prescription monitoring, medication
therapy management, disease state management, drug utilization evaluation or review,
vaccination, testing, or collaborative therapy management provided in a pharmacy, clinic,
hospital or medical institution.
18. "Primary health care provider" means a health care provider who is primarily responsible for
the treatment of an injured employee's compensable injury.
19. "Prior authorization" or "preservice review" means the evaluation by the organization or a
managed care vendor of a proposed medical service for medical necessity, appropriateness,
and efficiency prior to the services being performed based on medically accepted standards
and an objective evaluation of the medical services.
20. "Remittance advice" means the form used by the organization to inform payees of the reasons
for payment, reduction, or denial of medical services.
21. "Retrospective review" means the organization's or a managed care vendor's review of a
medical service for medical necessity, appropriateness, and efficiency after treatment has
occurred.
22. "Special report" means an allied health care professional's written response to a specific
request from the organization for information, including information on causation, aggravation,
preexisting conditions, and clarification of complex medical conditions, requiring the creation
of a new document or the previously unperformed analysis of existing data. The explanatory
reports required for procedures designated as "by report" under section 92-01-02-27 are not
special reports.
23. "Utilization review" means the provision of prior authorization or preservice review, the review
of medical patterns and trends, and the analysis of the appropriateness of medical services
provided to an injured employee based on medically accepted standards and an objective
evaluation of the medical services.
24. "Work hardening" or "work conditioning" means an individualized, medically prescribed and
monitored, work-oriented treatment process which involves the injured employee participating
in an exercise program or simulated or actual work tasks that are structured and graded to

progressively increase physical tolerances, stamina, endurance, and productivity to return the
injured employee to any level of work or a specified job.
History: Effective January 1, 1994; amended effective October 1, 1998; January 1, 2000; May 1, 2002;
April 1, 2014; April 1, 2016; April 1, 2020; January 1, 2022; January 1, 2024; January 1, 2026.
General Authority: NDCC 65-02-08, 65-02-20, 65-05-07
Law Implemented: NDCC 65-02-20, 65-05-07
### § 92-01-02-29.1. Medical necessity.

1. A medical service or supply necessary to diagnose or treat a compensable injury, which is
appropriate to the location of service, is medically necessary if it is widely accepted by the
practicing peer group and has been determined to be safe and effective based on published,
peer-reviewed, scientific studies.
2. Services that present a hazard in excess of the expected medical benefits are not medically
necessary. Services that are controversial, obsolete, experimental, or investigative are not
reimbursable unless specifically preapproved or authorized by the organization. Requests for
authorization must contain a description of the treatment and the expected benefits and
results of the treatment.
3. The organization will not authorize or pay for the following treatment:
a. Massage therapy unless specifically preapproved or otherwise authorized by the
organization. Massage therapy must be provided by a licensed physical therapist,
licensed occupational therapist, or licensed chiropractor.
b. Chemonucleolysis; acupressure; reflexology; rolfing; injections of colchicine except to
treat an attack of gout precipitated by a compensable injury; injections of chymopapain;
injections of fibrosing or sclerosing agents except where varicose veins are secondary to
a compensable injury; and injections of substances other than cortisone, anesthetic, or
contrast into the subarachnoid space (intrathecal injections).
c. Treatment to improve or maintain general health (i.e., prescriptions or injections of
vitamins, nutritional supplements, diet and weight loss programs, programs to quit
smoking) unless specifically preapproved or otherwise authorized by the organization.
Over-the-counter medications may be allowed in lieu of prescription medications when
approved by the organization and prescribed by the health care provider and dispensed
and processed according to the current pharmacy transaction standard. Dietary
supplements, including minerals, vitamins, and amino acids are reimbursable if a specific
compensable dietary deficiency has been clinically established in the claimant. Vitamin
B-12 injections are reimbursable if necessary because of a malabsorption resulting from
a compensable gastrointestinal disorder.
d. Articles such as beds, hot tubs, chairs, Jacuzzis, vibrators, heating pads, home
furnishings, waterbeds, exercise equipment, cold packs, hot packs, and gravity traction
devices are not compensable except at the discretion of the organization under
exceptional circumstances.
e. Vertebral axial decompression therapy (Vax-D treatment).
f. Intradiscal electrothermal annuloplasty (IDET).
g. Prolotherapy (sclerotherapy).
h. Surface electromyography (surface EMG).

i. Athletic trainer services that are provided to a claimant via an agreement, or a contract of
employment between a trainer and a claimant's employer, or an entity closely associated
with the employer.
j. Spine strengthening program (e.g. MedX or SpineX or other substantially equivalent
program).
k. Electrodiagnostic studies performed by electromyographers who are not certified or
eligible for certification by the American board of electrodiagnostic medicine, American
board of physical medicine and rehabilitation, or the American board of neurology and
psychiatry's certification in the specialty of clinical neurophysiology. Nerve conduction
study reports must include either laboratory reference values or literature-documented
normal values in addition to the test values to be eligible for payment.
l. Trigger point injections. No more than twenty injections may be paid over the life of a
claim. If a trigger point injection is administered, the organization may not pay for
additional modalities such as cryotherapy and osteopathic manipulations performed in
conjunction with the trigger point injection. For purposes of this paragraph, injections
billed under CPT code 20552 or 20553 count as a single injection.
m. Acupuncture therapy. No more than eighteen treatments may be paid for the life of the
claim. The organization may waive this requirement in conjunction with programs
designed to ensure the ongoing evolution of managed care to meet the needs of injured
workers and providers.
n. Dry needling.
o. Opioid therapy exceeding ninety milligrams morphine equivalents daily unless the
following criteria are met when a prescription exceeding ninety milligrams morphine
equivalents daily is exceeded and as the organization deems necessary:
(1) Documented treatment plan consistent with the organization's utilization review
process;
(2) Participation in a psychosocial consult with a health care provider, preferably a
licensed psychologist or psychiatrist outside the health care provider's network, to
address the risk and harms of opioid use under the centers for disease control and
prevention "Guideline for Prescribing Opioids for Chronic Pain". The psychosocial
consult should include standardized screening using validated tools for mental
health and substance abuse conditions, as well as a risk stratification plan; and
(3) Recent documentation of attempts to taper opioid use and employ non-opioid
therapies for pain control.
p. Benzodiazepine therapies extending beyond a cumulative duration of four weeks, unless
prescribed for treatment of a compensable anxiety disorder. In addition, the following
criteria must be met when the cumulative duration of four weeks is exceeded and as the
organization deems necessary:
(1) A documented treatment plan consistent with the organization's utilization review
process;
(2) Participation in a psychosocial consult with a health care provider, preferably a
licensed psychologist or psychiatrist outside the health care provider's network, to
address the risk and harms of benzodiazepine use. The psychosocial consult
should include standardized screening using validated tools for mental health and
substance abuse conditions, as well as a risk stratification plan; and

(3) Recent documentation of attempts to taper benzodiazepine use and employ
non-benzodiazepine therapies.
History: Effective January 1, 1994; amended effective October 1, 1998; January 1, 2000; May 1, 2002;
July 1, 2004; July 1, 2006; April 1, 2008; April 1, 2009; July 1, 2010; April 1, 2012; April 1, 2014; April 1,
2016; July 1, 2017; April 1, 2020; January 1, 2022.
General Authority: NDCC 65-02-08, 65-02-20, 65-05-07
Law Implemented: NDCC 65-02-20, 65-05-07, 65-05-40
### § 92-01-02-29.2. Acceptance of rules and fees.

Medical service providers rendering treatment of any kind, regardless of the state or country where
services are provided, including inpatient and outpatient services, to a claimant who comes under the
organization's jurisdiction must comply with managed care services under these rules. All providers
shall cooperate with the organization and the managed care vendor and shall provide to the
organization or the managed care vendor, without additional charge, the medical information requested
in relation to the reviewed service.
History: Effective January 1, 1994; amended effective October 1, 1998; January 1, 2000.
General Authority: NDCC 65-02-08, 65-02-20, 65-05-07
Law Implemented: NDCC 65-02-20, 65-05-07
### § 92-01-02-29.3. Motor vehicle purchase and modification.

1. An order is required from the primary health care provider with documentation of objective
medical evidence that supports the necessity for purchase of a specially equipped motor
vehicle or modification of an existing motor vehicle directly due to the compensable work
injury.
a. The order must be obtained and submitted to the organization prior to consideration of a
purchase or modification.
b. The order must include the date of an in-person office visit that coincides with the date of
the order.
2. Prior to any motor vehicle modification or specially equipped motor vehicle purchase, the
organization shall complete a review to determine if the most appropriate assistive device is
currently being utilized by an injured employee for the injured employee's functional needs.
The review by the organization may require the following criteria:
a. A primary health care provider shall provide a referral for a mobility assessment.
b. The mobility assessment must be performed by a licensed or certified occupational or
physical therapist with specific training in rehabilitation mobility or functional evaluations.
c. The mobility assessment report must contain clear documentation of functional limits of
standing and walking with an assistive device and documentation to support how the
other assistive devices were ruled out as not medically appropriate for functional needs.
3. If the appropriate assistive device is determined through the mobility assessment process, the
organization may begin the review for a specially equipped motor vehicle purchase or motor
vehicle modification eligibility, if appropriate.
4. Upon completion of the mobility assessment, if a manual wheelchair, power mobility device, or
both are needed, the following must occur:

a. A primary health care provider shall provide a referral for a wheelchair or seating
evaluation.
b. The wheelchair or seating evaluation must be completed by an assistive technology
professional or similarly situated professional, which includes an itemization of all
elements needed for the manual wheelchair or power mobility device and matches the
functional deficits outlined in the mobility assessment.
c. Upon completion of the wheelchair or seating evaluation, an analysis must be completed
by the assistive technology professional or similarly situated professional to determine
the appropriate vehicle modifications that match the mobility assessment and the
wheelchair or seating evaluation.
5. If an existing vehicle cannot be repaired or modified, the organization, in its sole discretion,
may approve the purchase of a specially equipped motor vehicle.
6. The organization may request a minimum of two itemized cost quotes. The organization may
decrease or add the number of cost quotes needed accordingly.
7. Actual vehicle or modification purchase may not occur until the organization reviews the
request and issues recommendations or decisions as to whether eligible for the benefit.
8. Any appeal of a decision under this section must be adjudicated pursuant to North Dakota
Century Code section 65-02-20.
History: Effective April 1, 2009; amended effective April 1, 2012; April 1, 2014; July 1, 2017; April 1,
2020; January 1, 2026.
General Authority: NDCC 65-02-08
Law Implemented: NDCC 65-05-07(5)(b)
### § 92-01-02-29.4. Home modifications.

