Annual report, [1997]

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STATE BOARD OF
WORKERS' COMPENSATION
ANNUAL REPORT
GEORGIA

Georgia State Board of Workers' Compensa
ANNUAL REPO
This report consists of data taken from calendar year 1996 and fiscal year 1997. Statistical information was extracted on December 31, 1997.
270 Peachtree Street, N.W. Atlanta,Georgia 30303-1299

Established in 1920 by the Georgia legislature, the State Board of Workers' Compensation serves over 187,000 employers and 3,380, 724 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 access to the Georgia Workers' Compensation program for injured workers and employers in a manner that is sensitive, responsive and effective ...to insure efficient processing and swift resolution of claims ... while encouraging workplace safety and return to work... and protecting the employer from tort liability.
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 Appellate Division .............................................. I0 Claims Processing Division................................ I I Fraud/Compliance Division................................ 12 Legal Division........................................................ 13 Licensure and Quality Assurance Division..... IS Managed Care and Rehabilitation Division.... 16
PART Ill SUBSEQUENT INJURYTRUST FUND.. 19

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 Pamela R. Carter
In memory of Joe Moore

PART IV STATISTICAL CHARTS & TABLES ......... 23 PART V APPENDICES................................................. 29

The "1997 Annual Report" is a presentation of calendar year
1996 claim information and fiscal year 1997 operational statistics.

T-A-GLANCE

DECEMBER 31, 1997
A T-A-GLANCE, provides a capsule look at statistics for lost time and medical only financial information and exceptions. Exceptions are those cases which, because of Rehabilitation, ADR conferences, ALJ hearings, Appellate review, or Stipulated Settlements require Board involvement beyond claims processing. Information presented in this Annual Report is as of December 31, 1997.

1996

1995

1994 1993

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

47,815

50,595

54,155

53,527

OPEN .........................

13,474

7,140

4,272

2,749

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

34,341

43,455

49,883

50,778

WC-4 CASE PROGRESS REPORT

Total Weekly Benefits .......... $ 135,796,367 246,469,779 341,554,617 398,395,617
Physicians Benefits ............. 64,090,069 96,951,706 115,935,589 134, 127,170

Hospital 67,997,842 98,758,834 112,892,232 120,544,165 Pharmacy Benefits .............. 5,083,886 9,396,822 13,949,876 18,120,556

Physical Therapy ................ 10,948,220 15,802,553 15,702,400 12,396,149

Chiropractic ...................

414,791

861,245 1,068,793

655,096

Other ......................... 13,712,628 19,296,998 27,824,561 31,425,756

Rehabilitation .................. 9,945,542 13,371,040 15,407,581 16,420,803

Late Payment Penalties .........

750,030

856,978 1,054,538 I,269,489

Assessed Attorney's Fees .......

332,438 863,590 1,251,785 1,476,680

Burial ..........................

365,002 580,009

545,166

533,272

TOTAL .......................... $ 309,436,815 503,209,554 647,187,138 735,364,753

AVERAGE COST OF A CASE .... $ AVERAGE LOST WORK DAYS ....

6,472 54

9,946 83

11,951 103

13,738 161

MEDICAL ONLY CASES:

WC-26 REPORT OF MEDICAL ONLY ........................... TOTAL AMOUNT PAID ......... $

168,226 82,480,458

180,074 57,962,731

166,356

250,647

45,683,402 135,098,733

TOTAL PAYMENTS ALL CASES ........................ $ 391,917,273 561' 172,285 692,870,540 870,463,486

WC-14 NOTICE OF CLAIM/

REQUEST FOR HEARING BY

DOl .........................

1996

1995

1994

1993

Total Received ................ ALJ Referred ................. ALJ Scheduled ................ Disposed Prior to Hearing .... ALJ Held .....................
ADR Disposed all DOl'S ..

14,344 8,414 8,344 7,256 1,088
4,762

20,917 10,127 10,008 8,470
1,538
4,001

27,712 11,731 11,196 9,436
1,760
3,007

20,741 11,802 10,458 8,729
1,729
*

Appellate Review all DOl'S .... Submits ...................... Hearings .....................

