Annual report, Georgia, 1996

Georgia State Board of WorlzBrs' Compensat
ANNUAL REPO
ThiS report consists of data taken from calendar year 1995 and fiscal year 1996. Statistical information was extracted on December 31, 1996.
270 Peachtree Street, N.W. Atlanta,Georgia 30303-1299

Established in 1920 by the Georgia legislature, the State Board of Workers' Compensation serves over 186,000 employers and 3,422,000 workers. The State Board of Workers' Compensation is funded by assessments from insurance companies and self-insured employers. An employee injured on the job, covered by the law, may become eligible for replacement of a portion of lost wages, medical payments, vocational rehabilitation services and other benefits.

MISSION STATEMENT
To provide superior compensation services to Georgia workers and employers in a manner that is sensitive, responsive and effective ... in order to minimize the impact of workplace injuries.
MISSION VALUES
We are committed to being a service-oriented organization that: Treats people with respect Is responsive and sensitive to client needs Listens carefully Communicates clearly and openly Acts honestly and fairly Strives for excellence through innovation, personal
initiative, teamwork and staff development Manages resources effectively to achieve positive
results

CONTEN

AT-A-GLANCE

PART I ORGANIZATION

Introduction........................................................... 2

The Three-Member Board

3

Organizational Structure

4

PART II ACHIEVEMENTS & ACTIVITIES

Administrative Services Division

6

Claims Processing Division

10

Licensure and Quality Assurance Division..... I I

Managed Care and Catastrophic

Disability Division

. 12

Legal Division

14

Fraud/Compliance Division................................ 16

PART III SUBSEQUENT INJURY TRUST FUND.. 17

Published by
State Board of Workers' Compensation
270 Peachtree Street N.W. Atlanta. Georgia 30303-1299
Chairman Harrill L. Dawkins
Director Carolyn C. Hall
Director Vicki L. Snow
Executive Director Jennifer A. Green
Director Legal Division J. Dixon Belk
Editor Joe Moore

PART IV STATISTICAL CHARTS &TABLES PART V APPENDICES

The" 1996 Annual Report"

21

is a presentation of

calendar year

1995 claim information

27

and fiscal year 1996

operational statistics.

T-A-GLANCE

1995

1994

1993

1992

CREATED CASES: .............

48,991

53,811

53,393

53,774

byWC-1 .......................

41,371

44,840

45,495

46,308

DECEMBER 31, 1996

byWC-14 ...................... OPEN ............................

7,620 14,420

8,971 7,995

7,898 4,598

7,466 2,761

AT-A-GLANCE contains lost time
and medical only financial information and exception statistics.

CLOSED .........................

34,571

45,816

48,795

51,013

WC-4 CASE PROGRESS REPORT

Total Weekly Benefits .......... $ 140,535,143 266,647,483 352,641,766 416,392,718

Physicians Benefits ............. 64,755,143 102,1 I 1,550 122,771,764 158,749,427

Hospital ....................... 70,018,187 102, I60,448 I 16,732,075 125,606,3 I5

Pharmacy Benefits .............. 4,907,272 11,121,832 15,289,627 20,569,592

Exceptions are those cases which, because of Rehabilitation, ADR conferences, ALJ hearings, Appellate review, or Stipulated Settlements require

Physical Therapy ................ Chiropractic ................... Other ......................... Rehabilitation .................. Late Payment Penalties ......... Assessed Attorney's Fees ....... Burial ..........................

10,077,456 13,667,379 535,668 908,255
11,500,823 23,574,597 7,498,513 14,463,138
591,143 870,039 448,597 1,007,863 525,782 503,094

10,099,178 639,226
27,766,266 15,606,989
1,175,536 1,257,587
550,218

7,317,969 466,132
25,691,064 27,114,503
1,180,744 1,458,348
470,910

Board involvement

TOTAL .......................... $ 311,394,060 537,035,678 664,530,232 785,017,722

beyond claims process-

ing or data gathering.

AVERAGE COST OF A CASE .... $

6,308

9,980

12,446

14,598

Information presented AVERAGE LOS, WORK DAYS ....

53

60

117

180

for this Annual Report is as of December 31,

MEDICAL ONLY CASES:

1996 and is specific to injury years.

WC-26 REPORT OF MEDICAL

ON~ ...........................

180,074

166,356

250,647 1 255,074

TOTAL AMOUNT PAID ......... $ 57,962,731 45,683,402 135,098,733 81,494, I08

TOTAL PAYMENTS ALL CASES ........................ $ 369,356,791 582,719,080 799,628,965 866,51 1,830

WC-14 NOTICE OF CLAIM/ REQUEST FOR HEARING BY 001 .........................
Total Received ................ ALJ Referred ................. ALJ Scheduled ................ Disposed Prior to Hearing .... ALJ Held .....................
ADR Conferences all DOl'S ..
ALJ Hearings all DOl'S ........
Appellate Review all DOl'S .... Submits ...................... Hearings .....................