1. An order is required from the primary health care provider with documentation of objective
medical evidence that supports the necessity for home modifications directly due to the
compensable work injury.
a. The order must be obtained and submitted to the organization prior to consideration of a
home modification.
b. The order must include the date of an in-person office visit that coincides with the date of
the order.
2. Prior to any home modifications, the organization shall complete a review to determine if the
most appropriate assistive device is currently being utilized by an injured employee for the
injured employee's functional needs. The review by the organization may require the following
criteria:
a. A primary health care provider referral for a mobility assessment.
b. The mobility assessment must be performed by a licensed or certified occupational or
physical therapist with specific training in rehabilitation mobility or functional evaluations.
c. The mobility assessment report must contain clear documentation of functional limits of
standing and walking with an assistive device and have documentation to support how
the other assistive devices were ruled out as not medically appropriate for functional
needs.

3. If the appropriate assistive device is determined through the mobility assessment process, the
organization may begin the review for home modification eligibility, if appropriate.
4. A primary health care provider shall make a referral for an in-home functional assessment to
be completed in the home environment:
a. The in-home functional assessment shall be performed by a licensed or certified
occupational or physical therapist with specific training in rehabilitation mobility or
functional evaluations.
b. The in-home functional assessment must be completed in-person. Virtual assessments
may be approved as determined by the organization.
c. The in-home functional assessment report must contain documentation of the functional
limitation the modification is addressing and the medical need for that modification.
5. The organization may request a minimum of two itemized cost quotes. The organization may
decrease or add the number of cost quotes needed accordingly.
6. Actual construction or modification cannot occur until the organization reviews the request and
issues recommendations or decisions as to eligibility for the benefit.
7. Payment by the organization may not occur until the modification work is completed, or at
least, completed in documented phases or at the discretion of the organization.
8. The organization may request that the contractor for proposed home modification be in good
standing (example: licensed in the state, bonded, etc.)
9. Real estate modifications to driveways, sidewalks, or passageways may be approved if
evidence supports that those routes are needed to provide safe passageway for the injured
employee.
10. Any appeal of a decision under this section must be adjudicated pursuant to North Dakota
Century Code section 65-02-20.
11. Modifications will be considered upon receipt of documentation establishing injured
employee's ownership of the residence to be permanently modified.
12. Modifications within new construction will be considered upon receipt of the original floor
plan/specifications and cost estimate, as well as the modified floor plan and cost estimate.
History: Effective April 1, 2012; amended effective April 1, 2014; April 1, 2016; July 1, 2017; April 1,
2020; January 1, 2026.
General Authority: NDCC 65-02-08
Law Implemented: NDCC 65-05-07
### § 92-01-02-29.5. Power mobility devices.

1. An order is required from the primary health care provider with documentation of objective
medical evidence that supports the necessity for a power mobility device directly due to the
compensable work injury.
a. The order must be obtained and submitted to the organization prior to consideration of a
purchase.
b. The order must include the date of an in-person office visit that coincides with the date of
the order.

2. Prior to any power mobility device purchase, the organization shall complete a review to
determine if the most appropriate assistive device is currently being utilized by an injured
employee for the injured employee's functional needs. The review by the organization may
require the following criteria:
a. A primary health care provider shall provide a referral for a mobility assessment.
b. The mobility assessment must be performed by a licensed or certified occupational or
physical therapist with specific training in rehabilitation mobility or functional evaluations.
c. The mobility assessment report must contain clear documentation of the functional limits
of standing and walking with an assistive device. Documentation contained in the mobility
assessment must support reasons why a cane, walker, or manual wheelchair cannot be
used to complete activities of daily living.
3. If the appropriate assistive device is determined through the mobility assessment process, the
organization may begin the review for power mobility device eligibility, if appropriate.
4. Upon completion of the mobility assessment, if a manual wheelchair, power mobility device, or
both are needed, the following must occur:
a. A primary health care provider shall provide a referral for a wheelchair or seating
evaluation.
b. The wheelchair or seating evaluation must be completed by an assistive technology
professional or similarly situated professional, which includes an itemization of all
elements needed for the manual wheelchair or power mobility device and matches the
functional deficits outlined in the mobility assessment.
c. The organization may request a minimum of one itemized cost quote for the power
mobility device from the medical service provider. The organization may request a
second itemized cost quote from the medical service provider at the organization's
discretion.
5. If the power mobility device is primarily intended for outdoor use or recreational purposes, the
device is not medically necessary.
6. Upgrades to a power mobility device are not considered medically necessary if the upgrade is
intended primarily for luxury, outdoor, or recreational purposes. Specific items such as power
tilt or recline seating will only be approved if the injured employee is at risk of additional
medical complications, has issues with transfer, or an upgrade will help manage the injured
employee's tone and spasticity.
7. If an injured employee does not sustain a catastrophic injury or if exceptional circumstances
do not exist as provided in subsection 5 of North Dakota Century Code section 65-05-07, but
the injured employee is approved for a power mobility device, the organization, in its sole
discretion, may approve a vehicle modification or adaptation for the injured employee, but may
not approve a vehicle purchase.
8. All initial and replacement requests for power mobility devices must meet the criteria in this
section.
9. An appeal of a decision made by the organization under this section must be adjudicated
pursuant to North Dakota Century Code section 65-02-20.
History: Effective July 1, 2017; amended effective April 1, 2020; January 1, 2026.
General Authority: NDCC 65-02-08

Law Implemented: NDCC 65-05-07
### § 92-01-02-29.6. Footwear.

1. An order is required from the primary health care provider with documentation of objective
medical evidence that supports the necessity for purchase of footwear directly due to the
compensable work injury.
a. The order must be obtained and submitted to the organization prior to consideration of
purchase.
b. The order must include the date of an in-person office visit that coincides with the date of
the order and a specific description of the footwear being requested.
2. The organization shall purchase one pair of footwear per claim during the acute rehabilitation
phase.
3. The organization shall pay a medical service provider for modifications to regular footwear
purchased by an injured employee after a billing is received by the medical service provider if
the modifications are due to the work injury and there is objective medical evidence to support
the necessity of the modifications.
4. Custom orthotic inserts and custom-made medical orthotic shoes must be preapproved by the
organization. There must be objective medical evidence to support custom orthotic inserts and
custom-made medical orthotic shoes must be a necessity due to the work injury.
5. The organization shall approve the footwear prior to purchase. If the footwear is approved, the
organization shall pay the medical service provider after a billing is received. The organization
may not prepay an injured employee to purchase footwear and may not place orders for
footwear for an injured employee.
6. An appeal of a decision made by the organization under this section must be adjudicated
pursuant to North Dakota Century Code section 65-02-20.
History: Effective April 1, 2020: amended effective January 1, 2024; January 1, 2026.
General Authority: NDCC 65-02-08
Law Implemented: NDCC 65-02-20, 65-05-07
### § 92-01-02-29.7. Prosthetic devices.

1. For the initial prosthesis an order is required from the primary health care provider with
documentation of objective medical evidence that supports the necessity for purchase of a
prosthesis directly due to the compensable work injury.
a. The order must be obtained and submitted to the organization prior to consideration of
purchase.
b. The order must include the date of an in-person office visit that coincides with the date of
the order and a specific description of the type of prosthesis being requested.
2. An injured employee shall undergo an evaluation and assessment by a treating provider,
therapist, or prosthetist and that evaluation must contain recommendations based on medical
necessity and conform to the primary health care provider's order.
3. The organization may require additional assessments to determine the functional levels of an
injured employee who is being considered for the prosthesis.

4. The organization will purchase and maintain a single prosthesis per affected limb absent
extraordinary circumstances. Extraordinary circumstances are determined by the organization
in its sole discretion. Extraordinary circumstances may not be supported by nonwork activities.
5. The prosthesis must be a body-powered device absent extraordinary circumstances.
Extraordinary circumstances are determined by the organization in its sole discretion.
Extraordinary circumstances may not be supported by nonwork activities.
6. The organization shall approve the prosthesis prior to purchase. If the prosthesis is approved,
the organization shall compensate the medical services provider according to the appropriate
fee schedule.
7. Repurchase or repair of a prosthesis must be determined by the organization in its sole
discretion.
8. Replacement requests for a prosthesis must meet independently the criteria in this section.
9. A minimum of two itemized cost quotes may be requested by the organization. The
organization may decrease or add the number of cost quotes required.
10. An appeal of a decision made by the organization under this section must be adjudicated
pursuant to North Dakota Century Code section 65-02-20.
History: Effective January 1, 2024; amended effective January 1, 2026.
General Authority: NDCC 65-02-08
Law Implemented: NDCC 65-02-20, 65-05-07
### § 92-01-02-30. Medical services.

1. Medical services.
a. Medical services that are not medically necessary are not reimbursable.
b. Frequency and extent of treatment may not be more than the nature of the injury or
process of recovery requires, and must be provided in accordance with utilization and
treatment standards as prescribed by the organization or the managed care vendor. The
organization may require evidence of the efficacy of treatment.
2. Medical services may be reimbursed only when provided according to a written treatment
plan. A copy of the treatment plan, signed by the allied health care professional, must be
provided to the organization within fourteen days of beginning the treatment or within fourteen
days of learning that the treatment is claimed to be work-related, whichever occurs later.
However, a treatment plan is not required for a short course of treatment consisting of one or
two visits.
3. For purposes of this section, a treatment plan must include:
a. Objectives, including the degree of restoration anticipated.
b. Measurable goals.
c. Modalities and specific therapies to be used.
d. Frequency and duration of treatments to be provided.
e. Condition of the claimant which may require periodic modification of the plan of care
based on:

(1) Improvements in the claimant's status.
(2) Failure of the claimant to improve as expected.
(3) Intervention of care rendered, including education of the claimant, when
appropriate.
(4) Specific operative reports, test results, and consultation reports.
4. The cost of preparing a written treatment plan and supplying progress notes under this section
is included in the fee for the medical service.
5. The treatment plan requirements of this section may be modified or waived by the
organization.
6. X-ray images must be of diagnostic quality. Billings for x-rays are not reimbursable without a
report of the findings. Upon request of either the organization or the managed care vendor,
original x-ray images must be forwarded to the organization or the managed care vendor. A
reasonable charge may be made for the costs of delivery of images.
7. A generic brand of therapeutic equivalence must be dispensed, provided the generic
medication costs less. If the injured employee does not accept the generic equivalent at a
lower price, the injured employee is responsible for the cost difference between the generic
and brand name prescription medication. A branded equivalent of a generically available
medication requires prior approval by the organization and will be covered only when objective
medical evidence exists that the injured employee developed an adverse response to the
generic medication.
History: Effective January 1, 1994; amended effective October 1, 1998; January 1, 2000; May 1, 2002;
October 1, 2006; April 1, 2020; January 1, 2024.
General Authority: NDCC 65-02-08, 65-02-20, 65-05-07
Law Implemented: NDCC 65-02-20, 65-05-07
### § 92-01-02-31. Who may be reimbursed.

