Annual report, 1995

Georgia State Board of Workers' Compensation
Annual Report

Zell Miller, Governor
Harrill L. Dawkins, Chairman Don L. Knowles, Director M. Yvette Miller, Director
270 Peachtree Street, N.W. Atlanta, Georgia 30303-1299

m1-ss1- on statement
To encourage safety and assure benefits for injured employees

~~Lfl_/1920 by the Georgia Legislature, the State Board of Workers' Compensation serves
over 186,000 employers and 3,200,000 workers. The State Board of Workers' Compensation is funded by
assessments from insurance companies and selfinsured employers. An employee, covered by the law,
may become eligible for wage replacement, medical payments, vocational rehabilitation services and other benefits.
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CONTENTS

Overview

PART I ORGANIZATION

Published by
State Board of Workers' Compensation
270 Peachtree Street N.W. Atlanta, Georgia 30303-1299

Introduction .....

............. 2

The Three-Member Board

........ 3

The Office of Executive Director . . . . . . . . . 4

PART II ACHIEVEMENTS & ACTIVITIES

Chairman Harrill L. Dawkins
Director Don L. Knowles
Director M. Yvette Miller
Executive Director Farris N. Freeman
Chief Administrative Law Judge Patricia M. Killingsworth
Editor Joe Moore

Administrative Services Division.

10

Claims Processing Division ....

14

Licensure and Quality Assurance Division

15

Managed Care and Catastrophic

Disability Division

16

Legal Division . . . . . . . . . . . . . . . . . . . . I 8

Fraud/Compliance Division ........ .

21

PART Ill SUBSEQUENT INJURY TRUST FUND.

23

PART IV STATISTICAL CHARTS & TABLES .

27

The "1995 Annual Report"

PART V APPENDICES ............. .

37

is a presentation of

calendar year

1994 claim information

and fiscal year 1995

operational statistics.

OVERVIEW OF 1004

52,521 49,910 $166,303, 146 $3,166 $172,304,909 $3,452 $6,568 166,356 $45,683,902 $274 $384,292,131

indemnity cases reported with a date of injury in calendar year I994.
cases have been processed as of 12-3 1-95 and constitute the basis for this Annual Report.
indemnity dollars were paid on lost time cases as of December 3 I, 1995.
was the average indemnity payment on a lost time case.
medical dollars were paid on lost time cases as of December 31, 1995.
was the average medical payment on a lost time case.
was the average cost per lost time case.
cases were reported as medical only claims.
dollars were paid on medical only cases.
was the average cost of a medical only case.
dollars were paid out on all cases (lost time and medical only cases) as of 12-3 1-95.

The administrative expenses of Board operations was 0.61 % of the premiums collected by insurance companies and premium equivalent for self-insured employers in fiscal year (FYl 995). This assessment is the lowest in the United States.
The three-member board heard 1,115 cases (FY-1995) The administrative law judges heard 2,721 cases (FY-1995) There were 13,894 stipulations filed for settlement (FY-1995) 161,773 files were audited by claims examiners (CY-1994)
91,033 files were closed (CY-1994) Subsequent Injury Trust Fund reimbursed $57,333,270 to employers (FY-1995)

1
Organization
0

INTRODUCTION
It Rruv~75 ~since the Georgia Legislature enacted the
Workers' Compensation Law. The law created an organization called the Industrial Commission, the forerunner of today's State Board of Workers' Compensation, to encourage safety and assure benefits for injured employees.

~or to the passage of the law, an employee who was injured on the job could not expect benefits from the employer. Men, women, and children were often subjected to harsh and oppressive working conditions with little or no recourse for work-related injuries. Courts often denied recovery to employees by holding that employees assumed risks in taking the job, or were negligent, or were barred from recovery by the negligence of a fellow employee. Filing a suit in court was also unsatisfactory because trials were expensive and often lengthy. This posed a problem to an employee who needed money immediately to pay for medical expenses and replace lost wages. A successful suit could also force a small company out of business.
If facts concerning a claim are contested or liability is questioned, either the employee or the employer/insurer may request a hearing before an administrative law judge to resolve the issues. If either party is .dissatisfied with the decision, a party may request a review by the Appellate Division. Further appeals may be taken through the court system; however, the courts can review only disputed questions of law while administrative law judges and the Appellate Division determine both factual and legal issues.
Today, the workers' compensation law provides for specific benefits to be paid to employees for injuries arising out of and in the course of employment, without regard to negligence or fault, and, at the same time, provides the employer with limited liability. In Georgia, employers obtain workers' comp'ensation coverage through private

insurers or programs of self-insurance. The rights granted an employee under the law preclude any other legal remedies against an employer by an employee due to a work-related injury.
The law is applicable to all employers, including public corporations and nonprofit organizations that have at least three full-time or part-time employees. There are several categories of workers who are specifically exempted from the workers' compensation law; federal government employees, railroad employees, farmers and farm hands, domestic servants, business partners, some corporate executives, and independent contractors.
Although the Subsequent Injury Trust Fund is a separate state agency, the Board and the Fund work closely together. The Fund reimburses the employer/insurer for a portion of workers' compensation benefits paid in cases where a preexisting permanent impairment combines with a subsequent injury to produce a greater disability than would have resulted from the subsequent injury alone.
The workers' compensation program is entirely funded by assessments from insurance companies and self-insured employers.

THE THREE-NENBER BOARD
The ~-~93acvu:L constitutes the
Appellate Division and is responsible for the administration of the Workers' Compensation Law. The Board members are appointed by the Governor for a term of four years.
T:e responsibilities of the Board are divided into quasi-judicial, administra-
tive, and regulatory functions. The quasi-judicial function includes reviewing decisions of administrative law judges upon request of a party to the claim, and approving settlements. The administrative and regulatory functions of the State Board of Workers' Compensation include: monitoring all claims and benefit payments to injured workers, processing stipulated settlements, lump sum payments, advance payments, requests for changes in physicians if not resolved by the mediation section, ensuring that employers maintain required insurance coverage, approving applications of insurance companies to write workers' compensation insurance and applications of employers to act as self-insurers, and participating in programs to explain the functions of the Board to the general public.

Chairman Harrill L. Dawkins

Director Don L. Knowles

~o~ M. Yvette Miller

e

THE OFFICE OF EXECUTIVE DIRECTOR
The t)~4~ ~ g ) ~ h a s the
responsibility of the day-to-day operation of the State Board of Workers' Compensation.

Georgia's Workers' Compensation system has undergone enormous changes in the past year and these changes will continue as we work toward making the system more user friendly and reducing the paperwork involved in a statewide network of approximately 250,000 claims filed per year. Particularly exciting to the participants in the system is that data received by the Board for calendar year 1994 indicate the cost of workers' compensation will be significantly reduced from the past three years. This cost reduction has been brought about legislatively as well as administratively. This report will address many of the cost saving issues put in place last year.
The Board's computer data base expansion was completed in January of 1995 making available to the Board the ability to receive electronic data

transfer of statistical data in a timely manner from a selected number of insurers and selfinsurers as well as third party administrators. The electronic transmission of data will continue to grow as compatibility differences between the Board and insurers are resolved. Not only have we realized a growth in electronic transmissions from system participants, the Board has developed a monthly summary of all activities, both financial and statistical, which is used for comparative analyses. Questionable data can be identified immediately and addressed before getting to problem stages.