1,134 179 955

1,186 280 906

1,833 131
1,702

1,452
*
1,452

Stipulated Settlements by DOl's

6,834

9,298

11,307

11,260

Total Amount of Settlements

$66,752,026 I09,977,555 207,485,413 223,752,994

Average Settlement

$9,768

11,828

18,350

19,871

* Information not collected in this format.

47,815 cases were created with an injury date of 1996. Lost time cases are down over 11%. The open case count of 55,030 continues to fall (10%), reflecting improvements in claims management and timely reporting. 53% of all files show workers' compensation coverage provided by insurance carriers. This represents a 5% increase over the last reporting period. Self insurers, Captives, Funds and alternatives provide the balance of coverage. The number of cases heard by Administrative Law Judges continues to be impacted by the availability of quality mediation in the Alternative Dispute Resolution Unit.

0RGANIZATIO
PART 1

TRODUCTION

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 subject-

ed to harsh and oppressive work-

ing conditions with little or no

recourse for work-related

I t has been 77 years since the Georgia

injuries. Courts often denied recovery to employees by holding that employees assumed risks

Legislature enacted the in taking the job, were negligent,

Workers' Compensation or were barred from recovery by

Law. The law created an the negligence of a fellow

. .

employee. Filing a suit in court

orgamzatiOn called the was also unsatisfactory because

Industrial Commission, trials were expensive and often

the forerunner of

lengthy. This posed a problem to

today's State Board of an employee who needed money
immediately to pay for medical
Workers' Compensation, expenses and replace lost wages.

to encourage safety and A successful suit could also force

assure benefits for

a small company out of business.

injured employees.

Today, the workers' compensa-

tion law provides for specific

benefits to be paid to employees

for injuries arising out of and in

the course of employment, with-

out 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 pro-

grams 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-relat-

ed 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 officers, 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 BoA

The responsibilities of the Board are divided into judicial, administrative, and regulatory functions.
In their judicial capacity, the three members of the Board function as a three-judge appellate review panel, named the Appellate Division. The panel hears and reviews cases when a party to a claim files an appeal from an award of an administrative law judge of the Trial Division. The Appellate Division issues a written decision either adopting, amending, or reversing the decision issued by the Trial Division judge. The decision of the Appellate Division may then be appealed as a matter of right to the Superior Court having jurisdiction in the county of injury. A party dissatisfied with the order of the Superior Court may then file an application for appeal to the Court of Appeals or Supreme Court of Georgia, However, the right to file an appeal is discretionary with these courts.
The Appellate Division issues order approving settlements which have been agreed upon

and submitted by the parties in a claim. The judicial function also includes the responsibility of reviewing and issuing orders in claims where the employee is requesting an advance or lump sum payment of future benefits.
The administration and regulatory functions include responsibility for maintaining the efficient monitoring of all claims and benefit payments to injured workers, 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 members of the Board work with an advisory council to develop policies and laws affecting workers' compensation and each year, with the advice of the council, promulgates and adopts rules and regulation affecting workers' compensation processes.

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.

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Chairman Harrill L. Dawkins

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Director

Carolyn C. Hall

Director Vicki L. Snow

STATE BOARD OF WORKERS' COMPENSATION Total Budgeted Positions as of July I, 1997 162 Positions

BOARD DIRECTORS
8
Executive Director's Office 3

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.
Oversees the operations of the Board ... provides management supervision ... makes presentation to various groups as requested ... assists the Board Members as needed ... peer review of medical services.

ADMINISTRATIVE SERVICES DIVISION
16

APPEALS & SETTLEMENTS
DIVISION
13

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.

Researches cases appealed to Board ... recommends appropriate action ... reviews and approves stipulated settlements ... reviews and processes requests for advances ... receives and processes documents regarding appealed cases ... sets calendar for appellate hearings.

Maintains file room and filing system ... reviews cases prior to closure ... operates mailroom ... pro-cesses mail and forwards files and mail to divisions ... locates files and resolves problems caused by duplicate files.

FRAUD/ COMPLIANCE
DIVISION
14
Investigates incidents of non-compliance . . . Investigates incidents alleging fraud ... makes presentations to various groups regarding fraud/compliance.