1995
19,199 8,428 8,318 7,319 1,109
4,579
2,817
818 406 412

1994

1993

27,238 10,978 10,461 8,869
1,592

20,527 11,373 10,047 8,400
1,647

3,007 2,904

*
3,208

1,090
*
1,061

1,196
*
1,093

Stipulated Settlements Filed by

001 Year ....................

5,969

9,986

*

Total ......................... $ 60,413,960 I 18,326,291

Average Cost ................ $

10,121

11,849

*

* Information not collected in this file format.

1992
18,776 11,849 10,170 8,561
1,609
* * * * *
*
*

48,991 files were created with a date of injury year of 1995. Employer's First Report of Injury (WC-l) account for 41,371, of those files while 7,620 were created by the filing of Notice of Claim/Request for Hearing (WC-14). Average Lost Work Days are 53 in 1995, down from 180 days in 1992. The open case count of 57,239 continues to fall, reflecting better claims management and more timely reporting. 470/b of all files represent carrier covered cases, while the remaining 53% arc covered by other types of coverage, including self-insUl'ance, group funds and governmental entities. Administrative Law Judge hearings (2817) continue to decline in response to ADR activity.

ORGANIZATI
PART 1

TRODUCTION

I t has been 76 years 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 encollrage safety and assllre benefits for injured employees.

Prior 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, 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.
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 worker's compensation 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 fulltime 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.
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.
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-MEMBER Bo

The responsibilities of the Board are divided into quasi-judicial, administrative, 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.

The three-member Board 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.

}~J /. ZJ~~ ~l t. ~

Chairman
Harrill L. Dawkins

Director Carolyn C. Hall

Director
Vicki L. Snow

RGANIZATIONAL STRUCTURE
July I, 1996 - 162 Positions

INSURANCE CONSULTANT
I
Handles insurance related issues
Makes presentations to various groups as requested

BOARD DIRECTORS
6
Promulgates Workers' Compensation regulations Develops Workers' Compensation policy Hears appeals of Adminstrative Law Judges' Approves and submits budget requests for the agency
I
EXECUTIVE DIRECTOR'S
OFFICE 3
Oversees the operations of the Board Provides management supervision Makes presentations to various groups as requested

I
STAFF ATTORNEYS
5
Researches cases appealed to Board
Recommends appropriate action

ADMINISTRATIVE
SERVICES
DIVISION 16
Performs accounting functions
Performs personnel functions
Coordinates training sessions, presentations and public information
Coordinates employee training programs
Prepares budget Oversees purchasing Provides data pro-
cessing services Coordinates printing
services Manages contracts

CLAIMS
PROCESSING
DIVISION 27
Maintains fileroom and filing system
Reviews cases prior to closure
Operates mail room 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 rehab. suppliers
Licenses insurance companies
Performs quality assurance reviews of insurers and self-insuers
Maintains information on employers' insurance coverage
Maintains Safety Library

I
FRAUD! COMPLIANCE
DIVISION 13
Investigates incidents of non-compliance
Investigates incidents alleging fraud
Makes presentations to various groups regarding fraud! compliance
I MANAGED CARE
& CATASTROPHIC
DISABILITY DIVISION 8
Processes requests for rehab. services
Performs quality assurance reviews of rehab. suppliers
Holds conferences to resolve disputes
Conducts training for rehab suppliers
Reviews and approves rehab plans
Reviews applications of Managed Care Organizations

I
LEGAL
DIVISION
75
Screens requests for hearings
Holds formal hearings Reviews and approves
stipulated settlements Mediates changes in
physicians, rehab. suppliers, and attorney fees Makes presentations to various groups as requested Copies case files for attorneys and higher courts