1992 Lost Work Days Open Cases Files Reviewed Files Closed Late Filings of WC-ls Penalties Paid Per Month Delinquent WC-4s Full Board Appeals Hearing Request/Schedule/Settle/Heard
0

180 92,000 114,413 54,596
52% $61,000 41,000
1,407 217 days

1994 Lost Work Days Open Cases Files Reviewed Files Closed Late Filings of WC-ls Penalties Paid Per Month Delinquent WC-4s Full Board Appeals Hearing Request/Schedule/Settle/Heard

60 67,000 161,773 91,033
23% $35,000
9,000 1,115 140 days

The Drug Free Workplace Premium Credit Program continues to grow with hundreds of businesses qualifying for the 5% discount on insurance premiums as well as the enoromous savings realized by eleminating work-related problems associated with the abuse of drugs and alcohol.
1995 changes occurring in providing medical care to injured workers through the Physicians and Surgeons and Pharmaceutical Fee Schedule included a payment system for outpatient treatment by hospitals which was among the first in the country. Parmaceutical reimbursement payments were reduced from 1.5% of the average wholesale price to 1.2%.
Enacted by legislation in 1994 was a limited and controlled physician referral system for specialized or consultative treatment. This action has

resulted in better management of medical care for injured workers. Data to date indicated medical costs will decrease if not drastically at least significantly. As of this date, medical only claims costs have been reduced from 1992 to 1994 by $45 million and are expected to decrease even more for calendar year 1995.
Other examples of administrative changes which are noteworthy:
Average lost time work days have decreased from 180 in 1992 to 60 in 1994.
85% of cases closed within one year of the date of injury.
90% of all injuries reported have a return to work date reported within one year of the date of injury.
Our entire Board is committed to making the Workers' Compensation System in Georgia one that is fair and responsive to all. We welcome any comments or questions you may have.

e

ORGANIZATION STRUCTURE

State Board of Workers' Compensation Organizational Structure July 1, 1995 162 Positions

Board of Directors
6
I
Insurance Consultant
1

Promulgates Workers' Compensation regulations Develops Workers' Compensation policy Hears appeals of Administrative Law Judges' decisions and renders rulings on appeals Approves and submits budget requests for the agency

I

I

I

Executive Director's
Office 3

Staff Attorneys
5

Handles insurance related issues
Makes presentations to various groups as requested

Oversees the operations of the Board Provides management supervision Makes presentations to various groups as requested Assists the Board Members as needed Peer review of medical services

Researches cases appealed to Board
Recommends appropriate action

I
Administrative Services Division 16

I
Claims Processing
Division 27

Performs accounting functions
Performs personnel functions Coordinates training
sessions, presentations and public information Coordinates employee training programs Prepares budget Oversees purchasing Provides data processing services Coordinates printing services Manages contracts

Maintains fileroom and filing system
Reviews cases prior to closure
Operates mailroom Performs receptionist
duties Processes mail and
forwards files and mail to divisions Locates files and resolves problems caused by duplicate files
I
Licensure & Quality Assurance
Division 8

Certifies self-insurers and rehabilitation suppliers
licenses insurance companies Performs quality assurance
reviews of insurers and self-insurers Maintains information on employers' insurance coverage Maintains Safety Library
8

I
Fraud/Compliance Division 13

I
Legal Division
75

Investigates incidents of non-compliance
Investigates incidents alleging fraud
Makes presentations to various groups regarding fraud/ compliance
l
Managed Care & Catastrophic Disability Division
8

Screens requests for hearings
Holds formal hearings Reviews and approves
stipulated settlements Mediates changes in
physicians, rehabilitation suppliers, and attorney fees Makes presentations to various groups as requested Copies case files for attorneys and higher courts

Processes requests for rehabilitation services Performs quality assurance reviews of
rehabilitation suppliers Holds conferences to resolve disputes Conducts training for rehabilitation suppliers Reviews and approves rehabilitation plans Reviews applications of Managed Care
Organizations

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2
Achievements & Activities
8

THE ADMINISTRATIVE SERVICES DIVISION

the Accounting, Personnel, Training, and Data Processing Services Sections.

The Division has responsibility for account-
ing, payroll, budget, supplies, property management, training, personnel, annual reports, data transactions, word processing/PC training and support.
The Accounting Section provides internal support services to the Atlanta office of the State Board of Workers' Compensation and eight field offices. These services include responsibility for accounting records, payroll, purchasing, inventory controls, calculation of annual and supplemental assessments, and budget reports.

Assessments from approximately 723 self-insured employers plus 327 insurance companies writing workers' compensation coverage in Georgia fund the administrative expenses of operating the Board.

Table I Annual Operating Budget
FY 1995

Number Of Positions Personal Services

147 $7,368,707

Regular Operating Expenses: Motor Vehicle Expenses Supplies &Materials Repairs &Maintenance Rents (Other Than Real Estate) Insurance &Bonding Equipment Purchase Other Operating Expenses
Travel Publication & Printing Computer Charges Real Estate Rentals Telecommunications Per Diem, Fees &Contracts Postage Duplication &Rapid Copy Payments To State Treasury Total
I)

2,000 70,000 40,000 2,500 2,000 29,250 130,000 83,000 60,000 490,482 1,013,996 124,040 204,518 156,049 8,000 748,343
$ I 0,532,885

Table 2 Assessment Figures

Administrative

Fiscal

Premium

Funds

Premium

Year

Writings

Collected

Factor

981 372,557,664

3,508,873

0.942

982 409,282,004

3,833,869

0.937

983 426,111,752 4,258,646

0.999

984 431,195,478 4,500,632

1.07

985 416,563,243 4,817,044

1.16

986 475,412,585 5,556,765

1.21

987 586,706,797 5,982,699

1.02

988 739,280,403

6,919,856

0.924

989 911,523,434 7,477,511

0.820

990 1,061,301,347 8,008,400

0.755

991 1,239,497,523 8,334,378

0.672

992 1,474,997,352 8,537,789

0.577

993 1,598,890,476 9,214,010

0.579

994 1,648,162,040 9,690,796

0.587

995 1,701,221,644 I0,294,882 0.610

The Personnel Section is primarily responsible for: developing and disseminating State Board of Workers' Compensation policies and procedures to employees, processing personnel actions and ensuring they are handled efficiently and effectively, maintaining personnel records on each employee, maintaining and updating job descriptions and specifications on each position, serving as the Americans with Disabilities Act (ADA) agency coordinator, and preparing reports reflecting personnel activities as needed.

Budgeted Personnel Positions

FY 92 FY 93 FY 94

FY 95

FY96

165

137

142

147

162

The Personnel Section in conjunction with the Executive Director, recently updated the Workers' Compensation Procedures Manual. This manual includes reference sections for the employer and the insurer/self-insurer which provide useful information on how to process claims. The manual also includes a complete set of the new Board forms effective July 1, 1995.

During the past year, the Personnel Section worked closely with the Executive Director in establishing the new Fraud/Compliance Division. This new division includes 13 positions; two in the Albany Field Office, one in the Gainesville Field Office, one in the Rome area, and 9 in the Atlanta Office. The new division was fully staffed on September 1, 1995, and the response from the public regarding the new division's work has been rewarding.

An on-going project of the Personnel Section and one that the Board is excited about is the total revamping of the state personnel system known as GeorgiaGain. All Board managers have been trained in the new GeorgiaGain performance management system and will enter a second phase of training in the Spring of 1996 regarding the new employee evaluation system. Additionally, current state jobs are being compared to similar jobs in the public and private sectors. After this analyses is completed in 1996, a new classification and compensation system for employees will result.

