Section 94-03-03-02 - Application requirements1. A completed application for an award of compensation must be timely submitted to the division within one year from the date the criminally injurious conduct was reported to a law enforcement officer. The division may extend the time to submit a completed application in the interests of justice. The interests of justice include: a. The applicant is a minor.b. The applicant's physical and psychological condition substantially contributed to the applicant's inability to timely submit a completed application.c. The interests of justice do not include attorney error or mistake or lack of knowledge of the Crime Victims Compensation Act.2. A claimant for benefits shall submit a completed application for compensation signed by the claimant or the claimant's parent, guardian, or legal representative on an application form prescribed by the division. An employer, an assignee, a medical provider, a service provider, or an insurance company may not submit an application for benefits on behalf of a claimant. The claimant shall provide the following information to the division: a. Claimant information: (5) Residential and work telephone numbers;(8) Known disabilities prior to the criminally injurious conduct; and(9) Relationship to the victim if claimant is not the victim.b. Information regarding the criminally injurious conduct: (2) State or federal jurisdiction;(3) Date, time, and location the criminally injurious conduct was committed;(4) Date and time the criminally injurious conduct was reported to law enforcement authorities;(5) Name of law enforcement agency to which the criminally injurious conduct was reported;(6) Name of offender, if known; and(7) Brief description of the criminally injurious conduct and resulting injuries.c. Information on civil lawsuit, mediation, or settlement negotiation:(1) Statement whether the claimant has or will commence a civil lawsuit or seek damages related to the criminally injurious conduct; and(2) Name, address, and telephone number of claimant's attorney, if the claimant will be represented by counsel.d. Information on benefits from other collateral sources:(1) List the benefits claimant has received or may be eligible to receive from other collateral sources as a result of the criminally injurious conduct, including disability benefits; employer-paid leave, including sick leave or annual leave; health insurance, including medical, vision, and dental benefits; life insurance; Medicare; medical assistance or Medicaid; motor vehicle insurance; personal and charity fundraising, including online fundraising; restitution; social security benefits and social security disability benefits; veterans' benefits; workforce safety and insurance; and any other state, county or tribal public assistance, including food stamps.(2) For each benefit identified, provide the type of benefit, amount of benefits provided or to be provided, provider name, address, telephone number, and identification policy number, if applicable.e. The claimant's dated signature:(1) Certifies the claimant is eligible to submit a claim and that the information provided is true and correct to the best of the claimant's knowledge.(2) Authorizes the release of protected health information and confidential information necessary for the division to verify and administer the claim.3. The division shall review the application and supporting documents for eligibility and investigate the claim. If additional information is needed to determine the eligibility or validity of a claim, or to substantiate the degree of loss, the division may ask the applicant for further information or request it directly from outside entities to the extent permitted by law.4. If a claim is compensable, but there are insufficient funds to make a compensation award, the division may:a. Make a partial award and reconsider the claim later during the fiscal year; orb. Extend the claim into a subsequent fiscal year.N.D. Admin Code 94-03-03-02
Adopted by Administrative Rules Supplement 2017-363, January 2017, effective 1/1/2017.General Authority: NDCC 54-23.4-04
Law Implemented: NDCC 54-23.4-04, 54-23.4-06