ACHIEVEMENTS & ACTIVITI
PART 2

BI~ S MINISTRATIVE triIWff::::ft:::t[) ERVI CE S

he Administrative
TServices Division
Ii1t includes the
~~~~1~~:~I~~1~t;~;~;I;~~~~~I~ Accounting, Personnel,
Training and Data
Processing Services
Sections.

The Division has responsibility for accounting, 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 1996

Number of Positions Personal Services

163 $8.241,309

Regular Operating Expenses:

.:.:....:.:.;::: Motor Vehicle Expenses

2,000

Supplies & Materials

108,000

Postage

180,080

Repairs & Maintenance

53,000

Publications & Printing

56,000

Rents (Other than Real Estate)

1:lill~l:!:!I!i:t::"li:i:ii::!IIil:
111:li~i~:~illli:~i:ii1i!~I:iillil:.

Insurance & Bonding Duplication & Rapid Copy Equipment (Less than $1,000)

:;~::::::;::'~:::::::::;~":::::::::::::::::::::::::::::
~~IIJ~~r:~~f: l~~~I/tII

Other Operating Epenses Travel

4,000 2,000 5,000 37,920 26,000 109,340

Motor Vehicle Purchase

20,500

Equipment Purchase

37,685

Real Estate Rentals

1,080,290

Per Diem, Fees & Contracts

159,000

Computer Charges

304,488

Telecommunications

164,190

Payments to State Treasury

10 I,413

Total

$10,692,135

Table 2 Assessment Figures

Fiscal Year
1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996

Premium Writings

Administrative

Funds

Premium

Collected

Factor

475,412,585

5,556,7 65

1.21

586,706,797

5,982,699

1.02

739,280,403

6,919,856

0.924

911,523,434

7,477,511

0.820

1,061,301,347

8,008,400

0.755

1,239,497,523

8,334,378

0.672

1,474,997,352

8,537,789

0.577

1,598,890,476

9,214,010

0.579

1,648,162,040

9,690,796

0.587

1,70 I,221 ,644

10,294,882

0.610

1,678,771 ,284

10,662,667

0.625

~~:~:~:;:~:~:~:~:~:~:~:~:~:~:~:~:::::::::::~:fr::~

The primary goal of the Personnel Section is the selection and retention of individuals with the required skills to implement and support the Board's mission. To accomplish this and auxiliary goals the Personnel Office is responsible for developing and communicating sound practices and procedures which meet both federal and state employment guidelines and statutes and for providing an environment where employees become more productive and provide quality service to the constituency.
On October I, 1996 the State of Georgia implemented a new pay for performance plan by means of agency personnel offices. The Board's Personnel and Training section facilitated the training of staff who have supervisory responsibility on the new performance management process and the new forms for reporting employee performance. The Performance Management Process was built around the foundation of full employee participation in every phase of planning. coaching, evaluating and developing performance. If both the supervisor and the employee have done their jobs, there should be no surprises in FY 1997 as employee's performance is evaluated under this new process.
The Workers' Compensation Procedures Manual was updated by the Personnel Section with contributions from each Division. This manual documents the claims process and includes a reference section for both the employer and the insurer/self-insurer. The manual

also includes a complete set of the board forms for reporting after July I, 1996.
Education on the Georgia Workers' Compensation Law has continued to be a priority for the State Board. The Training Section expanded awareness programs for the public workers' compensation community as well as providing internal staff development programs.
In acknowledgement of the 1996 Olympic celebration in Atlanta, "Gold Medal Management; Winning in Workers' Compensation" was the theme of the 1996 Annual Educational Conference. The most extensive project of the Training Section, the 1996 program featured over 57 speakers from across the United States. The expertise of the faculty was shared with over 1000 attendees in five concurrent workshops. A total of 76 exhibitors displayed services. Physical Therapist and Occupational Therapist were added to the Continuing Education Certification process, increasing the total CEU offerings to 15 different professions.
Regional Educational Seminars were held in eight different cities throughout the State of Georgia. General Session topics included managed care, new rules and forms, settlements, and controlling costs. Issues specific to medical, legal, claims, and employer concerns were addressed in afternoon breakout sessions. The regional programs have been tremendously successful in addressing the

needs of the smaller communities throughout the state relative to workers' compensation law.
"Basic Training" was offered to insurers and self-insurers responsible for completion of basic workers' compensation claim forms. A highly successful seminar, the program resulted in the Guidelines on Completion of Basic Claims Processing Forms Handbook which was distributed to all regional seminar attendees.
Phase II of Georgia Gain was the primary staff development objective for the Training Section. With an implementation date of October 1996, managers and supervisors completed training on the new Performance Management Process aimed at raising the standards of productivity, quality and service of state employees. Further staff development included the Annual Workers' Compensation Law Institute for the administrative law judges and staff attorneys, advanced computer techniques, and continued mediation certification training.
In conjunction with the Medical Subcommittee of the Advisory Council and the Medical Association of Georgia, the Training Section anticipates the development of a training manual for medical providers during 1997. The Training Section will

continue to provide quality educational opportunities for the workers' compensation communities as well as ensuring a quality standard of service through continued staff development.