The Training Section of the State Board has continued to broaden educational efforts in both public information programs as well as internal staff development projects.
In an effort to maximize awareness of the Georgia Workers' Compensation System, Regional Educational Seminar sites were increased to eight strategic locations throughout the state. Topics included basic statutory provisions of the law, legal issues, promotion of the safety library, the mediation process, the role of managed care organizations and current legislative directions. By alternating site selections for the 1996 programs, we anticipate educating communities throughout Georgia on the workers' compensation process.
With constant employee changes in the workers' compensation work force, the Training Section recognizes the need for repetitive training on fundamental procedures. A one-day intensive seminar entitled "Clear Water From the Head of the Stream" emphasized the history of the law in Georgia, employer/employee rights and responsibilities, processing of State Board claim forms, medical provider procedures, settlements and alternative dispute resolution, all directed toward a "beginner's" perspective. In an effort to enhance quality assurance, future sessions will address proper form completion for insurers, selfinsurers and third party administrators.
As we strive for quality assurance from our workers' compensation communities, the State Board is participating in a new statewide Performance Management Process which will enhance the quality of our internal staff management expertise as well. Known as GeorgiaGain, the objective of the process is to provide the necessary link between departmental strategic plans and the

performance expectations of the State Board employees. Conducted by the Training/Personnel Section, the managers and supervisors underwent a four-day skills preparation session on the four elements of the new process: Planning, Coaching, Evaluation, and Development. The trial year for the new process begins in the Fall of 1995 with full implementation expected by the Fall of 1996. In addition to the new management process, internal staff development included advanced computer techniques and continued mediation certification training.
The most extensive project of the Training Section, the Annual Educational Conference, was especially eventful in 1995. The seminar, "Saluting the 75th Year of Workers' Compensation in Georgia" had over 1200 in attendance. Workshops were divided into five distinct areas; Legal, Medical, Rehabilitation, Insurer/Self-Insurer, and Claims. Fifty-seven (57) speakers in various areas of workers' compensation were featured. With the recent addition of court reporters accreditation, over ten (10) professions were approved for continuing education credits. A total of 76 exhibitors displayed services and served as the "hub" for networking opportunities. In recognition of the anniversary year, an extra day was added to the conference for a special presentation by Richard Pimentel, a nationally known expert in workers' compensation and Americans With Disabilities Act. Consideration had been given to expanding workshops, attendance, speakers, and exhibitors, however, the delivery of an effective, quality program of the current size is deemed more important in the educational objectives of the State Board.
The goals of the Training Section are to continue to provide quality educational opportunities for our workers' compensation communities by addressing specific needs, expanding accessibility to training sites and providing topics on the most current solutions to cost containment and effective, efficient delivery of benefits. Internally, our efforts in the GeorgiaGain Management Process will ensure a quality standard of service in our judicial, administrative, and regulatory functions as the State Board of Workers' Compensation.

Data Processing Services, with eight employees, is responsible for the quality input of the thousands of forms received by the Board each year. This unit is also responsible for the preparation of management reports, statistical analysis of the data captured, ad hoc reports, publications and support for the variety of computer applications in use at the Board.
The four operations in the unit are:
Data entry provides quality input of the information from the Board forms. In excess of three hundred thousand forms were received in 1994. These forms are the source documents for the database of information which allows the Board to serve the 186,000 employers and approximately three million workers covered by the State's Workers' Compensation Law.
Data services includes the generation of publications, operational, managerial, ad hoc, and statistical presentations of the data collected surrounding the establishment and resolution of a workers' compensation case.
On-line claims information is available to Board employees via a wide area network (WAN). Currently one hundred employees and nine field offices are on-line users of this system and through the use of laptop computers, Judges and employees in the Fraud unit gain additional access to data.
In accordance with Board rule (34-9-61 ), information about the Board's past year operation is formally presented to the Members of the Georgia General Assembly. An annual report is prepared to share this information with insurers, self insurers and other interested parties. Extracts of this information is provided to appropriate agencies of government such as the Georgia Department of Labor.

Quality control, as part of the larger Board goal, is a unit-wide activity which involves audits of claimant data, checks for coding consistency, form compliance from reporting parties, and timeliness of document flow.
Over 5000 telephone consultations were made with insurers, employers, employees and attorneys to obtain missing information or to clarify conflicting information on forms. The Board also maintains a toll free telephone (1-800-533-0682) providing claims assistance to the general public.
With over one hundred and fifty personal computers and the associated peripherals at the workstations of Board employees, operations support for them is critical. The unit provides both hardware and software problem determination and resolution and coordinates the introduction, training and testing of new Board applications on the Georgia On-Line network.
With the participation of insurers, self insurers and third party administrators (TPAs), we have successfully implemented receipt of the statistical data from case progress reports via electronic media. Through electronic data interchange (EDI) the Board has experienced both timely updates to claimant information and the elimination of thousands of pieces of paper. The Board is encouraging this method of reporting for all insurers, self-insurers and TPAs conducting business in Georgia. For information about reporting through EDI call the Board at this toll-free number 1 (800) 533-0682.
The current database of both active and closed cases totals over three hundred thousand records. As the Board seeks to meet new challenges in its mission with the addition of new operational procedures, the database will be expanded to capture and report this relevant data.

THE CLAINS PROCESSING DIVISION

The ~~~ g ) ~includes Document
Processing, File Room, and Case Management Units.
The Document Processing Unit is responsible for all receptionist/switchboard activities, handling
of all incoming and outgoing mail, processing correspondence, and maintenance of the record charge-out system. The unit coordinates twice-weekly courier service between Atlanta and the Board's offices in Albany, Augusta, Columbus, Dalton, Gainesville, Macon, Rome, and Savannah. During calendar year 1994 over 600,000 documents were processed.

The File Room Unit creates and maintains claim files and coordinates the transfer, retention, and destruction of claim files with the State Record Center. 51,281 new records were created during calendar year 1994. The File Room maintained approximately 161,000 records at the Board's Atlanta office. In addition, the State Record Center housed approximately 450,000 records which were closed during calendar years 1985 through 1993. The Board's claim files are destroyed an average of ten years after the date of closing.

The Case Management Unit is responsible for reviewing and closing 60% of all claims. The unit is also responsible for ensuring compliance with board rules and regulations, filing procedures, and the accurate and timely reporting of benefit cost and other statistical data. The 91,033 cases closed during calendar year 1994 represents and increase of 61 % over 1993. This increase was due to a joint effort by the Board, insurers, selfinsurers, and third part administrators to eliminate delinquent filings of Forms WC-4 (Case Progress Reports).

Table 3 Claims Processed Per Calendar Year
Reported As Indemnity Cases

Calendar Year
1989 1990 1991 1992 1993 1994

Medical Only Cases Reported
241,324 247,956 186,959 255,074 250,647 166,356

Reviewed
134,053 I 52,611 134,086 114,413 113,0 I 2 161,773

Created
54,870 55,756 52,282 52,906 52,507 S1,281

Closed
62,954 61,792 64,845 54,596 56,749 91,033

Chart I Claims Files Reviewed
and Closed per Calendar Year

20,000

Reviewed 1111 Closed{:

10,000

.. , ,914

61,791

.J4,749

"'

II

1989

1990

1991

1992

1993

1994

THE LICENSURE & QUALITY ASSURANCE DIVISION

The~ & ~~9)~

performs several major functions in the operation

of the State Board of Workers' Compensation.

The Licensure and Quality Assurance Division
acts as regulator for companies who self-insure for its Workers' Compensation obligations. This section reviews applications and makes recommendations to the Chairman and Directors for approval or disapproval, issues permits and maintains records for companies who self-insure. With the creation of the Georgia Self-Insurers Guaranty Trust Fund in January, 1991, all employers who self-insure, other than governmental entities and group self-insurers, must be accepted by the Georgia Self-Insurers Guaranty Trust Fund in addition to being approved by the Board. At the present time 419 private companies and 115 governmental entities are selfinsured. Certification is also provided for 141 Elberton Granite Association Members. Also, records are kept by this section identifying members of the 41 group self-insurance funds.
The Licensure and Quality Assurance Section provides insurance coverage information on employers who self-insure and for over 83,000 employers on file for insurance coverage reported to the National Council on Compensation Insurance. The Licensure and Quality Assurance Section maintains a computer terminal on line with NCC! and up-to-date insurance coverage information is provided to Board Personnel, injured workers, attorneys, medical providers and others who have need of this information.
This Division also issues permits to insurance companies who are certified to write workers' compensation insurance policies. In order to be permitted, insurers must fulfill the legal requirements and be issued a permit yearly. At this time, 327 insurance companies are permitted by the Board to write workers' compensation insurance.
Rehabilitation suppliers are registered by this division. Applications pertaining to certification are submitted to the Board before a certificate is granted. Suppliers must be qualified by education and experience, and must be certified by one of the five professional rehabilitation organizations. Presently there are 805 active rehabilitation suppliers registered with the Board.

