RPC

Peer Review Process

The purpose of the Peer Review Committee (hereinafter, Committee) is to educate, consult and review submitted issues and complaints and to act as a liaison to the Rehabilitation Professional, the Rehabilitation Advisory Board, the NC Industrial Commission and all other appropriate parties.  Persons wishing to file a complaint against a Worker’s Compensation (WC) Rehabilitation Professional must complete the attached Complaint Form and submit to Karen Smith of the Rehab Advisory Board.  Karen Smith will review all of the facts of the NCIC case and will contact involved parties as needed.

Karen Smith will serve as Chair of the Committee and will utilize the other members of the Rehab Advisory Board to serve as members of the Committee regarding a specific complaint.  All complaints will be sent directly to Karen Smith, who will review the complaint with all appropriate parties (verbally), including the person on whom the complaint is filed.  Should the Chair discover that the complaint has already been resolved, all committee members and involved parties will be informed that the complaint is resolved and no action is necessary.  The Chair will also verify the need for excusal of any members of the committee based on conflict of professional or personal interest.  If there is a reason to exclude one committee member or the Chair, then the Committee may appoint a Rehabilitation Professional to replace that member on an interim basis. 

If it is determined the complaint has merit, the Rehabilitation Professional will have 10 days to respond to the complaint or provide a written rebuttal.  The peer review process does not stop the rehabilitation process.

The complainant must be willing to grant permission to release all records of interactions to the Committee and to answer all questions from the Committee regarding the complaint.  Complainants other than the injured worker (or his/her legal representative), must obtain written permission from the injured worker to submit information (see attached consent form).

After the complaint is reviewed by the Committee, and a conclusion that education or training is needed for the Rehabilitation Professional, then the Committee will be responsible for establishing what education or training is needed and will refer the Rehabilitation Professional to the appropriate resource for obtaining that education or training. 

If the issue/complaint is unresolved at this level, the Committee, after gathering the facts of the case, will decide whether a violation of the Rules has been committed by the Rehabilitation Professional.  If the Committee finds that no violation has occurred, all parties will be notified in writing of the Committee’s findings.

If the Committee determines that there is enough evidence to indicate a violation of the Rules has been committed, a letter of instruction will be provided to the Rehabilitation Professional, which describes the Rule that was found to be violated and recommendations for resolution.  A second letter will be copied to all involved parties which, acknowledges that the Rehabilitation Professional was found in violation of [Rule #] and that appropriate recommendations have been made to the Rehabilitation Professional for resolution.

To print and complete the complaint form click here