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 described below.
Data entry provides quality input of the information from the Board forms. Over three hundred thousand forms were received in 1995. 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 laws.
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 the Board employees via a wide area network (WAN). Currently one hundred employees and eight field offices are on-line users of this system and with the introduction of laptop computers, Administrative Law Judges and employees in the Fraud/ Compliance Division 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 (1-800-5330682) providing claims assistance to the general public.
With over one hundred 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), the Board has 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 encourages 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 tollfree number (1-800-533-0682).
The current database of both active and closed cases at the Board total 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.

LAIMS PROCESSING

The Claims Processing Division includes Documents Processing, File Room, and Case Management Units.

The Documents Processing Unit is responsible for all incoming and outgoing mail activities, processing correspondence, and the 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 the calendar year 1995 over 500,000 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. A total of 50,50 I new records were created during calendar year 1995. The File Room maintained approximately 190,000 records at the Board's Atlanta office. In addition, the State Record Center housed approximately 450,000 records which were closed during calendar years 1986 through 1993. The Board's claim files are destroyed approximately ten years after the date of closing.

The Case Management Unit in association with the Quality Assurance Unit is responsible for the review of the Board's claim files. The claims examiners are responsible for reviewing claim files at creation, specific intervals during the life of the claim, and closure. Examiners compute average weekly wages, compensation rates, lost work days and timeliness of payments to ensure proper payment of indemnity benefits and late payment penalties. Medical reports are reviewed in accordance with American Medical Association (AMA) guidelines to ensure proper payment of permanent partial disability benefits. Claim files are also audited to ensure compliance with Board rules and regulations, filing procedures, and the accurate and timely reporting of benefit cost and other statistical data.A joint effort by the Board, insurers, self-insurers, and third party administrators to eliminate delinquent filings of Form WC-4 (Case Progress Reports) resulted in a dramatic increase in closures. During calendar year 1995, 50% more cases were closed (75,714) than created (50,50 I).

Calendar Year
1990 1991 1992 1993 1994 1995

Table 3

Claims Processed Per Calendar Year

Reported as Indemnity Cases

Medical Only

Cases Reported Reviewed

Created

Closed

247,956 186,959 255,074 250,647 166,356 180,074

152,611 134,086 114,413 113,012 161,773 154,584

55,756 52,282 52,906 52,507 51,281 50,501

61,792 64,845 54,596 56,749 91,033 75,714

l'

LICENSURE & QUALITY ASSURA

The Licensure and Quality Assurance Division regulates and licenses 430 companies who selfinsure their Workers' Compensation liabilities; 327 insurance companies who write policies of Workers' Compensation, and 700 rehabilitation suppliers who handle Workers' Compensation cases.
The Quality Assurance Section of this division performs audits on 100% of the Employer's First Report of Injury filed by selected insurance companies and selfinsurers. Determination is made on compliance with Board rules and regulations to assure that proper payment is being made to injured employees in a timely manner and that penalties are paid when applicable. The Quality Assurance Claims Examiners work with the insurers and selfinsurers to assist their claims examiners with the many technical aspects involved in filing Board forms correctly and timely. The Quality Assurance Claims Examiners perform other important regulatory functions, such as identifying errors and problems on files assigned to this section. In addition to quality reviews, examiners share responsibility with the Case Management Unit in the performance of routine file review. Review protocols include, computation of average weekly wages, compensation rates, lost work days, timeliness of payments and review of medical reports. Medical reports are reviewed in accordance with American Medical Association (AMA) guidelines to ensure proper payment of permanent partial disability

benefits. Compliance with Board rules and regulations is incorporated into all file reviews.
In addition, the Quality Assurance Claims Examiners are part of the team that manages and reviews the delinquent case progress reports project. As a result of this intensive review, the insurers and self-insurers have achieved a higher rate of compliance with Board rules and regulations than ever before.
The Division maintains an extensive data base to provide coverage information on self-insured and group fund employers in the State of Georgia. In addition, the Board is on-line with the National Council on Compensation Insurance main-frame computer where operators can access information on dates of coverage for all policies of insurance bought by employers in Georgia. Over 20,000 requests for coverage information are handled each year.