The Quality Assurance Section performs a number of other functions. Claims examiners are responsible for auditing 100% of first reports of injury filed by selected insurers and self-insurers to determine compliance with Board rules and regulations. These audits are furnished to insurers and self-insurers every six months to inform them of trouble spots and to mandate corrective action. Quality Assurance staff members work with insurers and self-insurers throughout the year in workshops to assist in training claim examiners with the many technical aspects involved in filing board forms correctly and timely.
In addition to performing audits, quality assurance claims examiners identify errors and problems on 40% of all files created by the Board. In performing these duties the quality assurance claims examiners reviewed over 43,000 files in calendar year 1994 to determine compliance.
The Quality Assurance Section also is part of the team that manages the regulation and review of delinquent case progress reports (WC-4's). As a result of this ongoing effort, the Board is in a much stronger regulatory position and insurers and self-insurers are in higher compliance with Board rules and regulations than ever before.
In August, 1992, the Board began a Workers' Compensation Safety Library that consists of video tapes on a wide variety of safety subjects. The third edition of the catalog has been issued and it contains many new video titles to aid employers in emphasizing and strengthening safety programs. The library is a valuable resource that is available at no cost to Georgia employers. The Safety Library began as a project of the Licensure and Quality Assurance Subcommittee of The Advisory Council to The State Board of Workers' Compensation. The insurers and self-insurers who are members of this committee recognize the importance of safety in the workplace as do the many companies and educational institutions who contribute material to the library.

MANAGED CARE & CATASTROPHIC DISABILITY DIVISION

9)~9)~
was created in 1995 secondary to a statutory provision which introduced managed care into Georgia's Workers' Compensation System.

0 n July 1, 1994, the board was authorized
to certify organizations as qualified to provide managed care to industrially injured workers.
It is anticipated that Managed Care will result in substantial cost savings, while permitting workers to have access to a significantly increased number of primary care physicians and specialty services. The National Commission on Compensation Insurance has recommended a premium discount up to 12% when a certified managed care organization is utilized. The board has redirected the resources of the Rehabilitation Division to accomplish the task of implementing the managed care program.
As rehabilitation assessments are no longer mandated for Georgia's non-catastrophically injured workers, the number of active rehabilitation cases has dropped from more than 20,000 in 1992, to 2,225 in 1995. Of these active cases, 387 are catastrophic in nature and continue to receive mandatory rehabilitation assistance. The remaining 1,838 cases represent serious injuries which occurred prior to July 1, 1992, when rehabilitation benefits became voluntary in nature for all but the catastrophically injured.

The Division continues to monitor the services provided to those employees who are entitled to the benefit of rehabilitation, while resources are re-directed to provide oversight of the certification and regulation of Workers' Compensation Managed Care Organizations. A continued effort will be maintained to assure that catastrophically injured workers receive timely and effective rehabilitation services.
The Managed Care and Catastrophic Disability Division is responsible for processing the applications of organizations seeking certification as Workers' Compensation Managed Care Organizations. In the first year of this program, eighteen organizations have applied for certification and of these, seven have received notice of certification and two applications have been withdrawn. It is anticipated that additional certifications will be awarded in the immediate future.

The Division is developing a quality assurance program to evaluate the effectiveness of managed care in delivering medical services to injured workers. A major component of this program will be the appointment of an advisory panel to assist the board in evaluating case management practice standards. Compliance audits will be conducted which will include a review of all grievances filed, as well as all peer review findings. Additional measures will be implemented as necessary.

The Division staff consists of a director, an administrative assistant, three coordinators and three secretaries. The professional staff will provide technical assistance to participants in the managed care program as well as dispute resolution assistance when grievances are appealed to the board. As trained mediators, coordinators will be utilized to facilitate care and minimize the number of hearings before Administrative Law Judges.

Case Assigned
Files Reviewed
Conferences
Cases Closed

Table 4 Rehabilitation Activity Fiscal Years 1990 -1995
FY 90 FY 91 FY 92 FY 93

FY 94

FY 95

10,949 20,271 20,252 8,858 2,895

17,162 244

23,166 275

22,996 198

19,512 150

I 0,252 83

5,691 13,131 13,464 11, I 05 4,653

1,488 5,702
82 1,914

FY 90 to FY 92 - Rehabilitation mandatory for catastrophic injury and vocational disability FY 93 to FY 95 - Rehabilitation mandatory for catastrophic injury only

THE LEGAL DIVISION

The ~ g ) ~ is responsible for processing all
requests for legal action in a contested claim. The Division is divided into four sections: Screening and Administration, Alternate Dispute Resolution, Settlements and Trial.

The Screening and Administration
Section is responsible for processing all notices of claims and requests for hearings to determine where the claim should be directed for resolution. The Section assigns those claims requiring an evidentiary hearing to administrative law judges in the Trial Division of the Board.
Claims not requiring a hearing will be assigned to the Alternative Dispute Resolution Section for further action. In addition, this Section offers claims assistance to injured employees, employers, insurers and attorneys concerning procedural matters, both in the office and by 1-800 telephone response. Copies of files are made at the request of a party, for a fee. Cases that are appealed to other courts from the board are also processed here. Requests for peer review of medical charges are referred to the appropriate peer review committee by this Section.
This Section screens over 1500 files per month, to be referred to either the Trial Section or Alternative Dispute Resolution Section for further action. Each month, between 40-50 Superior Court appeals are processed, between 400-500 files are copied at the request of the parties (over 40,000 pages), and over 4500 requests for assistance are handled, both in person and by telephone.
The Alternative Dispute Resolution Section handles those requests for legal action that do not require a full evidentiary hearing. This Section was restructured during the past year to include mediation conferences on a number of issues. Because of the success of the pilot project, there are now two administrative law

judges and three mediators assigned to this Section in Atlanta and one mediator based in Albany, where requests for review are handled by telephone communications, conferences, or by issuance of an interlocutory order. This staff currently handles approximately 500 claims per month, which would otherwise be assigned to the Trial Section to be scheduled for hearings. Because hearings are not required, this unit can handle the caseload equivalent of four hearing teams, and provide a tremendous amount of relief to judges in the trial section throughout the State. Issues handled by this Section include requests for change of physician, for approval of attorney fee contracts, for reinstatement or suspension of payment of income benefits to an employee, for provision of emergency medical treatment and resolution of other medical disputes, and for resolution of attorney fee lien disputes, in addition to various other requests. The goal of this Section is to speed up the resolution of claims which do not require an evidentiary hearing, and to resolve as many issues without trial as possible. The average length of time for a claim to be processed in this Section is now 50 days. Scheduling of mediation conferences throughout the State was commenced effective July 1, 1994, and the requests for conferences are already overtaking the capacity of the board personnel to schedule them. Statistics gathered during the past fiscal year clearly indicate the effectiveness of the Section, with trials and appeals reduced significantly as the number of conferences increase.