INSURANCE CONSULTANT
Handles insurance related issues ... makes presentations to various groups as requested.

LEGAL DIVISION
63
Screens requests for hearings ... holds formal hearings ... mediates changes of physicians, rehal bilitations suppliers, and attorney fees ... makes presentations to various groups as requested ... copies case files for attorneys and higher courts.

LICENSURE & QUALITY
ASSURANCE DIVISION
9
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.

MANAGED CARE & REHABILITATION DIVISION 8
Processes requests for rehabilitation services . .. performs quality assurance reviews of rehabilitation suppliers . . . holds conferences to resolves disputes ... reviews and approves rehabilitation plans ... reviews applications of Managed Care Organization.

ACHIEVEMENTS & ACTIVITI
PART 2

MINISTRATIVE SERVICES

The Administrative Services Division includes the 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 ofWorkers' 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 422 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

162 $8,666,608

Regular Operating Expenses: Motor Vehicle Expenses Supplies & Materials Postage Repairs & Maintenance Publications & Printing Rents (other than Real Estate) Insurance & Bonding Duplication & Rapid Copy Equipment (Less than $1 ,000) Other Operating Expenses
Travel Equipment Purchase Real Estate Rentals Per Diem, Fees & Contracts Computer Charges Telecommunications

2,000 105,000 200,000 51,000 85,000
1,500 3,200 5,000 33,374 30,000 156,840 28,252 I ,079,835 154,589 351,890 207,613

Total

$11,161,701

Table 2 Assessment Figures

Fiscal Year

Premium Writings

Administrative Funds Premium
Collected Factor

1987

586,706,797

5,982,699

1988

739,280,403

6,919,856

1989

911,523,434

7,477,5 II

1990

1,061,301,347

8,008,400

1991

1,239,497,523

8,334,378

1992

1,474,997,352

8,537,789

1993

1,598,890,476

9,214,010

1994

1,648,162,040

9,690,796

1995

1,70 I,221,644

I0,294,882

1996

1,678,771,284

I0,425,022*

1997

I,703,789,141

10,896,407

1.02 0.924 0.820 0.755 0.672 0.577 0.579 0.587 0.610 0.620* 0.640

* corrected

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.
As we approach the new millennium, the Training Section is continuing to expand educational efforts on Georgia's workers' compensation system. Eight Regional Educational Seminars were presented throughout the state during the spring. A record attendance of over I,400 participants had the opportunity to gain first hand knowledge from the Board Directors themselves through lecture, question and answer sessions, and an open forum at the end of each program.

The three-day Annual Educational Seminar held in August of each year has become one of the most successful workers' compensation conferences in the southeast. The 1997 seminar, "Toward 2000,The Direction of Workers' Compensation", consisted of five concurrent workshops featuring 62 experts from various components of the workers' compensation field. Renowned disability experts Richard Pimintel and Geri Jewell opened the seminar. Over I,000 attendees were registered and 76 exhibitors displayed services. A major achievement for the annual event is continuing education certification in the following professions:
American Association of Occupational Health Nurses - AAOHN Certification for Case Managers - CCM Certified Disability Management Specialist - CDMS Certified Registered Rehabilitation Nurse - CRRN Certified Rehabilitation Counselor - CRC Certified Work Adjustment and Vocational Evaluation
Specialist - CWAVES Continuing Legal Education - CLE Court Reporters Training Council of Georgia - CRTC Georgia Insurance Agents Georgia State Board of Chiropractors Georgia State Board of Occupational Therapy National Association of Athletic Trainers - NATABOC Physical Therapy Association of Georgia - PTAG

Additionally, the Managed Care and Rehabilitation Division of the Board conducted a Catastrophic Supervisor Workshop which was attended by 40 rehabilitation professionals.
Georgia Gain Performance Management Training has continued for supervisory personnel at the Board. Advanced computer training on a new software program is currently scheduled, and administrative law judges and staff attorneys completed their Annual Law Institute.
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.
Data entry provides quality input of the information from the Board forms. Over three hundred thousand forms were received in 1996. These forms

are the source documents for the database of information which allows the Board to serve the employers, insurers and 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 O.C.G.A. 34-9-61, information about the Board's past year operation is formally presented in an annual report.The report is prepared to share this information with the Georgia General Assembly, 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 5,000 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.