With the help of the self-insurers and insurers in Georgia who recognized the importance of safety in the work-place, the division initiated the Georgia Workers' Compensation Safety Library in 1992. The library now consists of over 300 video tapes on a wide variety of safety subjects including many in Spanish. Hundreds of Georgia employers are using materials from the Safety Library for their monthly safety meetings and to teach employees better safety practices. The library is a valuable resource that is available to Georgia employers at no cost.

The Licensure and Quality Assurance Division performs several major functions in the operation of the State Board of Workers' Compensation.

ED CARE & CATASTROPHIC DISABILITY

A s a resul~ ~f a statutory prOVISIOn, managed care was introduced into the Georgia Workers' Compensation System in 1994. A 12% credit on workers' compensation insurance premiums has been recommended by the National Council on Compensation Insurance (NCCI) for those companies utilizing a managed care organization.

On July I, 1994, the Board was authorized to certify organizations as qualified to provide managed care to employees injured on the job. In 1996 the Division began to see an increase in the level of interest and submission of applications for certification by managed care organizations (MCO). This was very encouraging! Managed Care was introduced to the worker's compensation system to provide: a patient advocacy program for the injured worker by keeping lines of communication open among all parties; quality assured medical care with access to a wider choice of providers; and, ultimately, return injured workers to their jobs more quickly with a delivery of cost savings to the system.
The Managed Care and Catastrophic Disability Division has developed an internal advisory group to review, in detail, all applicants desiring to be Certified Workers' Compensation Managed Care Organizations. A great deal of attention is given to this review process. The Division wants to be sure that the organization applying for certification meets the intent of Board Rule

208, specifically, financial stability, professional management, and a quality provider network. Each organization must outline, in detail, how they will provide internal dispute resolution, peer review, utilization review, and medical case management. The Division developed an indepth job description for case management within an MCO. It is only through Board Rule 208 that medical case management may be provided without the consent of all parties to the claim. Vocational services are to be provided by agreement of all parties both in and outside of a Certified Workers' Compensation Managed Care Organization.
For 1996, ten companies submitted applications for certification, bringing the total of applicants since July 1994 to twenty-eight. There are now a total of fourteen (14) Certified Workers' Compensation Managed Care Organizations. A list of all organizations who have applied and those who have been certified, along with the counties covered, is available from the Managed Care and Catastrophic Disability Division.

Non-Catastrophic rehabilitation continues to be a voluntary process requiring the agreement of all parties. Rehabilitation suppliers in the voluntary process do not have to file reports with the Board, but are required to maintain registration with the Board and practice under their assigned supplier number. This year the Division's Rehabilitation Coordinators have continued to monitor all of the catastrophic cases and the pre-July 1992 non-catastrophic rehabilitation files. The current totals of these files as of September 1996 are:

Pre-July 1992

non catastrophic cases: 902

Catastrophic cases:

437

Closures:

1,367

Over the course of the next year, Coordinators will be reviewing many of the pre-July 1992 non-catastrophic cases to ensure that services are still being delivered and are appropriate to the injured workers' current status. If there is no activity and with agreement of all parties, some of these cases will be closed. Looking forward to 1997, the

Division will take on a more active role in educating all parties in the workers' compensation system regarding managed care. Plans are in process for a managed care educational pamphlet to be distributed to applying MCO's, employers, carriers, and employees.
An MCO reference library in the Division exists for anyone desiring more information about the managed care process. A quality review process involving on site visits for the re-certifying MCO's is being developed. Data collection to provide meaningful statistics on the effect of the Certified Workers' Compensation Managed Care Organizations is also a priority. As the case load for Rehabilitation Coordinators decreases, their valuable knowledge and experience will be integrated into monitoring the activities, defining terminology and resolving disputes in the Certified Workers' Compensation Managed Care Organizations.

GAL

To facilitate the performance of its duties and fulfillment of its responsibilities, the Legal Division is divided into four sections: Screening & Administration Section, Alternative Dispute Resolution Section, Trial Section & Settlement Section.

The Legal Division is primarily responsible for processing all requests for legal action in contested cases. The Division screens files and incoming correspondence concerning the workers' compensation system and procedures and routes them for hearing or other appropriate action. The Division works to resolve disputes without the need for hearings and processes requests for changes in medical treatment or disputes over medical expenses. The Division also processes stipulated settlement agreements and requests for lump sum and advance payments. In addition, the Legal Division staff processes and monitors appeals to the appropriate court and coordinates continuing legal education programs.