1. Treatment that falls within the scope and field of the treating allied health care professional's
license to practice is reimbursable.
2. Paraprofessionals who are not independently licensed shall practice under the direct
supervision of a licensed allied health care professional whose scope of practice and specialty
training includes the service provided by the paraprofessional to be reimbursed.
3. Medical service providers may be refused reimbursement to treat cases under the jurisdiction
of the organization.
4. An entity operating under the authority of the federal government and granted authority to
receive direct reimbursement for payments made for medical treatment determined to be
related to the workers' compensation injury may be reimbursed.
5. Reasons for holding a medical service provider ineligible for reimbursement include one or
more of the following:
a. Failure, neglect, or refusal to submit complete, adequate, and detailed reports.
b. Failure, neglect, or refusal to respond to requests by the organization for additional
reports.
c. Failure, neglect, or refusal to respond to requests by the organization for drug testing.

d. Failure, neglect, or refusal to observe and comply with the organization's orders and
medical service rules, including cooperation with the organization's managed care
vendors.
e. Failure to notify the organization immediately and prior to burial in any death if the cause
of death is not definitely known or if there is question of whether death resulted from a
compensable injury.
f. Failure to recognize emotional and social factors impeding recovery of injured
employees.
g. Unreasonable refusal to comply with the recommendations of board-certified or qualified
specialists who have examined the injured employee.
h. Submission of false or misleading reports to the organization.
i. Collusion with other persons in submission of false or misleading information to the
organization.
j. Pattern of submission of inaccurate or misleading bills.
k. Pattern of submission of false or erroneous diagnosis.
l. Billing the difference between the maximum allowable fee set forth in the organization's
fee schedule and usual and customary charges, or billing the injured employee any other
fee in addition to the fee paid, or to be paid, by the organization for individual treatments,
equipment, and products.
m. Failure to include physical conditioning in the treatment plan. The medical service
provider should determine the injured employee's activity level, ascertain barriers specific
to the injured employee, and provide information on the role of physical activity in injury
management.
n. Failure to include the injured employee's functional abilities in addressing return-to-work
options during the recovery phase.
o. Treatment that is controversial, experimental, or investigative; which is contraindicated or
hazardous; which is unreasonable or inappropriate for the work injury; or which yields
unsatisfactory results.
p. Certifying disability in excess of the actual medical limitations of the injured employee.
q. Conviction in any court of any offense involving moral turpitude, in which case the record
of the conviction is conclusive evidence.
r. The excessive use, or excessive or inappropriate prescription for use, of narcotic,
addictive, habituating, or dependency inducing drugs.
s. Declaration of mental incompetence by a court of competent jurisdiction.
t. Disciplinary action by a licensing board resulting in suspension or revocation of the allied
health care provider's license.
History: Effective January 1, 1994; amended effective October 1, 1998; January 1, 2000; July 1, 2010;
July 1, 2017; January 1, 2018; April 1, 2020; January 1, 2026.
General Authority: NDCC 65-02-08, 65-02-20, 65-05-07
Law Implemented: NDCC 65-02-20, 65-05-07

### § 92-01-02-32. Physician assistant rules.

Physician assistants may be reimbursed within the scope of their licenses for services performed
under the supervision of a licensed physician.
History: Effective January 1, 1994; amended effective October 1, 1998; January 1, 2000; May 1, 2002;
April 1, 2009; April 1, 2020.
General Authority: NDCC 65-02-08, 65-02-20, 65-05-07
Law Implemented: NDCC 65-02-20, 65-05-07
### § 92-01-02-32.1. Physical therapy assistants, certified occupational therapy assistants, and

certified athletic trainers.
Physical therapist assistants, certified occupational therapist assistants, and certified athletic
trainers may be reimbursed when providing treatment under the direction and general supervision of
the physical therapist or occupational therapist. Physical and occupational therapists are responsible
for the assistants under their direction and supervision. Examination, evaluation, diagnosis, prognosis,
and outcomes are the sole responsibility of the physical therapist and occupational therapist. Physical
therapist assistants, certified occupational therapist assistants, and certified athletic trainers are not
allowed to perform functional capacity evaluations. Treatment by physical therapy aides or physical
therapy technicians is neither recognized nor will be reimbursed.
History: Effective July 1, 2017; amended effective April 1, 2020.
General Authority: NDCC 65-02-08, 65-02-20, 65-05-07
Law Implemented: NDCC 65-02-20, 65-05-07
### § 92-01-02-33. Utilization review and quality assurance.

The organization has instituted a program of utilization review and quality assurance to monitor and
control the use of health care services. The organization shall develop and identify the mode and
manner of submissions for utilization review and quality assurance requests.
1. Prior authorization for services must be obtained from the organization or its managed care
vendor at least seventy-two hours or three business days in advance of providing certain
medical treatment, equipment, or supplies. Medical services requiring prior authorization or
preservice review are outlined in section 92-01-02-34. Emergency medical services may be
provided without prior authorization, but notification is required within twenty-four hours of, or
by the end of the next business day following, initiation of emergency treatment.
Reimbursement may be withheld, or recovery of prior payments made, if utilization review
does not confirm the medical necessity of emergency medical services.
2. Documentation of the need for and efficacy of continued medical care by the allied health care
professional is required at the direction or request of the organization or the managed care
vendor while a claim is open.
3. The organization may require second opinion consultations prior to the authorization of
reimbursement for surgery and for conservative care which extends past sixty days following
the initial visit.
4. The organization may require preoperative psychosocial screens and psychological
evaluations prior to the authorization of reimbursement for surgery. The organization may
select the evaluators who will perform the screens and evaluations.
5. The organization may use the Official Disability Guidelines, the American College of
Occupational and Environmental Medicine's Occupational Medicine Practice Guidelines,
Guide to Physical Therapy Practice, The Medical Disability Advisor, Diagnosis and Treatment
for Physicians and Therapists Upper Extremity Rehabilitation, Treatment Guidelines of the

American Society of Hand Therapists, American Medical Association Guides to the Evaluation
of Disease and Injury Causation, or any other treatment and disability guidelines or standards
it deems appropriate to administer claims.
History: Effective January 1, 1994; amended effective October 1, 1998; January 1, 2000; July 1, 2006;
April 1, 2012; July 1, 2017; April 1, 2020.
General Authority: NDCC 65-02-08, 65-02-20, 65-05-07
Law Implemented: NDCC 65-02-20, 65-05-07
### § 92-01-02-34. Treatment requiring prior authorization, preservice review, and retrospective

review.
1. Certain treatment procedures require prior authorization or preservice review by the
organization or its managed care vendor. Requests for prior authorization or preservice review
must include a statement of the condition diagnosed; their relationship to the compensable
injury; the medical documentation supporting medical necessity, an outline of the proposed
treatment program, its length and components, and expected prognosis.
2. Requesting prior authorization or preservice review is the responsibility of the allied health
care professional who provides or prescribes a service for which prior authorization or
preservice review is required.
3. Allied health care professionals shall request prior authorization directly from the claims
adjuster for the items listed in this subsection. The claims adjuster shall respond to requests
within fourteen days.
a. Durable medical equipment.
(1) The organization shall pay rental fees for equipment if the need for the equipment is
for a short period of treatment during the acute phase of a compensable work injury.
The claims adjuster shall grant or deny authorization for reimbursement of
equipment based on whether the injured employee is eligible for coverage and
whether the equipment prescribed is appropriate and medically necessary for
treatment of the compensable injury. Rental extending beyond sixty days requires
prior authorization from the claims adjuster. If the equipment is needed on a
long-term basis, the organization may purchase the equipment. The claims adjuster
shall base its decision to purchase the equipment on a comparison of the projected
rental costs of the equipment to its purchase price. The organization shall purchase
the equipment from the most cost-efficient source.
(2) The claims adjuster shall authorize and pay for durable medical equipment,
including prosthetics and orthotics, as needed by the injured employee because of a
compensable work injury when substantiated by the health care provider. If the
items are furnished by the medical service provider or another provider, the
organization shall reimburse the medical service provider pursuant to its fee
schedule. Medical service providers shall supply the organization with a copy of
their original invoice showing actual cost of the item upon request of the
organization. Actual cost is a factor considered in determining cost-effectiveness
under North Dakota Century Code section 65-02-20. The organization shall repair or
replace originally provided damaged, broken, or worn-out prosthetics, orthotics, or
special equipment devices upon documentation from the health care provider that
replacement or repair is needed. Prior authorization for replacements is required.
(3) Equipment costing less than five hundred dollars does not require prior
authorization but remains subject to the organization's durable medical equipment
guidelines.

(4) An injured employee shall obtain a health care provider's order of medical necessity
before the purchase of a mobility assistance device.
(5) The organization may require assessments to determine the functional levels of an
injured employee who is being considered for a mobility assistance device.
b. Biofeedback programs; pain clinics; psychotherapy; physical rehabilitation programs,
including health club memberships and work hardening programs; chronic pain
management programs; and other programs designed to treat special problems.
c. Concurrent care. In some cases, treatment by more than one medical service provider
may be allowed. The claims adjuster shall consider concurrent treatment if the accepted
conditions resulting from the injury involve more than one system or require specialty or
multidisciplinary care. If requesting consideration for concurrent treatment, the primary
health care provider shall provide the claims adjuster with the name, address, discipline,
and specialty of all other medical service providers assisting in the treatment of the
injured employee; an outline of the provider's responsibility in the case; and an estimate
of how long concurrent care is needed. If concurrent treatment is allowed, the
organization shall recognize one primary health care provider who is responsible for
prescribing all medications if the primary health care provider is authorized to prescribe
medications; directing the overall treatment program; providing copies of all reports and
other data received from the involved medical service providers; and, in time loss cases,
providing adequate certification evidence of the injured employee's ability to perform
work. The claims adjuster shall approve concurrent care on a case-by-case basis. Except
for emergency services, all treatments must be authorized by the injured employee's
primary health care provider to be reimbursable.
d. Telehealth. The organization may pay for audio and video telecommunications instead of
a face-to-face "hands on" appointment for CPT codes designated by the American
medical association as teleheath codes. As a condition of payment, the injured employee
must be present and participating in the telemedicine appointment. The professional fee
payable is equal to the fee schedule amount for the service provided. The organization
may pay the originating site a facility fee at the scheduled amount.
4. Notwithstanding the requirements of subsection 5, the organization may designate certain
exemptions from prior authorization or preservice review requirements in conjunction with
programs designed to ensure the ongoing evolution of managed care to meet the needs of
injured employees and providers.
5. Medical service providers shall request prior authorization or preservice review from the
utilization review department for:
a. All nonemergent inpatient hospital admissions or nonemergent inpatient surgery and
outpatient surgical procedures.
b. All nonemergent major surgery. If the primary health care provider or consulting health
care provider believes elective surgery is needed to treat a compensable injury, the
primary health care provider or the consulting health care provider, with the approval of
the primary health care provider, shall give the utilization review department actual notice
at least seventy-two hours prior to the proposed surgery. Notice must give the medical
information that substantiates the need for surgery, an estimate of the surgical date and
the postsurgical recovery period, and the facility where surgery is to be performed. If
elective surgery is recommended, the utilization review department may require an
independent consultation with a health care provider of the organization's choice. The
organization shall notify the health care provider who requested approval of the elective
surgery, whether or not a consultation is desired. If requested, the consultation must be