The Stipulation Section processes applications for lump sum payments, advance payments and stipulated settlements. Because the statute requires board review of all workers' compensation settlements, staff in this Section review all applications to determine whether the legal requirements are met, and to ensure that the interests of all parties are fairly represented. After reviewing the requests, the Section makes recommendations for action to be taken by the Board. During fiscal year 1994-95, this Section processed over 13,894 stipulated settlement agreements, 946 requests for advances, and approved over 500 Subsequent Injury Trust Fund agreements.
The Trial Section holds hearings for those claims in which an evidentiary hearing was requested by the parties, and in which a mediation conference either could not be scheduled or could not resolve the issues. Hearings are held in the county where the injury occurs or a contiguous county. There are several hearing offices located throughout the state for the convenience of the parties. When necessary judges travel to locations provided by the counties to hear contested claims. There are currently 20 trial judges at the Board, all of whom were active members of the State Bar of Georgia in good standing for at least seven years prior to receiving their appointment. Although hearings are somewhat less formal than

in a State or Superior Court, they are conducted in accordance with the Civil Practice Act. Approximately 80% of those cases referred to the Trial Section are resolved by the parties without the necessity of a hearing, often through conferences with the judges. Cases are scheduled to be heard within 90 days of the date the hearing notice is mailed as required by the Act, and postponements are to be granted only upon legal grounds. Because of the amount of medical evidence tendered at the trial which must be reviewed, and the parties' requests for the transcript and submission of briefs to the judge, the award is generally issued in the claim 50-60 days following the hearing. Awards will state the findings of fact and conclusions of law of the administrative law judge, and may be appealed to the Appellate Division of the Board within 20 days of issuance. Trial judges, who work without law clerks, are responsible for scheduling their hearings, handling all motions and pre-trial conferences, presiding over hearings, and issuing awards in a timely manner. Despite all of these responsibilities, the average length of time for a claim to be processed in the Trial Section (scheduled and settled/heard) has been reduced over the past year to approximately 100 days. Unless a continuance is requested by the parties, a claim will be scheduled, heard, and the award issued in less than 140 days.

Chart 2 Average Cost to State Board
Trial vs. Mediation

. - - - - - - - - - - - Trial

For every dollar spent in the Legal Division on contested claims:
I claim can be resolved by trial or
5 claims can be resolved by mediation

Mediation

Chart 3 Total Dispositions
FY 95 21,808

71%

5%

Trial

Appellate

3% Superior Court

Chart 4 Trial Division New Cases Received/Hearings Held
16000 ~-----~~::;..=-------::-iiiiiiiii,-------,

11000

6000

1OOO ~=FY 1992
New Cases Received
II Resolved Prior to Hearing
ffl Hearings Held
e

FY 1993

FY 1994

THE FRAUD/COMPLIANCE DIVISION
The mission of the ~~~9)~
is to work with businesses operating in Georgia to assure compliance under the workers' compensation statute as well as to deter fraud.
T:e 1994 Georgia General Assembly passed legislation giving the State
Board of Workers' Compensation authority to create the Fraud and Compliance Division, with full staffing occurring in September of 1995. The Division's goal will be directed toward educating and assisting businesses, medical providers and others who are involved in workers' compensation to achieve a climate which will assure that legitimately injured workers receive benefits allowable under Title 34-9. The Division will investigate, prosecute and publicize fraud and noncompliance when it occurs throughout the state.
Currently there is a Division Director, a staff attorney, and seven investigators. The state has been divided into six districts with an investigator assigned to each with the exception of the Metropolitan Atlanta area where two investigators are assigned.
During the first two months of its existence the Division staff conducted a public awareness campaign of random compliance checks of 1,866 businesses. As a result, approximately 1,000 additional employees are now covered by workers' compensation insurance and $435,632 in new premiums were written. The Division is involved in on going investigations of suspected fraud in several cases and will pursue criminal prosecution when necessary.

THIS PAGE LEFT BLANK

Subsequent Injury Trust Fund

Board of Trustees
Edward J. Bartlett, Chairman Management Representative
James C. Thompson, Vice Chairman Labor Representative
Janis S. Murray, Secretary Insurance Representative
Yvonne Johnson Rehabilitation Professionals Representative
Lewis Lowe Public-at-Large Representative

Ex officio Members
John Oxendine Insurance Commissioner
Farris N. Freeman Executive Director Workers' Compensation Board
Anne D. Burnett Administrator

THE SUBSEClUENT INJURY TRUST FUND

g uw1, On

197 7, the Georgia General Assembly

enacted legislation establishing the Subsequent Injury

Trust Fund. It is designed to reduce the impact of

singularly-large workers' compensation claims in the

event a worker with a disability, injured on the job,

aggravates a pre-existing impairment.

The Fund helps workers with disabilities by
providing employers, who are not subject to the American With Disabilities Act, with incentives to hire or retain qualified workers with disabilities, and assists all insured employers by keeping workers' compensation premiums under control. If an employer is self-insured, it keeps the workers' compensation exposure at the deductible levels.
Although the Subsequent Injury Trust Fund is a separate state agency, the State Board of Workers' Compensation and the Fund work closely together. The Subsequent Injury Trust Fund is governed by a five-member Board of Trustees appointed by the governor for six-year terms. The actual administration of the Fund is conducted by an administrator and staff consisting of 22 employees.
In order for an employer/insurer to be eligible for reimbursement from the Fund, the employee's subsequent injury must be directly caused by the prior impairment, or combined with a prior impairment to create greater employer liability for lost time benefits and medical expenses. In addition, the employee must have a pre-existing impairment that the employer considered to be permanent and likely to be a hindrance to employment, and the employer must have knowledge of the prior impairment before the subsequent injury occurs.

The law also contains a list of conditions which are presumed to be permanent and likely to be a hindrance to employment provided the employer can demonstrate prior knowledge.
Employers/insurers may be reimbursed for all weekly income benefits payable after 104 weeks, for 50% of all medical and rehabilitation expenses between $5,000 and $10,000, and for 100% of all medical and rehabilitation expenses in excess of $10,000. If the subsequent injury was not caused by or related to a prior impairment, the reimbursement for medical expenses may be reduced or denied completely. Unless the employer/ insurer files a claim for reimbursement directly with the Fund, the Fund investigates the claim to determine eligibility for reimbursement. When a reimbursement agreement is reached between the Fund and the employer or insurer, it must be approved by the State Board of Workers' Compensation. If an agreement cannot be reached, either party may request a hearing with the Board.

Fiscal Year
1990/91 1991/92 1992/93 1993/94 1994/95

Table 5

Subsequent Injury Trust Fund Claim Activity

Cases

Cases

Cases

Cases

Cases Remaining

Received*

Accepted

Denied

Closed Open At End Of FY

Amount ($) Reimbursed

2630

538

3290

569

3507

691

4446

625

5371

987

96

1689

4020

28,791,733

190

2523

4784

28,053,008

178

2213

6427

40,247,803

80

3079

8266

41,840,983

123

4081

9847

57,333,270

*This information reflects actual cases received each fiscal year Uuly I - June 30). The remaining categories reflect cases closed and reopened and possibly closed again.

Administrative costs and reimbursements are funded through a nonlapsing public trust fund. The Fund's revenue consists of assessments from self-insured employers and insurers. In addition, interest received on investments is deposited in the Fund. The initial assessment was in fiscal

year 1978 and was based on a one-half percent premium tax against each insurer and self-insurer. Future assessments will be carried out when the Fund's net assets are less than 175% of disbursements made in a calendar year.