The Screening & Administration Section is responsible for processing all notices of claims and requests for hearings that have been referred to the Legal Division for possible action. Claims requiring an evidentiary hearing are assigned to an Administrative Law Judge in the Board's Trial Section. Claims for which a full evidentiary hearing may not be necessary are assigned to the Alternative Dispute Resolution Section for appropriate action. In addition, the Screening Section provides claims assistance and information concerning procedural matters. A toll free number is available for this type of assistance. Further, the Section makes copies of files and processes cases that are appealed to other courts.

The Alternative Dispute Resolution Section handles those requests for legal and other action that do not require a full evidentiary hearing. Currently, in addition to handling the motion practice in contested issues, the unit now provides mediation for a number of disputed issues and for all-issues settlement of claims. The section has exclusive jurisdiction over all requests for a change in the claimant's authorized treating physician and/or medical treatment and all motions that are filed in cases not otherwise assigned to an Administrative Law Judge for an evidentiary hearing. In addition the ADR Section Judges are responsible for approving attorney fee contracts and processing other requests for attorney's fees.
The ADR Section consists of two Administrative Law Judges and five full-time mediators, who are attorneys. In addition to full-time staff, there are also two Senior Administrative Law Judges who serve the Board as mediators on a contractual basis. While most matters are disposed of through mediation conferences and orders, a variety of disputes are addressed within the Section by written communications or telephone conferences.
Since mediation was instituted, the number of hearings and appeals has reduced significantly, and the number and type of issues resolved through mediation continues to increase. The ADR Section currently processes approximately 500 claims per month.

The goal of this Section is to facilitate the rapid resolution of disputes without the need for an evidentiary hearing. The average length of time that it takes for a claim to be processed through the ADR Section is 42 days.
The Trial Section is responsible for conducting hearings in those claims in which an evidentiary hearing is required. Hearings are required by statute to be held in the county where the injury occurs or a contiguous county. Parties may, however, agree to a change in venue upon approval of the Administrative Law Judge.
There are eight hearing offices located throughout the state of Georgia and Judges will also travel to locations provided by the different counties in order to conduct hearings in contested claims. There are currently 22 Administrative Law Judges at the Board. All are active members in good standing with the State Bar of Georgia and had been practicing attorneys for a minimum of seven years prior to receiving their judicial appointments.
Workers' compensation hearings are conducted in accordance with the Civil Practices Act, and the parties are generally represented by counsel. In accordance with the Workers' Compensation Law, cases are

scheduled to be heard within 60 days of the date the hearing notice is mailed and postponements are to be granted only upon strict legal grounds.
The Administrative Law Judge's award in a claim is generally issued within 60 days following the date of hearing. Any party dissatisfied with an Award may appeal the decision to the Appellate Division of the Board within 20 days of issuance. Absent any continuances being requested by the parties, a claim will be scheduled, heard, and the award will be issued in less than 103 days.
The Stipulation Section processes applications for lump sum payments, advance payments and stipulated settlement agreements. The Section reviews applications for settlement approval to determine whether all legal requirements are met and ensure that the interests of all parties are fairly represented.

The Georgia General Assembly passed legislation giving the State Board ofWorkers' Compensation authority to create the Fraud/Compliance Division, with full staffing occurring in September, 1995. The Division's primary goal has been 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 Workers' Compensation Law. The Division has begun to successfully investigate and prosecute both fraud and non-compliance throughout the state.

21 public appearances designed to educate and promote public awareness of workers' compensation. These seminars have successfully publicized ways to deter and prevent fraud in workers' compensation.
The investigative section continues to process suspected cases of fraud. Criminal warrants were issued in 16 cases. Other cases have been brought before the Board for assessment of civil fines and penalties.

As a direct result of the

increased publicity surrounding

fraud and non-compliance, the

:'..;,0~:"::":":.":".::."'

Division was divided into an investigations section and compli-

ance section, all under the direc-

tion of a Division Director.

While the investigators are locat-

ed in the Atlanta office, the com-

pliance officers are assigned

strategically across the state to

assure maximum effectiveness as

well.as to provide technical sup-

port to the investigators.

The first full year of operation (1996) has proven successful for the division. During this period, random compliance checks of over 6,500 businesses were conducted. As a result, approximately 6,400 additional employees are now covered by workers' compensation insurance, and $4 million in new premiums were written. The division has conducted

SUBSEQUENT INJURY TRUST Fu
PART 3

Board ofTrustees

Ex officio Members

Edward J. Bartlett, Chairman
Management Representative