completed within thirty days after notice to the primary health care provider. Within seven
days of the consultation, the organization shall notify the surgeon of the consultant's
findings. If the primary health care provider and consultant disagree about the need for
surgery, the organization may request a third independent opinion pursuant to North
Dakota Century Code section 65-05-28. If, after reviewing the third opinion, the
organization believes the proposed surgery is excessive, inappropriate, or ineffective and
the organization cannot resolve the dispute with the primary health care provider, the
requesting health care provider may request binding dispute resolution in accordance
with section 92-01-02-46.
c. Magnetic resonance imaging, a myelogram, discogram, bonescan, arthrogram, or
computed axial tomography. Tomograms are subject to prior authorization or preservice
review if requested in conjunction with a myelogram, discogram, bonescan, arthrogram,
computed axial tomography scan, or magnetic resonance imaging. Computed axial
tomography completed within thirty days from the date of injury may be performed
without prior authorization. The organization may waive prior authorization or preservice
review requirements for procedures listed in this subdivision when requested by a health
care provider who is performing an independent medical examination or permanent
partial impairment evaluation at the request of the organization.
d. Physical therapy and occupational therapy treatment beyond the first ten treatments or
beyond sixty days after first prescribed, whichever occurs first, or physical therapy and
occupational therapy treatment after an inpatient surgery, outpatient surgery, or
ambulatory surgery beyond the first ten treatments or beyond sixty days after therapy
services are originally prescribed, whichever occurs first. Postoperative physical therapy
and occupational therapy may not be initiated beyond ninety days after surgery date. The
organization may waive this requirement in conjunction with programs designed to
ensure the ongoing evolution of managed care to meet the needs of injured employees
or providers. Modalities for outpatient physical therapy services and outpatient
occupational therapy services are limited to two per visit during the sixty-day or
ten-treatment ranges set out in this subsection. The number of units performed and billed
per visit may not exceed four unless otherwise approved.
e. All nonemergent air ambulance services. If the primary health care provider or consulting
health care provider believes transfer to another treatment facility is needed to treat a
compensable injury, the primary health care provider or the consulting health care
provider or the transferring treatment facility, with the approval of the primary health care
provider, shall give the utilization review department actual notice prior to the proposed
transfer to the receiving treatment facility. Notice must give the medical information that
substantiates the need for transfer via air ambulance service, the name of the treatment
facility where transfer will occur, air service provider, and estimated cost. The
organization shall review the cost effectiveness and alternatives and provide notice to the
requesting health care provider or treatment facility within twenty-four hours, or by the
end of the next business day.
f. Thermography.
g. Intra-articular injection of hyaluronic acid.
h. Facet joint injections.
i. Sacroiliac joint injections.
j. Facet nerve blocks.
k. Epidural steroid injections.

l. Nerve root blocks.
m. Peripheral nerve blocks.
n. Botox injections.
o. Stellate ganglion blocks.
p. Cryoablation.
q. Radio frequency lesioning.
r. Facet rhizotomy.
s. Implantation of stimulators and pumps.
t. Speech therapy.
6. The organization will review all opioid therapies for medical necessity following the conclusion
of a chronic opioid therapy. For injured employees whose chronic opioid therapies have been
discontinued for noncompliance with North Dakota Century Code section 65-05-39, any
subsequent opioid therapies may not exceed ninety days.
7. Chiropractic providers shall request prior authorization or preservice review from the
organization's chiropractic managed care vendor for chiropractic treatment beyond the first ten
treatments or beyond sixty days after the first treatment, whichever occurs first. The evaluation
to determine a treatment plan is not subject to review. The organization may waive this
subsection in conjunction with programs designed to ensure the ongoing evolution of
managed care to meet the needs of injured employees or providers. Modalities for chiropractic
services are limited to two per visit during the sixty-day or ten-treatment ranges set out in this
subsection.
8. The organization may designate those diagnostic and surgical procedures that can be
performed in other than a hospital inpatient setting.
9. The organization or managed care vendor must respond to the medical service provider within
three business days of receiving the necessary information to complete a review and make a
recommendation on the service. Within the time for review, the organization or managed care
vendor must recommend approval or denial of the request, request additional information,
request the injured employee obtain a second opinion, or request an examination by the
injured employee's health care provider. A recommendation to deny medical services must
specify the reason for the denial.
10. The organization may conduct retrospective reviews of medical services and subsequently
reimburse medical service providers:
a. If preservice review or prior authorization of a medical service is requested by a medical
service provider and an injured employee's claim status in the adjudication process is
pending or closed; or
b. If preservice review or prior authorization of a medical service is not requested by a
medical service provider and the medical service provider can prove, by a
preponderance of the evidence, that the injured employee did not inform the medical
service provider, and the medical service provider did not know that the condition was, or
likely would be, covered under workers' compensation.
All medical service providers are required to cooperate with the managed care vendor for
retrospective review and are required to provide, without additional charge to the organization

or the managed care vendor, the medical information requested in relation to the reviewed
service.
11. The organization shall notify medical service provider associations of the review requirements
of this section prior to the effective date of these rules.
12. The organization shall respond to the medical service provider within thirty days of receiving a
retrospective review request.
History: Effective January 1, 1994; amended effective October 1, 1998; January 1, 2000; May 1, 2002;
March 1, 2003; July 1, 2004; July 1, 2006; April 1, 2008; April 1, 2009; July 1, 2010; April 1, 2012;
April 1, 2014; April 1, 2016; July 1, 2017; April 1, 2020; January 1, 2026.
General Authority: NDCC 65-02-08, 65-02-20, 65-05-07
Law Implemented: NDCC 65-02-20, 65-05-07
### § 92-01-02-35. Determining medically stationary status.

Repealed effective October 1, 1998.
### § 92-01-02-36. Elective surgery.

Repealed effective October 1, 1998.
### § 92-01-02-37. Concurrent care.

Repealed effective October 1, 1998.
### § 92-01-02-38. Changes of health care providers.

1. All changes from one health care provider to another must be approved by the organization.
Normally, changes will be allowed only after the injured employee has been under the care of
the primary health care provider for sufficient time for the health care provider to complete
necessary diagnostic studies, establish an appropriate treatment regimen, and evaluate the
efficacy of the therapeutic program.
2. North Dakota Century Code section 65-05-28 governs choice of health care provider. For
purposes of this rule, the following are not considered changes of health care provider by the
injured employee:
a. Emergency services by a health care provider;
b. Examinations at the request of the organization;
c. Consultations or referrals initiated by the health care provider;
d. Referrals to radiologists and pathologists for diagnostic studies;
e. When injured employees are required to change health care providers to receive
compensable medical services or time loss authorization because their health care
provider is no longer qualified as a primary health care provider; or
f. Changes of primary health care provider required due to conditions beyond the injured
employee's control. This would include when the health care provider terminates practice
or leaves the area.

3. The injured employee must be advised when and why a change is denied. The organization
reserves the right to require an injured employee to select another health care provider or
specialist for treatment:
a. When more conveniently located health care providers, qualified to provide the
necessary treatment, are available;
b. When the attending health care provider fails to observe or comply with the
organization's rules;
c. When, in a time loss case, reasonable progress toward return to work is not shown;
d. When an injured employee requires specialized treatment, which the primary health care
provider is not qualified to render, or which is outside the scope of the primary health
care provider's license to practice; or
e. When the health care provider is not qualified to treat each of several accepted
conditions. This does not preclude concurrent care when indicated as outlined in section
92-01-02-34.
4. When the organization finds the change of health care provider to be appropriate and has
requested the injured employee to change under this rule, the organization may select a new
primary health care provider if the injured employee unreasonably refuses or delays in
selecting another primary health care provider.
5. The organization in its discretion may authorize a change when it finds that a change is in the
best interest of returning the injured employee to a productive role in society.
History: Effective January 1, 1994; amended effective April 1, 1997; January 1, 2000; April 1, 2020;
January 1, 2022.
General Authority: NDCC 65-02-08, 65-02-20, 65-05-07
Law Implemented: NDCC 65-02-20, 65-05-07
### § 92-01-02-39. Hospitalization.

Repealed effective October 1, 1998.
### § 92-01-02-40. Palliative care.

Repealed effective January 1, 2022.
### § 92-01-02-41. Independent medical examinations - Definitions.

1. The organization may request an independent medical examination or independent medical
review pursuant to North Dakota Century Code section 65-05-28.
2. The organization shall provide at least fourteen days' notice to the injured employee of an
independent medical examination. The organization shall reimburse the claimant's expenses
for attending the independent medical examination pursuant to North Dakota Century Code
section 65-05-28.
3. As used in subsection 3 of North Dakota Century Code section 65-05-28 regarding allied
health care professionals designated or approved by the organization, "duly qualified allied
health care professional" means a person chosen by the organization who is an allied health
care professional who has the specialization necessary to perform an independent medical
examination or an independent medical review. The organization's determination of whether

an individual it has chosen is a duly qualified allied health care professional and the
organization's choice of the duly qualified allied health care professional who will perform an
independent medical examination or an independent medical review are not appealable
decisions and these decisions may not be considered when determining whether a claimant
has failed to submit to, or in any way intentionally obstructed, or refused to reasonably
participate in an independent medical examination.
4. As used in subsection 3 of North Dakota Century Code section 65-05-28, "reasonable effort"
means an attempt by the organization to locate and consider individuals as possible duly
qualified allied health care professionals for independent medical examinations using criteria
established by the organization. These attempts need not be exhaustive and need not be on a
specific case-by-case basis. An attempt may consist of a review performed by the organization
from time to time of individuals in North Dakota or other states in order to form an informal
group from which the organization may select an examiner. Whether the organization has
undertaken reasonable effort may not be considered when determining whether an injured
employee has failed to submit to, or in any way intentionally obstructed, or refused to
reasonably participate in an independent medical examination. Whether the organization has
undertaken reasonable effort may not be considered when weighing the opinion of the
examiner who performed the independent medical examination.
History: Effective January 1, 1994; amended effective October 1, 1998; July 1, 2010; April 1, 2020;
January 1, 2026.
General Authority: NDCC 65-02-08, 65-02-20, 65-05-07
Law Implemented: NDCC 65-02-20, 65-05-07
### § 92-01-02-42. Durable medical equipment.

Repealed effective October 1, 1998.
### § 92-01-02-43. Home nursing care.

1. When the primary health care provider believes special or attendant (home nurse) care is
needed, the health care provider shall submit the following information:
a. A description of the special or home nursing care required, including the estimated time
required (i.e., catheterization, three times per day, thirty minutes; bathing, two times per
day, one hour; toilet transfers as needed, dressing change, four times per day, two
hours).
b. The skill level or special training required to administer care (i.e., R.N.; L.P.N.; family
member who has received special training; or no special training required).
c. If known, the name and address of a person or facility willing to provide care.
d. The length of time special or home nursing care will be required.
2. Fees for home nurse or attendant care are based upon the organization's established fee
schedule.
3. The organization may authorize and pay for visiting nurse care necessary for evaluation or
instruction of a home health care provider.
4. When the injured employee or injured employee's family makes arrangements for caregivers,
the organization shall reimburse those providing the home nursing care.