BEGINNING BALANCE

Table 6 Subsequent Injury Trust Fund Revenues, Expenditures, And Fund Balance

FY 1991 /92

FY 1992/93

FY 1993/94

$2,833,994

$6,056,962

$977,362

FY 1994/1995 1,539,271

REVENUES Assessment Penalty Fines Income from No-Dependency Cases Interest on Investments Miscellaneous

30,898,879 44,500 203,650 989,597 6,178

35,215,387 11,987 339,074 725,730 8

42,777,253 12,780 197,730 701,397 11,407

57,576,165 46,950 254,000
1,438,634 2,597

TOTAL REVENUE

32,142,804

36,292,186

43,699,767

59,318,346

EXPENDITURES Personal Services Operating Expenses Reimbursement Paid

522,487 344,341 28,053,008

636,169 487,814 40,247,803

648,206 749,469 41,840,983

756,179 511,479 57,333,270

TOTAL EXPENDITURES

28,919,836

41,371,786

43,138,658

58,600,928

FUND BALANCE

$6,056,962

$977,362

1,539,271

2,256,689

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1994 Statisical Charts & Tables

INDUSTRY

The chart below represents the percent distribution of processed cases by industry. Of the 49,910 lost time cases processed for accident year 1994, MANUFACTURING had the largest number of reported lost time cases.

Chart 5 Percent distribution of processed indemity cases,
by major industry division/total employees

Manufacturing

25%

Construction Trans po rtati on/Commun icati on/Uti Iiti es
Wholesale Trade Retail Trade
Agri/forest/Fishing/Mining

B cases (total = 49,910)
employees (total = 3,422, I00)
19%

Government Services

19% 25%

Finance/Insurance/Real Estate

0

10

20

30

40

PERCENT

Table 7 Selected Comparisons Accident Year I992- I994

I Total Cases Reported 2 Cases Reported Insurers 3 Cases Reported Self-Insurers/Other 4 Percent-Cases Processed (12/31/95) 5 Actual Cost-Processed Cases 6 Average Actual Benefit Cost-Processed Cases 7 Medical-Only Cost 8 Total Benefit Cost (Line 5+7) 9 Cases Not Cost-Processed IO Cases remaining open as of 12-31-95 11 Cases closed as of 12-31-9.5

I992a* 53,335 34,495 18,840
95% $752,788,885
$14,144 $95,318,208 $848,107,093
2,841 11,556 41,743

l993b* 51,356 29,936 21,420
93% $456,275,919
$8,884 $135,098,733 $591,374,652
4,037 17,919 33,437

1994 52,521 27,900 21,924
95% $338,608,229
$6,568 $45,683,902 $384,292,131
2,611 8,215 44,306

* a. 1992 information updated 12-31-95 * b. 1993 information is as of 12-31-95

Processed case - an indemnity case, open or closed, for which data from at least one case progress report has entered the electronic data information system, in addition to code data from the First Report of Injury.

BENEFIT ANALYSIS-MEDICAL-ONLY CASES
Medical-only cases include all injuries for which medical costs alone were paid. Table 8 lists medical-only activity for calendar years I992 - I994.

Total Cases Total Cost Average Cost

Table 8 Medical-only Cases ( 1992-1994)

1992 255,074 $81,494, I08 $350.18

1993 250,647 $135,098,733 $539.65

1994 166,356 $45,683,902
$274

Chart 6 Part of body injured in work place accident
Injuries to the back occurred most frequently according to the First Report of Injury

EYES HEAD (except eyes)

ARMS HANDS FINGERS
BACK LEGS FEET TOES BODY SYSTEMS MULTIPLE

11,037

UNCLASSIFIED HEAD
INTERNAL ORGANS ALL OTHER TYPES

0

2000

4000

6000

8000

10,000

20,000

* Cases processed 49,910

Chart 7 Most common occurring injuries in work place accidents
Types of injuries most commonly reported on First Reports of Injury

Carpal tunnel syndrome Cuts or Lacerations
Dusts, Gases, Fumes, Vapors Fall from a different level Falls from a ladder or scaffolding
Foreign Body in Eye Lifting
Pushing or Pulling Robbery or criminal assault
Slip did not fall Steam or Hot Fluids Struck or injured by a falling or flying object Unknown or unclassified

0

2000

4000

6000

8000

10000

Chart 8 Distribution of created cases
Figures are not comparable to processed figures.
Total Cases: 52,521 Closed: 44,306 Open: I0,505

Carrier Covered Self-Insurance and Other Coverage
Claim Only/Unknown/No-Coverage*
*As case progress reports are received and processed, this category will decrease

Chart 9 Injury Distribution by Industry

Agriculture, Forestry, Fishing, Mining (2%) Unclassified (2%) Services (19%)

Finance, Insurance, Real Estate (2%) Government (9%) -

Transportation, Communication, Utilities (I0%)

Retail Trade (16%)
Reported lost time injuries totaled approximately 52,521 in 1994. Of the major industry divisions, manufacturing followed by retail trade had the highest incidence of injuries.

Chart I 0 Employment - Reported injury
During the last ten years the ratio of reported lost time injuries to employment has remained relatively constant at two per I 00 workers (2%). Employment estimates were obtained from the Georgia Department of Labor.

3,000,000

c::::,

c::::,

c::::,

c::::,

c::::,

c::::,

0

0

c::::,

c::::,

-,.::-:r--;

L,:.-I"-\;

2,000,000

1,000,000

0 1984 1985 1986
II Lost Time Injuries
Total Employment

c::::,

c::::,

c::::,

c::::,

c::::,

c::::,

c::::,

c::::,

c::::,

0

0

0

c::::,

c::::,

c::::,

0-,

c::::,

"!..

t"'--l

tv'\

tv'\

1993 1994

The table below shows the distribution of reported lost time cases in each county for 1994.

REPORTED CASES BY COUNTY BREAKDOWN

Table 9

County
Appling Atkinson Bacon Baker Baldwin Banks Barrow Bartow Ben Hill Berrien Bibb Bleckley Brantley Brooks Bryan Bulloch Burke Butts Calhoun Camden Candler Carroll Catoosa Charlton Chatham Chattahoochee Chattooga Cherokee Clarke Clay Clayton Clinch Cobb Coffee Colquitt Columbia Cook Coweta Crawford Crisp Dade Dawson Decatur Dekalb Dodge Dooly Dougherty

Employed
7,615 2,723 4,156 1,001 16,267 5,641 15,888 30,932 7,607 6,021 67,049 4,695 4,862 6,477 7,780 20,773 7,679 6,905 1,559 16,086 3,397 37,457 21,939 4,203 99,086 1,955 10,835 57,819 42,354 1,423 106,507 3,618 286,788 15,091 15,928 34,060 6,462 30,439 4,610 8,556 6,202 6,829 10,296 328,051 8,404 3,906 41,575

Injuries
89 41 67 14 331 36 141 445 155 129 1,283 46 34 57 52 182 65 96 30 223 39 557 219 47 1,729 17 98 404 565
8 1,659
72 3,078
248 246 233 100 530
31 212
52 45 119 3,391 134 74 809

County
Douglas Early Echols Effingham Elbert Emanuel Evans Fannin Fayette Floyd Forsyth Franklin Fulton Gilmer Glascock Glynn Gordon Grady Greene Gwinnett Habersham Hall Hancock Haralson Harris Hart Heard Henry Houston Irwin Jackson Jasper Jeff Davis Jefferson Jenkins Johnson Jones Lamar Lanier Laurens Lee Liberty Lincoln Long Lowndes Lumpkin Macon

Employed
42,048 4,691 1,010 12,670 7,602 7,697 4,053 7,606
37,679 42,987 27,885
8,512 348,058
6,407 952
30,223 19,412
9,156 4,584 239,257 13,809 59,761 3,748 8,441 8,376 8,164 3,702 36,874 43,125 4,020 16,747 3,847 5,284 7,339 3,700 3,716 10,452 6,895 2,604 19,601 8,310 14,602 3,430 2,659 34,818 7,652 4,935
e

Injuries
400 78 10 97 92
128 55 69
316 812 367 106 7,900
90 8
521 316 112
55 2,508
178 859
34 122 47
84 30 416 436 59 171 44 63 116 28 42 42 96 18 203 61 109 26
9 577
89 89