James c. Thompson,Vice Chairman
Labor Representative Janis S. Murray, Secretary
Insurance Representative Yvonne Johnson
Rehabil itation Professionals Representative Lewis Lowe Public-at-Large Representative

John Oxendine Insurance Commissioner
Jennifer A. Green Executive Director Workers' Compensation Board
Anne D. Burnett Administrator

SEQUENT INJURY TRUST FUND

On July 1,1977, 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 is injured on the job, and aggravates a preexisting 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 contained 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. 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.

Table 5
Subsequent Injury Trust Fund Claim Activity

Fiscal Year

Cases Received*

Cases Accepted

Cases Denied

Cases Closed

Cases Remaining Amount ($) Open at End of FY Reimbursed

1991/92 1992/93 j 993/94 1994/95 1995/96

3290 3507 4446 5371 5602

569 691 625 987 1029

190

2523

178

2213

80

3079

123

4081

102

5321

4784 6427 8266 9847 10,440

28,053,008 40,247,803 41,840,983 57,333,270 63,422,887

*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 onehalf percent premium tax against each insurer and self-insurer.

Future assessments will be levied out when the Fund's net assets are less than 175% of disbursements made in a calendar year.

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

BEGINNING BALANCE
REVENUES Assessment Penalty Fines Income from No-Dependency Cases Interest on Investments Miscellaneous
TOTAL REVENUE
EXPENDITURES Personal Services Operating Expenses Reimbursement Paid
TOTAL EXPENDITURES
FUND BALANCE

FY 1992/93 $6,056,962

FY 1993/94 $977,362

FY 1994/95 $1,539,271

FY 1995/96 $2,256,689

35,215,387 11,987
339,074 725,730
8
36,292,186

42,777,253 12,780
197,730 70 I,397
11,407
43,699,767

57,576,165 46,950
254,000 1,438,634
2,597
59,318,346

62,479,268 1,050
163,000 1,727,719
3,386
64,374,423

636,169 487,814 40,247,803
41,371,786
$977,362

648,206 749,469 41,840,983
43,138,658
$1,539,271

756,179 511,479 57,333,270
58,600,928
$2,256,689

899,400 631,518 63,422,887
64,953,805
$1,677,307

WI

THIS PAGE LEFT BLAHK

1995 STATISTICAL CHARTS & TABL
PART 4

DUSTRY

The chart below represents the percent distribution of processed cases by industry. Of the 49,362 lost time cases processed for accident year 1995, SERVICES had the largest number of reported lost time cases.

Chart I Percent distribution of processed indemnity cases,
by major industry division/total employees

19%
Manufacturing

Construction
Transportation/ Communication/Utilities
-_-66%% Wholesale Trade _7% Retail Trade
Agri/Forest/FishinglMining .2%
I 1%
Government _ 8 %

cases (total + 49,362) employees (total + 3,422,000)

Services
24%
Finance/Insurance/Real Estate

Not Elsewhere Classified
-L,--------r-------r-------,-----,

o

10

20

30

40

PERCENT

Chart 2 Part of body injured in work place accidents
Injuries to the back occurred most frequently according to the Employer's First Report of Injury

Eyes .452

Head (except eyes) 1 176

Arms

2219

Hands

2006

Fingers

2371

Back

12,093

Legs

5080

Feet

3186

Toes 1334

Body Systems _907

Multiple

2492

Unclassified

8092

Head _812

Internal Organs

2083

All Other Types

7059

I

I

I

0

2000 4000 6000 8000 10000 20000

* Cases processed 49,362

Chart 3 Most common occurring injuries in work place accidents
Types of injuries most commonly reported on the Employer's First Report of Injury

Carpal tunnel syndrome 1382 Cuts or Lacerations .561
Dusts, Gases, Fumes, Vapors 1 219 Fall from a different level 2691 Falls from a ladder or scafolding _ 987
Foreign Body in Eye 1287 Lifting 9317
Pushing or Pulling 3001 Robbery or criminal assault 461
Slip did not fall 2284
Steam or Hot Fluids I 367
Struck or injured by a falling or flying object 3307 Unknown or unclassified

o

2000

4000

6000

8000 10000

Chart 4 Employment - Reported injury
During the last ten years the ratio of reported lost time injuries to employment has remained relatively constant. Employment estimates were obtained from the Georgia Department of Labor

DOl YEAR

I 45.600
1985

1986

1987

1988 1989

1990

1991 1992

1993 1994

1995
0

1,000,000

. . Lost Time Injuries
l1li Total Employment

2,500,000 2,600,000

2,000,000

2,800,000 2,900,000

2,900,000

2,900,000

3,000,000

3,200,000

3,300,000

3,000,000

3,422,000

REPORTED CASES By Cou

TABLE 7

The table below shows the distribution of reported lost time cases in each county for 1995.

County

Injuries

County

Injuries

Appling Atkins 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

97 47 49
5
278 31 129 428 189 91 1241 44 39 64 43 168 81 93 21 195 39 562 179 44 1647 20 117 383 599
5
1456 71
2853 319 245 221 85

Coweta Crawford Crisp Dade Dawson Decatur Dekalb Dodge Dooly Dougherty Douglas Early Echols Effingham Elbert Emanuel Evans Fannin Fayette Floyd Forsythe Franklin Fulton Gilmer Glascock Glynn Gordon Grady Greene Gwinnett Habersham Hall Hancock Haralson Harris Hart Heard

481 21 181 58
50
143 3246
100
71 785 448 98
3
99
92
138 59 67 364 691 351 127 8463 128 8 546 299 66 56 2734
160
802 17 128 86 69 28

County
Henry Houston Irwin Jackson Jasper Jeff Davis Jefferson Jenkins Johnson Jones Lamar Lanier Laurens Lee Liberty Lincoln Long Lowndes Lumpkin Macon 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

Table 7 (continued)

Injuries
400 467
38 178 44 60 92 55 34 34 102
17 236 58 141 29
10 544 76 90 57 71 90
38 73 18 221 106 19
77
178 1004 231
67 29 168 131 88 75 39 144 37 108
3 90 24 1046

County
Rockdale Schley Screven Seminole Spalding Stevens Stewart Sumter Talbot 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 State Unknown

Injuries
387 30 43 30 338 127 23 213 10 4 102 29 59 42 351 343 157 29 9 367 59 23 88 131 241 217 349 33 97 140 6 16 95 797 23 49 63 71 1044 2564

ApPENDIC
PART 5