5. Payment to individuals who provide services under this section does not constitute an
employer and employee relationship between the organization and the provider of care.
6. The organization may not pay a rate for home nursing care which exceeds the cost of nursing
facility care under the applicable case-mix classification in section 75-02-06-17.
History: Effective January 1, 1994; amended effective October 1, 1998; July 1, 2006; April 1, 2008;
April 1, 2020.
General Authority: NDCC 65-02-08, 65-02-20, 65-05-07
Law Implemented: NDCC 65-02-20, 65-05-07
### § 92-01-02-44. Special programs.

The organization may enter into special agreements for services provided by, or under the direction
of, licensed medical service providers authorized to bill the organization. Special agreements may be
made for services not covered under the fee schedule and may include multidisciplinary or
interdisciplinary programs such as pain management, work hardening, and physical conditioning.
Special programs include new programs and pilot projects to streamline, waive, or modify selected
managed care rules to provide medical care for injured employees with greater efficiency.
The organization shall establish payment rates for special agreements and may establish outcome
criteria, measures of effectiveness, minimum staffing levels, certification requirements, special reporting
requirements, and other criteria to ensure injured employees receive good quality and effective services
at a reasonable cost. The organization may terminate special agreements and programs upon thirty
days' notice to the medical service provider.
History: Effective January 1, 1994; amended effective April 1, 1997; October 1, 1998; April 1, 2020.
General Authority: NDCC 65-02-08, 65-02-20, 65-05-07
Law Implemented: NDCC 65-02-20, 65-05-07
### § 92-01-02-45. Organization responsibilities.

1. As soon as reasonably possible after receiving a bill, the organization shall:
a. Pay the charge or any portion of the bill that is not denied;
b. Deny all or a portion of the bill on the basis that the injury is not compensable, or the
service or charge is excessive or not medically necessary; or
c. Request specific additional information to determine whether the charge or service is
excessive or not medically necessary or whether the condition is compensable.
2. The organization shall provide notice of nonpayment to the injured employee when the injured
employee is personally responsible for the payment of a charge. The organization shall
provide notice of nonpayment to the medical service provider through a remittance advice of
denial of part or all of a charge, or shall provide notice to the medical service provider for any
request for additional information. The notice must include:
a. The basis for denying all or part of a charge because the treatment was not for a
compensable injury.
b. The basis for denying or reducing excessive charges and the specific amounts denied or
reduced.
c. The basis for denying the charge for an excessive service.
d. The basis for denying a charge as not being medically necessary.

e. A request for records or other information needed to allow proper determination of the
bill.
3. Any payment incorrectly made to a medical service provider may be recovered from the
medical service provider by the organization.
4. The organization will pay a reasonable fee for a special report as defined in section
shall include in the special report the time required to prepare the report or the organization
may not pay for the report. Time spent and the complexity of the issues will be considered
when determining the reasonableness of the fee. Such services should be billed under current
procedural terminology code 99080 with a description of "special report".
History: Effective January 1, 1994; amended effective April 1, 1997; October 1, 1998; April 1, 2020.
General Authority: NDCC 65-02-08, 65-02-20, 65-05-07
Law Implemented: NDCC 65-02-20, 65-05-07
### § 92-01-02-45.1. Medical service provider responsibilities and billings.

1. A medical service provider shall complete the registration process and corresponding forms
identified by the organization to receive payments for services.
2. A medical service provider may not submit a charge for a service which exceeds the amount
the medical service provider charges for the same service in cases unrelated to workers'
compensation injuries.
3. All bills must be fully itemized, including ICD codes, and services must be identified by code
numbers found in the fee schedules or as provided in these rules. The definitions of
commonality in the guidelines found in the current procedural terminology must be used as
guides governing the descriptions of services, except as provided in the fee schedules or in
these rules. All bills must be submitted to the organization within one year of the date of
service or within one year of the date the organization accepts liability for the work injury or
condition.
4. All medical service providers shall submit charges for medical services on the most current
version of the UB 04, CMS 1500, or ADA form, or the corresponding electronic versions of
each. All pharmacy charges must be submitted electronically to the organization's pharmacy
managed care vendor using the current pharmacy transaction standard. Accepted electronic
medical billing formats are outlined in section 92-01-02-45.2. Medical service bills may not
include charges for more than one workers' compensation claim, and must include the
following:
a. The injured employee's full name and address;
b. The injured employee's claim number;
c. Date and nature of injury;
d. The area of the body treated, with the appropriate ICD-10-CM code, including
identification of right or left, as appropriate;
e. Date of service;
f. Facility's name and address and telephone number where the service was rendered;
g. Name of allied health care professional providing the service along with the rendering
allied health care professional's national provider identifier (NPI);

h. Billing facility's name, address, zip code, telephone number; medical service provider's
NPI and tax identification number; along with the billing facility's NPI;
i. Referring or ordering health care provider's NPI;
j. Place of service;
k. Appropriate procedure code or hospital revenue code;
l. Charge for each service;
m. Units of service;
n. If dental, tooth numbers;
o. Total bill charge.
5. All records submitted by medical service providers, including notes, except those provided by
an emergency room health care provider and those on forms provided by the organization,
must be typed to ensure that they are legible and reproducible. Copies of office or progress
notes are required for all followup visits. Documentation must be authentic to the visit and may
not include cloned, copied, or irrelevant documentation for purposes of up-coding a service.
Office notes are not acceptable in lieu of requested narrative reports. Communications may
not refer to more than one claim. Addendums and late entries to notes or reports must be
signed and must include the date they were created. Addendums or late entries to notes or
reports created more than sixty calendar days after the date of service may be accepted at the
organization's sole discretion.
6. Medical service providers shall submit with each bill a copy of medical records or reports
which support the necessity of a service being billed and its relationship to the work injury,
including the level, type, and extent of the service provided to injured employees.
Documentation required includes:
a. Laboratory and pathology reports;
b. X-ray findings;
c. Operative reports;
d. Office notes and physical, chiropractic, and occupational therapy progress notes;
e. Consultation reports;
f. History, physical examination, and discharge summaries;
g. Special diagnostic study reports; and
h. Special or other requested narrative reports.
7. If the medical service provider does not submit records with a bill and still does not provide
those records upon request of the organization, the charges for which records were not
supplied may not be paid by the organization, unless the medical service provider submits the
records before the decision denying payment of those charges becomes final. The medical
service provider may also be liable for the penalty provided in subsection 6 of North Dakota
Century Code section 65-05-07.
8. Disputes arising out of reduced or denied reimbursement are handled in accordance with
section 92-01-02-46. In all cases of accepted compensable injury or illness under the

jurisdiction of the workers' compensation law, a medical service provider may not pursue
payment from an injured employee for treatment, equipment, or products unless an injured
employee desires to receive them and has accepted responsibility for payment, or unless the
payment for the treatment was denied because:
a. The injured employee sought treatment from that medical service provider for conditions
not related to the compensable injury or illness.
b. The injured employee sought treatment from that medical service provider which was not
prescribed by the injured employee's primary health care provider. This includes ongoing
treatment by the allied health care professional.
c. The injured employee sought treatment from that allied health care professional after
being notified that the treatment sought from that allied health care professional has been
determined to be unscientific, unproven, outmoded, investigative, or experimental.
d. The injured employee did not follow the requirements of subsection 1 of North Dakota
Century Code section 65-05-28 regarding change of health care providers before
seeking treatment of the work injury.
e. The injured employee is subject to North Dakota Century Code section 65-05-28.2, and
the health care provider requesting payment is not a preferred provider and has not been
approved as an alternative health care provider under subsection 2, 3, or 4 of North
Dakota Century Code section 65-05-28.2.
9. A medical service provider may not bill for services not provided to an injured employee and
may not bill multiple charges for the same service. Rebilling must indicate that the charges
have been previously billed.
10. Pursuant to North Dakota Century Code section 65-05-33, a medical service provider may not
submit false or fraudulent billings.
11. Only one office visit designation may be used at a time except for those code numbers relating
specifically to additional time.
12. If an injured employee is seen initially in an emergency department and is admitted
subsequently to the hospital for inpatient treatment, the services provided immediately prior to
the admission are part of the inpatient treatment.
13. If an allied health care professional is asked to review records or reports prepared by another
allied health care professional, the allied health care professional shall bill for the review of the
records using CPT code 99080 with a descriptor of "record review".
14. If there is a dispute over the amount of a bill or the necessity of services rendered, the
organization shall pay the undisputed portion of the bill and provide specific reasons for
nonpayment or reduction of each medical service code.
15. If medical documentation outlines that a non-work-related condition is being treated
concurrently with the compensable injury and that condition has no effect on the compensable
injury, the organization may reduce the charges submitted for treatment. In addition, the allied
health care professional must notify the organization immediately and submit:
a. A description or diagnosis of the non-work-related condition.
b. A description of the treatment being rendered.
c. The effect, if any, of the non-work-related condition on the compensable injury.

The allied health care professional shall include a thorough explanation of how the
non-work-related condition affects the compensable injury if the allied health care professional
requests authorization to treat the non-work-related condition. Temporary treatment of a
non-work-related condition may be allowed, upon prior approval by the organization, provided
the condition directly delays recovery of the compensable injury. The organization may not
approve or pay for treatment for a known pre-existing non-work-related condition for which the
injured employee was receiving treatment prior to the occurrence of the compensable injury,
which is not delaying recovery of the compensable injury. The organization may not pay for
treatment of a non-work-related condition when it no longer exerts any influence upon the
compensable injury. If treatment of a non-work-related condition is being rendered, the allied
health care professional shall submit reports monthly outlining the effect of treatment on both
the non-work-related condition and the compensable injury.
16. In cases of questionable liability when the organization has not rendered a decision on
compensability, the medical service provider has billed the injured employee or other
insurance, and the claim is subsequently allowed, the medical service provider shall refund
the injured employee or other insurer in full and bill the organization for services rendered.
17. The organization may not pay for the cost of duplicating records when covering the treatment
received by the injured employee. If the organization requests records in addition to those
listed in subsection 5, records prior to the date of injury, or records necessary for a
coordination of benefits determination, the organization shall pay a charge of no more than
twenty dollars for the first twenty-five pages and seventy-five cents per page after twenty-five
pages. In an electronic, digital, or other computerized format, the organization shall pay a
charge of thirty dollars for the first twenty-five pages and twenty-five cents per page after
twenty-five pages. This charge includes any administration fee, retrieval fee, and postage
expense.
18. The medical service provider shall assign the correct approved billing code for the service
rendered using the appropriate provider group designation. Bills received without codes must
be returned to the medical service provider.
19. Billing codes must be found in the most recent edition of the physician's current procedural
terminology; health care financing administration common procedure coding system; code on
dental procedures and nomenclature maintained by the American dental association; or any
other code listed in the fee schedules.
20. A medical service provider shall comply within thirty calendar days with the organization's
request for copies of existing medical data concerning the services provided, the patient's
condition, the plan of treatment, and other issues pertaining to the organization's
determination of compensability, medical necessity, or excessiveness or the organization may
refuse payment for services provided by that medical service provider.
21. A medical service provider may not bill an injured employee a fee for the difference between
the maximum allowable fee set forth in the organization's fee schedule and usual and
customary charges, or bill the injured employee any other fee in addition to the fee paid, or to
be paid, by the organization for individual treatments, equipment, and products.
History: Effective January 1, 1994; amended effective April 1, 1996; October 1, 1998; January 1, 2000;
May 1, 2002; April 1, 2008; July 1, 2010; April 1. 2012; April 1, 2014; April 1, 2016; July 1, 2017; April 1,
2020; January 1, 2022; January 1, 2026.
General Authority: NDCC 65-02-08, 65-02-20, 65-05-07
Law Implemented: NDCC 65-02-20, 65-05-07, 65-05-28.2