County Madison Marion Mcduffie Mcintosh Meriwether Miller Mitchell Monroe Montgomery Morgan Murray Muscogee Newton Oconee Oglethorpe Paulding Peach Pickens Pierce Pike Polk Pulaski Putnam Quitman Rabun Randolph Richmond Rockdale Schley Screven Seminole Spalding Stephens Stewart Sumter Talbot

Employed 11,223 3,087 8,705 3,126 8,446
2,389 8,789 7,201 3,193 5,736 16,044 74,021 21,742 9,811 4,384 24,973 9,262 7,732 6,452 4,793 13,644 3,733 6,977
963 5,800 2,914 79,977 32,872 1,342 6,044 4,034 27,331 11,656 2,196 12,865 2,308

Table 9 (continued)

Injuries 63 65
109 21 62 22
154 139
24 77 197 1,207 243 63 34 152 151 77 48 34 185 35 98
0 96 42 1,072 386 29 40 20 332 133 40 228 15

County Taliaferro Tattnall Taylor Telfair Terrell Thomas Tift Toombs Towns Treutlen Troup Turner Twiggs Union Upson Walker Walton Ware Warren Washington Wayne Webster Wheeler White Whitfield Wilcox Wilkes Wilkinson Worth Out of Town Unknown

Employed 608
6,196 3,159 4,350 4,226 18,075 17,511 10,349 2,497 2,464 24,026 3,632 3,770 5,927 12,012 28,220 20,252 14,329 2,232 8,766 9,979 1,072 1,780 7,658 42,936 2,819 4,964 4,366
8,463 xxxx xxxx

Injuries 1
108 31 68 50
361 325 145
39 21 244 68 39 76 135 243 178 370 33 77 139
9 13 93 823 27 47 50
80
1,130 2,770

e

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5
Appendices

APPENDIX A
GLOSSARY
Advance payment - a partial lump sum payment.
Average weekly wage - the wage upon which indemnity payments are calculated. It is the average of the weekly wages earned by an injured employee for the 13 weeks immediately preceding the injury.
Benefit cost - payments made or payable to an injured or occupationally ill employee, dependent(s) or the Subsequent Injury Trust Fund, including indemnity for lost wages, medical, and other miscellaneous cost.
Actual benefit cost - actual benefit cost as reported to date during the life of the claim. Does not include anticipated future cost.
Claim - a request for payment of money or for necessary services, in accordance with the workers' compensation law, based upon occurrence of a work-related injury or illness.
Closed case - a case in which all benefits due have been paid.
Compensable case - a case which qualifies the injured or occupationally ill worker or dependents for any of the benefits under the workers' compensation law, whether this be compensation for loss of earnings, medical treatment, rehabilitation, etc.
Indemnity benefit (income benefit) - payments made under the provisions of the workers' compensation law to the injured or occupationally ill worker, dependent(s) or the Subsequent Injury Trust Fund, excluding payment made for burial, medical or related expenses.
Indemnity case - a case in which an indemnity payment was made.
Lost time case - a case in which more than seven days of disability have occurred.
Lost work days - actual days on which, because of occupational injury or illness, the employee was away from work. The number of lost workdays (consecutive or not) does not include the day of injury or onset of illness or any normal scheduled off days even though able to work. Fatalities are calculated at one day or actual lost work days to date of death.

Lump sum payment - a single payment of all remaining weekly indemnity benefits.
Medical-only case - an occupational injury or illness, where medical and related benefits are paid or payable, but where indemnity benefits are not payable.
Nature of injury or illness - identifies the injury or illness in terms of its principal physical characteristics such as bums, poisoning, and sprains.
Open case - a case in which benefits may still be payable.
Part of body - identifies the part( s) of the injured or ill person's body directly affected by the injury or illness described.
Permanent partial disability - partial in character but permanent in quality, resulting from loss or loss of use of body members or from partial loss of use of the employee's body as a whole.
Processed case - a case, open or closed, for which data from at least one case progress report has entered the electronic data information system, in addition to code data from the first report of injury.
Source of injury or illness - identifies the object, substance, exposure, or bodily motion which directly produced or inflicted the injury or illness described; for example: chemicals, machines, and ladders.
Stipulated settlement - final resolution of a contested case by an agreement of the parties and approval of the three-member Board.
Temporary partial disability - partial in character but temporary in quality; able to perform work at a reduced rate of pay for no more than 350 weeks immediately following an occupational injury and before the employee has reached maximum recovery.
Total disability - total in character and either temporary or permanent in quality; unable to perform any work for pay as a result of an occupational injury or illness.
Type of accident - identifies the event which directly resulted in the injury or illness, such as fall, robbery or criminal assault, and motor vehicle accident.

APPENDIX B
EXECUTIVE DIRECTOR
Ms. Farris N. Freeman 270 Peachtree Street, NW Atlanta, Georgia 30303-1299 404-656-2048

ADMINISTRATIVE LAW JUDGES

ATLANTA

Judge Judith Blackwell Judge Viola Drew Judge Patricia M. Killingsworth,
Legal Director Judge Johnny Mason Judge Charles Mobley Judge Carolyn S. Weeks

Alternate Dispute Resolution Unit: Judge Carolyn C. Hall Judge Calvin B. Southard 270 Peachtree Street, NW Atlanta, Georgia 30303-1299 404-656-3875

ALBANY-

Judge Gordon R. Zeese Suite 203, Albany Towers 235 Roosevelt Avenue Albany, Georgia 31701 912-430-4280

AUGUSTA

Judge T. Raworth Williamson 1056 Clausson Road Suite 224 Augusta, Georgia 30907 706-66 7-4062

COLUMBUS

Judge Tasca Badcock Judge Claude Bray Judge William S. Cain 102-A Second Avenue Columbus, Georgia 31901 706-649- 7520

DALTON

Judge J. Dixon Belk Judge Stephen K. Fain Suite 315 415 East Walnut Avenue Dalton, Georgia 30721-4406 706-272-2260

GAINESVILLE

Judge William A. Murray Old Coca-Cola Building Suite l00C 301 Green Street Gainesville, Georgia 30501 770-535-5713

MACON

Judge Robert Gerson Judge Sallie Rich Jocoy Suite 235, Building D 3312 Northside Drive Macon, Georgia 31201 912-471-2051

ROME

Judge R. David Whittenburg 607 Broad Street Suite 50 Rome, Georgia 30161-3059 706-295-6781

SAVANNAH

Judge Leesa Bohler Judge Jerome J. Stenger Suite 601 Seven East Congress Street Savannah, Georgia 31401 912-651-6222

APPENDIX C

ADMINISTRATIVE LAW JUDGEHEARING DISTRICTS

(7

DECATUR

GRADY

THOMAS

e

GEORGIA WORKERS' COMPENSATION ACT AMENDED ON: TOTAL DISABILITY-CODE SECTION 114-404 - O.C.G.A. 34-9-261
Waiting period Waiting period recoverable after (consecutive from disability date) Maximum weekly benefit Percent of average weekly wage (13 weeks prior to accident) Minimum weekly benefit Maximum weekly duration from date of disability and not date of accident Total maximum benefit Maximum healing period before any rating of permanent disability required

TEMPORARY PARTIAL DISABILITY-CODE SECTION 114-40S - 0.C.G.A. 34-9-262 Maximum weekly benefit Maximum weekly duration from date of injury Percent of difference in wages before and after injury Total maximum compensation

PERMANENT PARTIAL DISABILITY-CODE SECTION 114-406 - 0.C.G.A. 34-9-263

Maximum weekly benefit

Percent of difference in wages

SPECIFIC MEMBER-LOSS OR LOSS OF USE OF:

Wks.

Wks.