PENDIX 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 workrelated 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 burns, 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 perma~ent 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 date 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 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 a fall, robbery or criminal assault, and motor vehicle accident.

ApPENDIX

EXECUTIVE DIRECTOR
Ms. Jennifer A. Green 270 Peachtree Street, NW Atlanta, Georgia 30303-1299 404-656-2048
ADMINISTRATIVE LAW JUDGES
ATLANTA Judge J. Dixon Belk, Director Legal Division Judge Judith Blackwell Judge Brenda Bono Judge Viola Drew Judge Johnny Mason Judge Charles Mobley Judge Carolyn S. Weeks
Alternate Dispute Resolution Unit: Judge Elizabeth Lammers 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 3170 I 912-430-4280
AUGUSTA Judge T. Raworth Williamson 1056 C1ausson Road Suite 224 Augusta, Georgia 30907 706-667-4062
COLUMBUS Judge Tasca Badcock Judge Claude Bray Judge William S. Cain 102-A Second Avenue Columbus, Georgia 3190 I 706-649-7520

DALTON 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 100C 30 I Green Street Gainesville, Georgia 3050 I 770-535-5713
MACON Judge Robert Gerson Judge Sallie Rich Jocoy Suite 235, Building D 3312 Northside Drive Macon, Georgia 3 120 I 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

2

SUMMARY OF WORKERS' COMPENSATION PROVISIONS

0GEORGIA WORKERS' COMPENSATION ACT AMENDED ON:

TOTAL DISABILITY - CODE SECTION 114-404 - O.e.G.A. 34-9-26I

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 114-405 - O.e.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 - O.c.G.A. 34-9-263

Maximum weekly benefit

Percent of difference in wages

SPECIFIC MEM8ER - lOSS OR lOSS OF USE OF:

Weeks

Weeks

Thumb

60

Arm

225

1st (index) finger

4C

Foot

135

2nd (middle) finger

35

leg

225

3rd (ring) finger

30

Eye

150

4th (little) finger

25

loss of Hearing (one ear)

Great toe

30

Total Industrial

75

Other toes

20

loss of Hearing (both ears)

Hand

160

Total industrial

150

Disfigurement

None

DisabilitylBody as a whole 300

DEATH BENEFITS - CODE SECTION 114-413 - O.C.G.A. 34-9-265

Maximum weekly benefit

Maximum duration from date of injury

Burial expense

Total Maximum benefit

7-1-86 7 days 28 days $175 66 2/3% $25 Unlimited No $ amount None $117 350 weeks 66 213% $40.950 $175 66 2/3%
$175 Various $5,000 $65,000'

7-1-9D 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'

7-1-92 7 days 21 days $250 66 2/3% $25 400 weeks" No $ amount None $175 350 weeks 66 2/3% $61,250 $250 66 2/3%
$250 Various $5.000 $100,000'

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 in lump sum payment Statute of limitations: For reporting accidents to the Board O.LG.A. 34-9-82 For appeal to Three-Member Board For appeal to Superior (ourt For appeal to Court of Appeals Number of employees required to come under law Surviving spouse only after one year Except for catastrophic injuries which are unlimited

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

All others Various
Various
Unlimited
7% per annum
I or 2 years - see OU.A. 34-9-82 20 days from award 20 days from award 30 days from award 3

All others Various
Various
Unlimited
7% per annum
I or 2 years - see O.LG.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" No $ amount None
$192.50 350 weeks 66 2/3% $67,375
$275 66 2/3%
$275 Various $5.000 $100,000'
All others Various
Various
Unlimited
7% per annum
I or 2 years see O.LG.A. 34-9-82 20 days from award 20 days from award 30 days from award 3

7-1-96
7 days 21 days $30D 66 2/3% $25 400 weeks" No $ amount None
$192.50 350 weeks 66 2/3% $67,375
$300 66 2/3%

~ ~
t:Ij
Z 0
><1---1
~

$300 Various $5,000 $100,000'
All others Various
Various
Unlimited
7% per annum
I or 2 years - see O.e.G.A. 34-9-82 20 days from award 20 days from award 30 days from award 3

ApPENDIX

FORM# WC-I WC-2 WC-2(a) WC-3 WC-4 WC-6 WC-7
WC-IO WC-II WC-12 WC-14
WC-20(a) WC-25 WC-26 WC-PI WC-P2 WC-P3 WC-102 WC-102(g) WC-102(j) WC-104
WC-108(a) WC-108(b) WC-121 WC-131
WC-200(a) WC-200(b) WC-206
WC-207 WC-208(a)
WC-240 WC-243 WC-244
FORM WC-RI WC-R2 WC-R2A WC-R3

BOARD FORMS/JULY 1996

REVISION DATE 96 96 96 96 96 95 95

COLOR Tan Lt. Blue Goldenrod Coral Mint Green White White

96

White

96

White

96

White

96

White

96

Lt. Pink

96

White

96

White

96

Pink

96

Pink

96

Pink

96

White

96

White

95

White

95

White

95

White

96

Gold

95

White

95

White

95

White

96

White

95

White

95

White

95

White

95

White

96

White

95

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) 656-4893 Notice of Election or Rejection of Workers' Compensation Coverage Standard Coverage Form Group Self-Insurance Fund Members Request for Copy of Board Records Notice of Claim/Request for Hearing/Request for Mediation/Notice of Representation Medical Report Application for Lump Sum/Advance Payment Yearly Report of Medical Only Cases Panel of Physicians Conformed Panel of Physicians WC/MCO Panel Request for Documents to Parties Motion/Objection to Motion Attorney Leave of Absence Notice to Employee of Medical Release to Return to Work with Restrictions or Limitations Attorney Fee Approval Attorney Withdrawal/Lien Notice of Use of Servicing Agent Designation by Insurer of Office for Service of Notices Change of Physician/Additional Treatment by Consent Request/Objection for Change of Physician/Additional Treatment Reimbursement Request of Group Health Insurance Carrier/Healthcare Provider Authorization and Consent to Release Information Application for Certification ofWC/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.

REVISION DATE 7/92 7/92 7/90 7/90

COLOR Lt. Green Lt. Green Lt. Green Lt. Green

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