### § 92-01-02-45.2. Medical service provider electronic billing responsibilities.

Medical service providers shall submit electronic medical bills and supporting documentation to the
organization unless the health care provider is exempt.
1. A medical service provider is exempt from the requirement of electronic submission of medical
bills if:
a. The provider submits fewer than fifty bills per calendar year; or
b. The provider can sufficiently demonstrate electronic medical bill implementation will
create an unreasonable financial hardship and can provide supporting documentation,
such as financial statements or other documentation which reflect the financial hardship.
The exemption process must be initiated by the medical service provider. Granting an
exemption lies solely within the organization's discretion and is not subject to appeal.
2. The organization shall identify and maintain an electronic billing source to enable the
transaction of these services.
3. All medical service providers shall submit the most current version of the following electronic
medical bill processing standards:
a. Professional billing - ASC X12 837P;
b. Institutional/hospital billing - ASC X12 837I; or
c. Dental billing - ASC X12 837D.
History: Effective April 1, 2020; amended effective January 1, 2021.
General Authority: NDCC 65-02-08, 65-05-07
Law Implemented: NDCC 65-02-20, 65-05-07, 65-05-07.3
### § 92-01-02-46. Medical services disputes.

1. This rule provides the procedures followed for managed care disputes. Retrospective review is
the procedure provided for disputing the denial of payment for a medical service charge based
on failure to request prior authorization or preservice review. Binding dispute resolution is the
procedure provided for disputing managed care recommendations, including bill audit and
review. Disputes not arising from managed care follow the reconsideration and hearing
procedures provided by North Dakota Century Code section 65-01-16.
2. If the organization denies payment for a medical service charge because the medical service
provider did not properly request prior authorization or preservice review for that service, the
medical service provider may request a retrospective review of that service. Requests for
retrospective review must be made in writing, within thirty days after the notice that payment
for the service is denied, addressed to the organization utilization review department.
Requests for retrospective review should not be sent to the managed care vendor. The
request must contain:
a. The injured employee's name.
b. The claim number.
c. The date of service.
d. A statement of why the medical service provider did not know and should not have
known that the injury or condition may be a compensable injury.

e. The information required to perform a preservice review or prior authorization of the
service.
If the medical service provider knew or should have known that the patient may have a
compensable work injury when the medical services for that injury were provided, the request
for retrospective review must be denied. If the medical service provider did not know and
should not have known that the patient may have a compensable work injury when the
medical services for that injury were provided, a retrospective preservice review or prior
authorization may be done. The organization may determine if the medical review is required
to determine medical necessity, or if the medical review is waived based on the supporting
documentation. If the organization continues to deny payment for the service, the medical
service provider may request binding dispute resolution under this rule.
3. A party who wishes to dispute a utilization review recommendation first shall exhaust any
internal dispute resolution procedures provided by the managed care vendor or the utilization
review department. A party who wishes to dispute a final recommendation of a managed care
vendor or a prior authorization or preservice review decision under section 92-01-02-34 shall
file a written request for binding dispute resolution with the organization within thirty days after
the final recommendation or decision. The request must contain:
a. The injured employee's name.
b. The claim number.
c. All relevant medical information and documentation.
d. A statement of any actual or potential harm to the injured employee from the
recommendation.
e. The specific relief sought.
4. A party who wishes to dispute a denial or reduction of a service charge arising from bill audit
and review shall file a written request for binding dispute resolution with the organization within
thirty days after the date of the organization's remittance advice reducing or denying the
charge. The request must contain:
a. The injured employee's name.
b. The claim number.
c. The specific code and the date of the service in dispute.
d. A statement of the reasons the reduction or denial was incorrect, with any supporting
documentation.
e. The specific relief sought.
5. The organization shall review the request for binding dispute resolution and the relevant
information in the record. The organization may request additional information or
documentation. If a party does not provide the requested information within fourteen days, the
organization may decide the dispute on the information in the record.
6. The organization may request review by allied health care professionals, at least one of whom
must be licensed or certified in the same profession as the allied health care professional
whose treatment is being reviewed, or by an external expert in medical coding or other
aspects of medical treatment or billing, to assist with its review of the request. The

organization may request an independent medical examination to assist with its review of a
request.
7. At the conclusion of its review, the organization shall issue its binding decision. The
organization shall issue its decision by letter or notice, or for a decision that is reviewable by
law, the organization may issue its decision in an administrative order instead of a letter or
notice.
History: Effective January 1, 1994; amended effective April 1, 1997; October 1, 1998; January 1, 2000;
May 1, 2002; July 1, 2004; April 1, 2020; January 1, 2022; January 1, 2024; January 1, 2026.
General Authority: NDCC 65-02-08, 65-02-20
Law Implemented: NDCC 65-02-20
### § 92-01-02-46.1. Pharmacy services disputes.

1. Binding dispute resolution must be used for disputing managed care recommendations,
including point of sale alterations or denials for pharmacy services. Disputes not arising from
managed care must follow the reconsideration and hearing procedures provided by North
Dakota Century Code section 65-01-16.
2. When the organization denies payment for a pharmacy service charge the medical service
provider or injured employee may request review of that service. Requests for review must be
made in writing, within thirty days after the initial denial of payment, addressed to the
organization claims adjuster assigned to handle the injured employee's claim. Requests for
review may not be sent to the managed care vendor. The request must contain:
a. The injured employee's name.
b. The claim number.
c. The date of service and service denied.
d. The specific relief sought.
e. The information required to perform a review of the service. If the organization continues
to deny payment for the service, the medical service provider may request binding
dispute resolution under this rule.
3. The organization shall review the request for binding dispute resolution and the relevant
information in the record. The organization may request additional information or
documentation. If a party does not provide the requested information within fourteen days, the
organization may decide the dispute on the information in the record.
4. At the conclusion of its review, the organization shall issue its binding decision. The
organization shall issue its decision by letter or notice, or for a decision that is reviewable by
law, the organization may issue its decision in an administrative order instead of a letter or
notice.
History: Effective April 1, 2020.
General Authority: NDCC 65-02-08
Law Implemented: NDCC 65-02-20
### § 92-01-02-47. Providers performing peer review.

Repealed effective March 1, 2000.

### § 92-01-02-48. Elements of filing.

1. For purposes of this section, unless the context otherwise requires:
a. "Appropriate record" means a legible medical record or report from a provider, or any
other relevant and material information, substantiating the type, nature, extent, and
work-relatedness of an injury, which is adequate to verify the level, type, and extent of
services provided.
b. "Bill" means a provider's statement of charges and services rendered for treatment of a
work-related injury.
c. "Bill review" means the review or audit of medical bills and any associated medical
records by workforce safety and insurance and may include review for duplications,
omissions, actual delivery of billed services and items, accuracy of charges and
associated coding, and improper concurrent bills for services involving evaluation or
treatment of work-related and non-work-related problems.
d. "Wage verification" means federal and state income tax returns; W-2 forms; daily, weekly,
biweekly, semimonthly, or monthly employer payroll statements; and income statements
prepared in accordance with generally accepted accounting practices.
2. The elements of filing for an application for workers' compensation benefits are satisfied when
the organization has received:
a. The first report of injury form completed and signed by the injured employee or someone
acting on the injured employee's behalf. The employer's report may be deemed admitted
pursuant to North Dakota Century Code sections 65-01-16 or 65-05-01.4;
b. Wage verification as requested by the organization, if disability benefits are claimed; and
c. Appropriate records from the provider necessary to determine the type, nature, extent,
and potential work-relatedness of the injury or disability.
3. The elements of filing for a reapplication are satisfied when the organization is in receipt of:
a. The C4 form or other correspondence requesting benefits signed by the employee;
b. Wage verification as requested by the organization, if disability benefits are claimed; and
c. Appropriate records from the provider.
4. The elements of filing for payment of a medical bill are satisfied when a bill review is
completed and after the organization has received:
a. A bill from the provider or employee; and
b. Appropriate records from the provider or employee.
5. If the organization requests additional information from the employee needed to process an
application or a reapplication and the employee does not provide the information, elements of
filing are not satisfied until the employee provides the requested information.
6. The organization may waive elements of filing in conjunction with programs established for the
expedited processing of selected claims.
History: Effective January 1, 1994; amended effective January 1, 1996; April 1, 1997; February 1,
1998; January 1, 2000; July 1, 2006; April 1, 2016; April 1, 2020; January 1, 2022.

General Authority: NDCC 65-02-08
Law Implemented: NDCC 65-02-08, 65-05-02
### § 92-01-02-49. Determination of employment.

1. Any service performed for another for remuneration under any agreement or contract of hire
express or implied is presumed to be employment unless it is shown that the individual
performing the service is an independent contractor as determined by the "common law" test.
a. An employment relationship exists when the person for whom services are performed
has the right to control and direct the individual person who performs the services, not
only as to the result to be accomplished by the work but also as to the details and means
by which that result is accomplished. It is not necessary that the employer actually direct
or control the manner in which the services are performed; it is sufficient if the employer
has the right to do so. The right to discharge is a significant factor indicating that the
person possessing that right is an employer. The right to terminate a contract before
completion to prevent and minimize damages for a potential breach or actual breach of
contract does not, by itself, establish an employment relationship. Other factors indicating
an employer-employee relationship, although not necessarily present in every case, are
the furnishing of tools and the furnishing of a place to work to the person who performs
the services. The fact that the contract must be performed at a specific location such as
building site, does not, by itself, constitute furnishing a place to work if the nature of the
work to be done precludes a separate site or is the customary practice in the industry. If a
person is subject to the control or direction of another merely as to the result to be
accomplished by the work and not as to the means and methods for accomplishing the
result, the person will likely be an independent contractor. A person performing services
as an independent contractor is not as to such services an employee. Persons such as
physicians, lawyers, dentists, veterinarians, public stenographers, and auctioneers,
engaged in the pursuit of an independent trade, business, or profession, in which they
offer their services to the public, are independent contractors and not employees.
b. In determining whether a person is an independent contractor or an employee under the
"common law" test, the following twenty factors are to be considered:
(1) Instructions. A person who is required to comply with other persons' instructions
about when, where, and how the person is to work is ordinarily an employee. This
control factor is present if the person or persons for whom the services are
performed have the right to require compliance with instructions.
(2) Training. Training a person by requiring an experienced employee to work with the
person, by corresponding with the person, by requiring the person to attend
meetings, or by using other methods, indicates that the person or persons for whom
the services are performed want the services performed in a particular method or
manner.
(3) Integration. Integration of the person's services into the business operations
generally shows that the person is subject to direction and control. When the
success or continuation of a business depends to an appreciable degree upon the
performance of certain services, the persons who perform those services must
necessarily be subject to a certain amount of control by the owner of the business.
(4) Services rendered personally. If the services must be rendered personally,
presumably the person or persons for whom the services are performed are
interested in the methods used to accomplish the work as well as in the results.