Thumb ...................... 60 Arm . . . . . . . . . . . . . . . . . . . . . 225

1st (index) finger ................ 40 Foot. . . . . . . . . . . . . . . . . . . . . 13S

2nd (middle) finger ............... 3S Leg . . . . . . . . . . . . . . . . . . . . . 225

3rd (ring) finger ................. 30 Eye . . . . . . . . . . . . . . . . . . . . . 125

4th (little) finger ................ 25 Loss of hearing (one ear)

Great toe .................... 30

Total Industrial . . . . . . . . . . . . . 60

Other toes .................... 20 Loss of hearing (both ears)

Hand . . . . . . . . . . . . . . . . . . . . . . 160

Total Industrial . . . . . . . . . . . . . ISO

Disfigurement . . . . . . . . . . . . . . . . None Disability/Body as a whole . . . . . . . . 350

DEATH BENEFITS-CODE SECTION 114-413 - O.C.G.A. 34-9-265 Maximum weekly benefit Maximum duration from date of injury Burial expenses Total Maximum benefit

7/1/85
7 days 28 days $15S 66 2/3% $25 Unlimited No $ amount None
$104 350 weeks 66 2/3% $36,400
$155 66 2/3%
Same except
Loss of vision one eye ...... 150 weeks
Loss of hearing one ear ...... 75 weeks
Body as a whole ............ 300 weeks
$155 Various $5,000 $65,000*

7/1/86 7 days 28 days $175 66 2/3% $25 Unlimited No $ amount None
$117 350 weeks 66 2/3% $40,9,50
$175 66 2/3%
$175 Various $5,000 $65,000*

PARTIAL DEPENDENTS According to the ratio that the contribution bears to wages, times the amount due a spouse-------Maximum
MEDICAL BENEFITS Medical Allowance
MISCELLANEOUS Interest on lump sum payment Statute of limitations: For reporting accidents to the Board ....................... . O.C.G.A. 34-9-82 .................................. . For appeal to Three-Member Board ........................ . For appeal to Superior Court ............................ . For appeal to Court of Appeals .......................... . Number of employees required to come under law

All others Various
Various
Unlimited
7% per annum I or 2 years - see O.C.G.A. 34-9-82 30 days from award 30 days from award 30 days from award 3

All others Various
Various
Unlimited
7% per annum I or 2 years - see O.C.G.A. 34-9-82 30 days from award 30 days from award 30 days from award 3

**Surviving spouse only after one year **Except for catastrophic injuries which are unlimited

7/1/90
7 days 21 days $225 66 2/3% $25 Unlimited No $ amount None
$150 350 weeks 66 2/3% $52,500
$225 66 2/3%
$225 Various $5,000 $65,000*
All others Various
Various
Unlimited
7% per annum I or 2 years - see O.C.G.A. 34-9-82 20 days from award 20 days from award 30 days from award 3

7/1/92
7 days 21 days $250 66 2/3% $25 400 weeks** $100,000 None
$175 350 weeks 66 2/3% $61,250
$250 66 2/3%
$250 Various $5,000 $100,000*
All others Various
Various
Unlimited
7% per annum I or 2 years - see 0.C.G.A. 34-9-82 20 days from award 20 days from award 30 days from award 3

7/1/94
7 days 21 days

.,..

$275

66 2/3% $25 400 weeks** $I00,000 None
$192.50 350 weeks 66 2/3% $67,375

-Ill
>C

$275 66 2/3%

$275 Various $5,000 $100,000*
All others Various
Various
Unlimited
7% per annum I or 2 years - see O.C.G.A. 34-9-82 20 days from award 20 days from award 30 days from award 3

APPENDIX E

Board Forms/July 1995:

Most board forms are available as hard copy cut forms and on disk for WordPerfect 5.1. The edition date of 7/95 applies to most forms. Rehabilitation forms are available as hard copy cut forms only.

Form# WC-1 WC-2 WC-2a WC-3 WC-4 WC-6 WC-7
WC-8 WC-10 WC-11 WC-12 WC-14 WC-20a WC-25 WC-26 WC-30 WC-Pl WC-P2 WC-P3 WC-102 WC-102ga WC-102gb WC-102i WC-102j WC-102k WC-104
WC-108a WC-108b WC-121 WC-131 WC-200a WC-200b WC-200c WC-206
WC-207 WC-208a
WC-240 WC-243 WC-244

Color Tan Lt. Blue Goldenrod Coral Mint Green White White
White White White White White Lt. Pink White White White White White White White White White White White White White
White Gold White White White White White White
White White
White White White

Title Employer's First Report of Injury Notice of Payment or Suspension of Benefits Notice of Payment or Suspension of Death Benefits Notice to Controvert Case Progress Report Wage Statement Application for Self-Insurance - *Packet available through Licensure & Quality Assurance Division - (404) 656A893 Corporate Officer Rejection or Revoke Rejection Notice to Elect Coverage Standard Coverage Form Request for Copy of Board Records Notice of Claim/Request for Hearing Medical Report Application for Lump Sum/Advance Payment Yearly Report of Medical Only Cases Farm Labor Employer Election/Revocation of Coverage Panel of Physicians Conformed Panel of Physicians WC/MCO Panel Request for Documents Motion Objection to Motion Notice of Representation by an Attorney Attorney Leave of Absence Verification of Job Search Notice to Employee of Medical Release to Return to Work with Restrictions or Limitations Attorney Fee Approval Attorney Withdrawal/Attorney Fee Lien Notice of Use of Servicing Agent Designation by Insurer of Office for Service of Notices Change of Physician/Additional Treatment by Consent Request for Change of Physician/Additional Treatment Objection to Request for Change of Physician/Additional Treatment Reimbursement Request of Group Health Insurance Carrier/Healthcare Provider Authorization and Consent to Release Information Application for Certification of WC/MCO - * Packet available through Managed Care & Catastrophic Disability Division - (404) 656-3784 Notice to Employee of Offer of Suitable Employment Reduction in Benefits Reimbursement Request of Group Insurance Carrier/Disability Benefits Provider

Rehabilitation forms are available in hard copy form only at the present time.

Form # WC-Rl WC-R2 WC-R2A WC-R3

Revision Date 7 /92 7 /92 7 /92 7 /92

Color Lt. Green Lt. Green Lt. Green Lt. Green

Title Request for Rehabilitation Rehabilitation Transmittal Report Individualized Rehabilitation Plan Request for Rehabilitation Closure

BOARD PUBLICATIONS:
Bill of Rights for the Injured Worker
How the Workers' Compensation Applies to Employers
Workers' Compensation Safety Library Catalog
For a nominal charge additional publications are available:
Schedule of Fees for Physicians, Surgeons, and Pharmaceuticals ................................................. $15.00
Schedule of Fees for Rehabilitation .................................................................................................. $4.00
Workers' Compensation Procedure Manual .................................................................................... $30.00
Board forms and publications are available from: State Board of Workers' Compensation 270 Peachtree Street, N.W. Atlanta, Georgia 30303-1299 or 404-656-3870
This 1995 Annual Report was prepared by Joe Moore, Data Processing Services Section. For additional copies or information call (404) 656-3815.
Additional Publications:
Georgia Workers' Compensation Law, Rules and Regulations Annotated Available from: The Michie Company Law Publishers P.O. Box 7587 Charlottesville, Virginia 22906- 7587 1-800-562-1197
Georgia Workers' Compensation Practice Manual Available from: Institute of Continuing Legal Education
P. 0. Box 1885 Athens, Georgia 30603-1885
Cost $27.00

I wish here to express my gratitude to Ms. Farris Freeman for her guidance and drive. She constantly provided me with enthusiastic support and advice. Finally I offer my deep appreciation to the staff of the Board for their energy, competence, and devotion to the project.
Joe Moore Editor, 1995 Annual Report

GEORGIA STATE BOARD OF WORKERS' COMPENSATION
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