(5) Hiring, supervising, and paying assistants. If the person or persons for whom the
services are performed hire, supervise, and pay assistants, that factor generally
shows control over the persons on the job. However, if one person hires,
supervises, and pays the other assistants pursuant to a contract under which the
person agrees to provide materials and labor and under which the person is
responsible only for the attainment of a result, this factor indicates an independent
contractor status.
(6) Continuing relationship. A continuing relationship between the person and the
person or persons for whom the services are performed indicates that an
employer-employee relationship exists. A continuing relationship may exist when
work is performed at frequently recurring although irregular intervals.
(7) Set hours of work. The establishment of set hours of work by the person or persons
for whom the services are performed is a factor indicating control.
(8) Full time required. If the person must devote substantially full time to the business of
the person or persons for whom the services are performed, such person or
persons have control over the amount of time the person is able to do other gainful
work. An independent contractor, on the other hand, is free to work when and for
whom the person chooses.
(9) Doing work on the premises of the person or persons for whom the services are
performed. If the work is performed on the premises of the person or persons for
whom the services are performed, that factor suggests control over the person,
especially if the work could be done elsewhere. Work done off the premises of the
person or persons receiving the services, such as at the office of the worker,
indicates some freedom from control. This fact by itself does not mean that the
person is not an employee. The importance of this factor depends on the nature of
the service involved and the extent to which an employer generally would require
that employees perform such service on the employer's premises. Control over the
place of work is indicated when the person or persons for whom the services are
performed have the right to compel the worker to travel a designated route, to
canvass a territory within a certain time, or to work at specific places as required.
(10) Order or sequence set. If a person must perform services in the order or sequence
set by the person or persons for whom the services are performed, that factor
shows that the person is not free to follow the person's own pattern of work but must
follow the established routines and schedules of the person or persons for whom
the services are performed. Often, because of the nature of an occupation, the
person or persons for whom the services are performed do not set the order of the
services or set the order infrequently. It is sufficient to show control, however, if such
person or persons retain the right to do so.
(11) Oral or written reports. A requirement that the person submit regular or written
reports to the person or persons for whom the services are performed indicates
control. By contract, however, parties can agree that services are to be performed
by certain dates and the persons performing those services can be required to
report as to the status of the services being performed so that the person for whom
the services are being performed can coordinate other contracts that person may
have which are required in the successful total completion of a particular project.
(12) Payment by hour, week, month. Payment by the hour, week, or month indicates an
employer-employee relationship, provided that this method of payment is not just a
convenient way of paying a lump sum agreed upon as the cost of a job. Payment

made by the job or on a straight commission generally indicates that the worker is
an independent contractor.
(13) Payment of business or traveling expenses, or both. If the person or persons for
whom the services are performed ordinarily pay the person's business or traveling
expenses, or both, the person is an employee. An employer, to be able to control
expenses, generally retains the right to regulate and direct the person's business
activities.
(14) Furnishing of tools and materials. If the person or persons for whom the services
are performed furnished significant tools, materials, and other equipment, it is an
indication an employer-employee relationship exists.
(15) Significant investment. If the person invests in facilities that are used by the person
in performing services and are not typically maintained by employees (such as the
maintenance of an office rented at fair value from an unrelated party), or if the
person invests in other business expenses (such as equipment and supplies,
vehicles, liability insurance, advertising, or other promotion of services), that factor
tends to indicate that the person is an independent contractor. Lack of investment in
expenses relative to the performance of services indicates dependence on the
person or persons for whom the services are performed for such facilities and
indicates the existence of an employer-employee relationship.
(16) Realization of profit or loss. A person who may realize a profit or suffer a loss as a
result of the person's services (in addition to the profit or loss ordinarily realized by
employees) is generally an independent contractor, but the person who cannot is an
employee. If the person is subject to a risk of economic loss due to significant
investment or a bona fide liability for expenses, that indicates that the person is an
independent contractor. The risk that a person will not receive payment for services,
however, is common to both independent contractors and employees and thus does
not constitute a sufficient economic risk to support a finding of an independent
contractor.
(17) Working for more than one firm at a time. If a person performs services under
multiple contracts for unrelated persons or firms at the same time, that generally
indicates that the person is an independent contractor. A person who performs
services for more than one person may be an employee for each of the persons,
especially when such persons are part of the same service arrangement.
(18) Making service available to general public. If a person makes the person's services
available to the general public on a regular and consistent basis that indicates an
independent contractor relationship.
(19) Right to dismissal. The right to dismiss a person indicates that the person is an
employee and the person possessing the right is an employer. An employer
exercises control through the right of dismissal, which causes the person to obey
the employer's instruction. An independent contractor, on the other hand, cannot be
fired without liability for breach of contract so long as the independent contractor
produces a result that meets the contract specifications.
(20) Right to terminate. If either person has the right to end the relationship with the
person for whom the services are performed at any time the person wishes without
incurring liability, that indicates an employer-employee relationship. If a contract can
be terminated by the mutual agreement of the parties before its completion or by
one of the parties to the contract before its completion to prevent a further breach of

contract or to minimize damages, that indicates an independent contractor
relationship.
2. The factors described in paragraphs 3, 6, 15, 16, 17, 18, 19, and 20 of subdivision b of
subsection 1 must be given more weight in determining whether an employer-employee
relationship exists.
History: Effective January 1, 1994; amended effective January 1, 2007; April 1, 2012.
General Authority: NDCC 65-02-08
Law Implemented: NDCC 65-01-03
### § 92-01-02-49.1. Determination of employment status.

A person may apply to the organization for a determination of whether that person is an employer
as that term is defined by North Dakota Century Code title 65. A person claiming not to be an employer
under the Workers' Compensation Act has the burden of proving by a preponderance of the evidence
that the person is not an employer. The request for a determination must be in writing and must be
supported by evidence of the employment status of the requesting party. If the party is asserting an
independent contractor relationship, the party must submit copies of written contracts, if any,
establishing the relationship. The organization may request, and the party shall provide promptly, any
additional relevant information bearing on the issue of the employer status of the party. After review of
the evidence, the organization shall issue its decision determining the employment status of the
requesting party under North Dakota Century Code title 65. This determination is effective for no more
than one year from the date of the decision and may be reconsidered or revoked at any time by the
organization. The requesting party has a continuing obligation to notify the organization of any material
change in that party's business relationships, and a failure to notify the organization of a material
change shall nullify the organization's certification as of the date of the change.
History: Effective January 1, 1996; amended effective May 1, 1998.
General Authority: NDCC 65-02-08
Law Implemented: NDCC 65-09-01
### § 92-01-02-49.2. Attorney fee reimbursement for employers.

1. The organization may reimburse attorney fees and costs under this section regardless of the
state in which the injury occurred.
2. The organization retains the ability to select or approve counsel secured by the employer.
3. Employers shall submit attorney billing statements from their attorney and all time must be
recorded in increments of no more than six minutes, or one-tenth of an hour.
History: Effective January 1, 2026.
General Authority: NDCC 65-02-08
Law Implemented: NDCC 65-02-37
### § 92-01-02-50. Other states' coverage.

1. The terms used in this section have the same meaning as in North Dakota Century Code
title 65 and in North Dakota Administrative Code title 92, except:
a. "Covered employment" means hazardous employment principally localized in this state
which involves incidental operations in another state. The term "covered employment"
does not include employment in which the employer is required by the laws of that other
state to purchase workers' compensation coverage in that other state.

b. "Employee" means any North Dakota employee as that term is defined in North Dakota
Century Code section 65-01-02 who engages in covered employment and who is eligible
to file for workers' compensation benefits in another state if the employee suffers a
work-related illness or injury or dies as a result of work activities in that state. The term
"employee" also includes a person with optional workers' compensation coverage in this
state under North Dakota Century Code section 65-04-29 or 65-07-01 who engages in
covered employment and is eligible to file for workers' compensation benefits in another
state if that person suffers a work-related illness or injury or dies as a result of work
activities in that state.
c. "Employer" means an employer as defined in North Dakota Century Code section
65-01-02, who is not materially delinquent in payment of premium, and who has
employees engaged in covered employment. An employer is not materially delinquent in
payment of premium if the premium is no more than thirty days delinquent.
d. "Incidental operations" means business operations of an employer for fewer than thirty
consecutive days in which the employer has no contacts sufficient, under the workers'
compensation laws of that other state to subject the employer to liability for payment of
workers' compensation premium in that other state and which operations do not require
the employer to purchase workers' compensation insurance under the laws of that state.
2. If an employee, hired in this state for covered employment by an employer covered by the
Workers' Compensation Act of this state, receives an injury while employed in incidental
operations outside this state, the injury is subject to the provisions of this section if the
employee elects to receive benefits under the workers' compensation laws of that other state
in lieu of a claim for benefits in this state. This section applies only if the workers'
compensation laws of the other state allow the employee to elect to receive benefits under the
laws of that state. If the employee does not or cannot elect coverage under the laws of
another state, the injury is subject to the provisions of North Dakota Century Code chapter
65-08.
The provisions of this section do not apply to:
a. States having a monopolistic state fund.
b. States having a reciprocal agreement with this state regarding extraterritorial coverage.
c. Compensation received under any federal act.
d. Foreign countries.
e. Maritime employment.
f. Employer's liability or "stop-gap" coverage.
3. An employee who elects to receive benefits under the workers' compensation laws of another
state waives the right to seek compensation under North Dakota Century Code title 65.
4. The organization may pay, on behalf of an employer, any regular workers' compensation
benefits the employer is obligated to pay under the workers' compensation laws of a state
other than North Dakota, with respect to personal injury, illness, or death sustained as a result
of work activities by an employee engaged in covered employment in that state, if the
employee or the employee's dependents elect to receive benefits under the other state's laws
in lieu of benefits available under the North Dakota Workers' Compensation Act. The term
"dependents" includes an employee's spouse. The organization may pay benefits on behalf of
an employer but may not act nor be deemed as an insurer, nor may the organization
indemnify an employer for any liabilities, except as specifically provided in this section.

The benefits provided by this section are those mandated by the workers' compensation laws
of the elected state. This includes benefits for injuries that are deemed compensable in that
other state but are not compensable under North Dakota Century Code chapters 65-05 and
65-08. Medical benefits provided pursuant to this section are subject to any fee schedule and
other limitations imposed by the workers' compensation law of the elected state. The North
Dakota fee schedule does not apply to this section.
The organization may reimburse an employer covered by this section for legal costs and for
reasonable attorney's fees incurred. Reimbursement will be considered only if the employer is
sued in tort in another state by an injured employee or an injured employee's dependents
relative to a work-related illness, injury, or death; or if the employer is alleged to have failed to
make payment of workers' compensation premium in that other state by the workers'
compensation authorities of that state. This reimbursement may be made only if it is
determined by the organization or by a court of competent jurisdiction that the employer is
subject to the provisions of this section and was not required to purchase workers' coverage in
that other state relative to the employment of the injured employee. Attorney fees and costs
will be paid as set forth in section 92-01-02-11.1. If the other state has an appeal process that
differs from the organization, the organization may pay fees consistent with, but may not
exceed the fees and caps set forth in section 92-01-02-11.1.
The organization may not reimburse any legal costs, attorney's fees, nor any other costs to a
coemployee sued in tort by an injured employee.
5. If a claim for workers' compensation benefits is compensable in this state and a claim for
workers' compensation benefits for the same injury or death is filed in another state, the
organization may defend, at the organization's expense, using counsel and resources of the
organization's choosing, any claim, proceeding, or suit against a North Dakota covered
employer. The organization may exceed the fees and caps set forth in section 92-01-02-11.1
for this subsection. The organization has the right to investigate and settle these claims,
proceedings, or suits.
The organization may not defend a claim for workers' compensation benefits, proceeding, or
suit if that claim for workers' compensation benefits is not compensable in this state.
6. The organization may contract with a qualified third-party administrator to adjust and
administer claims arising under this chapter. The organization shall pay the costs of the
third-party administrator from the general fund.
7. Benefits paid on behalf of an employer pursuant to this section will be charged against the
employer's account for experience rating purposes. The experience rating loss will be equal to
the actual claim costs. The assessment charge plus appropriate penalties and interest, if any,
levied pursuant to North Dakota Century Code section 65-04-04.4, will be assessed on all
claims brought under this section.
8. The employer shall notify the organization when a claim is filed in another state by an
employee covered by this section. The employer shall notify the organization of the claim in
writing. The employer has thirty days after actual knowledge of the filing of a claim in which to
notify the organization. That time can be extended for thirty days by the organization if the
employer shows good cause for failing to timely notify the organization. If the employer fails to
timely notify the organization when a claim is filed in another state by an employee covered
under this section, the organization may not pay benefits under this section.
The organization may not pay costs, charges, or penalties charged against an employer for
late reporting of an injury or claim to the workers' compensation authorities of the state of
injury.

9. The exclusive remedy provisions of North Dakota Century Code sections 65-01-01, 65-01-08,
65-04-28, and 65-05-06 apply to this section.
History: Effective January 1, 1994; amended effective April 1, 1997; July 1, 2004; July 1, 2006; July 1,
2010; April 1, 2014; April 1, 2016; April 1, 2020.
General Authority: NDCC 65-02-08
Law Implemented: NDCC 65-08.1-02, 65-08.1-05
### § 92-01-02-51. Amnesty period for employers, employees, and providers.

Repealed effective July 1, 2006.
### § 92-01-02-51.1. Payment of copies requested by subpoena.

Any person, as defined in North Dakota Century Code section 1-01-49, served with a subpoena by
the organization which directs the production of copies of documents may charge the organization
copying costs. Those persons shall charge, and the organization shall pay, no more than twenty-five
cents per page and up to ten hours for labor not to exceed twenty-five dollars per hour. A payment for
copies may exceed the amounts listed herein if, in the discretion of the organization, the production has
been or will be uniquely taxing.
History: Effective July 1, 2006.
General Authority: NDCC 65-02-08
Law Implemented: NDCC 65-02-11
### § 92-01-02-51.2. Work defined.

As used in subsection 3 of North Dakota Century Code section 65-05-08 and North Dakota Century
Code section 65-05-33, "work" means physical or mental effort exerted to do or to make something for
any amount of remuneration or physical or mental effort exerted to do or to make something that a
reasonable person would consider commonly done or made for remuneration.
History: Effective July 1, 2006.
General Authority: NDCC 65-02-08
Law Implemented: NDCC 65-05-08(3), 65-05-33
### § 92-01-02-52. Procedure for penalizing delinquent employer accounts.

Repealed effective May 1, 2002.
### § 92-01-02-53. Workforce safety and insurance scholarship fund - Application criteria -

Refund.
An applicant for a workers' compensation scholarship offered under North Dakota Century Code
section 65-05-20.1 must complete the application form required by the organization. The form, at a
minimum, must require the applicant provide:
1. Name, address, date of birth, sex, social security number;
2. Educational history, including transcripts if requested;
3. Proof of association to the organizational claim leading to the application;
4. Access to receive information regarding other financial aid or assistance; and
5. Any other information the organization requires to administer this program.

The scholarship committee will use the information on the application form to determine which
applicants receive the scholarship and may require an applicant to submit additional supporting
information. The minimum required grade point average is a two point zero on a four point zero scale,
or its equivalent. The organization may award individual scholarships in any amount up to the maximum
amounts provided in North Dakota Century Code section 65-05-20.1. Applicants who are awarded the
scholarship one year must reapply to receive the scholarship in a subsequent year. If the amount
awarded to the applicant is greater than the amount owed the institution over the course of the school
year, the excess award must be refunded to the organization. If the applicant who is awarded a
scholarship withdraws from the institution and there are scholarship funds to be refunded, the institution
shall refund those funds to the organization according to the refund priorities of the institution.
History: Effective August 1, 1997; amended effective May 1, 2000; July 1, 2006; April 1, 2016;
January 1, 2024.
General Authority: NDCC 65-02-08
Law Implemented: NDCC 65-05-20.1
### § 92-01-02-53.1. Vocational rehabilitation grant program.

The organization may award grants to entities to promote injured workers' skill upgrading, remedial
education, and optimal transition into the labor force. To be eligible, entities must submit proposals that
identify a vocational need and explain how the entity intends to meet it within a suggested period of
time. When determining awards, the organization shall consider the validity of the identified need, a
proposal's cost-effectiveness and its general impact on vocational services for injured workers. The
awarding of grants rests within the discretion of the organization. Upon request, entities that are
awarded grants must report to the organization regarding the use and efficacy of a grant with as much
specificity as the organization reasonably requires. In event that grant is not used for the purposes for
which it was awarded or an entity is nonresponsive to reasonable requests for reports, an entity may be
required to repay the grant and the organization may pursue repayment by civil action.
History: Effective April 1, 2012.
General Authority: NDCC 65-02-08
Law Implemented: NDCC 65-05.1-08(3)
### § 92-01-02-54. Deductible programs.

The organization and an employer may contract for a deductible program. When a deductible
program contract is entered, the employer shall reimburse the organization for benefits payable on
individual claims up to the agreed deductible amount. The organization shall provide a reduced
premium to participating employers based on an actuarial analysis of the contracted deductible and the
rate classification of the employer. For purposes of calculating premiums, the experience rate utilized
will exclude actual and expected primary losses.
For an additional premium, the organization may provide aggregate excess coverage limiting the
maximum liability for losses of the employer during a policy period. Premiums will be derived from
actuarial analysis and a selected aggregate limit. The aggregate limit will be agreed upon by the
employer and the organization.
1. Eligibility. Eligibility for participation in a deductible program is based on the financial stability
and resources of the employer. Participating employers must be in good standing with the
organization.
The organization may require participating employers to submit to a financial audit to ensure
financial stability. The audit may include a credit check and review of company financial
reports.

The organization shall analyze each proposed contract based on risk analysis and sound
business practices. The organization may refuse any deductible program if it determines that
the proposed contract does not represent a sound business practice or decision. Past
participation in a deductible program does not guarantee continued eligibility. The organization
may decline renewal of any deductible program.
2. Claim payment. The organization shall process and pay claims in accordance with North
Dakota Century Code title 65. The employer shall reimburse the organization for all costs paid
by the organization on individual claims up to the amount of the contractually agreed
deductible.
If a third-party recovery on a claim is made, the recovery will be allocated according to the
terms of the contractual agreement between the organization and the employer, subject to
North Dakota Century Code section 65-04-19.3.
The organization shall deduct any delinquent deductible reimbursements from any
subrogation amounts recovered on any claim.
3. Premium payment. Premium is due at policy inception pursuant to the terms of the
contractual agreement between the organization and the employer.
4. Financial security. The organization may require an employer to provide a bond, letter of
credit, or other security approved by the organization to guarantee payment of future employer
obligations incurred by a deductible contract.
History: Effective May 1, 2000; amended effective May 1, 2002; July 1, 2004; July 1, 2006.
General Authority: NDCC 65-02-08
Law Implemented: NDCC 65-04-19.3
### § 92-01-02-55. Dividend programs.

The organization may offer dividends to qualifying employers. Eligibility and distribution:
1. Dividends are not guaranteed.
2. If an employer's account has been in effect for less than an entire premium year, any dividend
offered shall be prorated by the number of months the employer's account has been active
with the organization. Premiums paid and losses incurred during a dividend review period
defined by the organization, and other criteria identified by the organization, may be used to
determine the amount of the dividend. Minimum premium and volunteer accounts are not
eligible for dividend payments.
3. The organization shall offset past-due balances on any account by the dividend earned on that
account.
4. A dividend is distributed in the form of a premium credit to an employer's account and may not
reduce an employer's premium below the minimum premium. No monetary disbursements of
dividends can be made by the organization.
5. An employer who is noncompliant, delinquent, uninsured, or who has failed to submit a payroll
report may be ineligible for a dividend for the payroll period following the year in which the
employer was noncompliant, delinquent, uninsured, or failed to submit a payroll report.
History: Effective May 1, 2000; amended effective July 1, 2004; July 1, 2006; July 1, 2010; April 1,
2020; January 1, 2024.
General Authority: NDCC 65-02-08
Law Implemented: NDCC 65-04-19.3

### § 92-01-02-56. Retrospective rating program.

Repealed effective January 1, 2024.
### § 92-01-02-57. Medical expense assessments.

An employer may file an incident report with the organization through the organization's web site. If
an incident report is filed with the organization by midnight central time of the next organization
business day following the workplace injury or incident and a claim is filed for benefits within fourteen
calendar days of the date of injury, the organization shall waive the two hundred fifty dollar medical
expense assessment.
The organization shall notify an employer by electronic transmission or by regular mail of the
assessment of a medical expense assessment. The billing statement must inform the employer of the
ability to appeal the decision of the organization.
History: Effective July 1, 2006; amended effective April 1, 2008; April 1, 2020.
General Authority: NDCC 65-02-08
Law Implemented: NDCC 65-04-04.4, 65-04-19.3
### § 92-01-02-58. Premium credit for military members.

1. Applicants for this premium credit shall complete and submit a complete application provided
by the organization. The organization may decline an application for this program.
2. An applicant must be in good standing, as defined in section 92-05-02-01(2), with the
organization to qualify for this program.
3. An applicant to this program who is noncompliant, delinquent, uninsured, or who has failed to
submit a payroll report may be ineligible for this program.
History: Effective January 1, 2026.
General Authority: NDCC 65-02-08
Law Implemented: NDCC 65-04-19.4