PELLATE DIVISION

The division is comprised of the Stipulations Section, the Staff Attorneys, and the appellate Court Clerks.

The Appellate Division was created in 1997 to expedite and coordinate the quasi-judicial functions of the Board; specifically the review of decisions of the administrative law judges upon request of a party to the claim and the review and approval of settlements. The division is comprised of the Stipulations Section, the Staff Attorneys, and the appellate Court Clerks. The Appellate Court Clerks process all requests for appeal to the Board and any other filings or correspondence related to claims pending before the Board. The Clerks also schedule cases for oral argument

before the three Directors who serve as the judges of the Appellate Division. The Staff Attorneys assist the Board in the research and review of appealed cases. The Stipulations Section processes applications for Jump sum payments, advance payments and stipulated settlement agreements.
The examiners review applications for settlement approval to determine whether all legal requirements are met and ensure that the interests of all parties are fairly represented.

0

CLAIMS PROCESS!

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 1996 over 650,000 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 47,815 new records were created during calendar year 1996. 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 1987 through 1994. 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 1996, 82% more cases were closed (86,991) than created (47,815).

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

Calendar Year
1991 1992 1993 1994 1995 1996

Table 3 Claims Processed Per Calendar Year

Medical Only Cases Reported

Reported as Indemnity Cases

Reviewed

Created

Closed

186,959 255,074 250,647 166,356 180,074 168,226

134,086 114,413 i 13,012 161,773 154,584 183,311

52,282 52,906 53,527 54,155 50,595 47,815

64,845 54,596 56,749 91,033 75,714 86,991

1

UD/COMPLIANCE

The mission of the Fraud/Compliance Division is to work with businesses operating in Georgia to assure compliance under the Workers' Compensation Law, to deter fraud through public relations and investigations, and to enforce the rules and regulations of the Workers' Compensation Board.

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.
As a direct result of the increased publicity surrounding fraud and non-compliance, the Division was divided into an investigations section and compliance section, all under the direction of a Division Director. While the investigators are located in the Atlanta office, the compliance officers are assigned strategically across the state to assure maximum effectiveness as well as to provide technical support to the investigators.

Since operations began, the Compliance Unit has conducted over 18,000 random compliance checks of businesses.As a result over 2,200 additional businesses

now carry workers' compensation insurance coverage. These businesses were operating in violation of the law prior to being contacted.The compliance checks resulted in insurance coverage for an additional 12,000 employees, generating over $7 million in _::iditional new premiums. The division has conducted 30 public appearances designed to educate and promote public awareness of workers' compensation. These seminars continue to successfully publicize ways to deter and prevent fraud in workers' compensation.
Effective July I, 1997, the Legislature granted law enforcement powers to the Fraud Unit. This legislation authorizes those Fraud Age,Jts who are Certified Peace Officers to execute search warrants and make arrests pursuant to workers' compensation investigations.
To date, the Fraud Unit has initiated 96 arrest warrants as a result of investigating over 300 cases referred to the division in 1997.These arrests cleared 60 cases with an estimated loss of $4.5 million.

2

LEG

The Legal Division is responsible for reviewing and processing all requests for hearings and for conducting hearings in contested cases. Additionally, the Division makes copies of files, upon request, for a fee, answers questions concerning the workers' compensation system and procedures, processes requests for change of physician, coordinates requests for peer review of medical expenses, approves attorney fee contracts, provides legal research for the Board, monitors appeals to the courts and coordinates continuing legal education programs. The Division is divided into three sections: Screening & Administration, Alternative Dispute Resolution and Trial.
The Screening & Administration Section is responsible for processing all notices of claims and requests for hearings to determine where the claims should be directed for resolution. The Section assigns those claims requiring an evidentiary hearing to Administrative Law Judges in the Trial Section. 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 a toll free 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 in this section. Requests for peer review of medical charges are referred to the appropriate peer review committee by this Section.
As with the previous year, this section screens over 1300 files per month which are then referred to either the Trial Section or Alternative Dispute Resolution Section for further action. Each month between 3040 Superior Court appeals are processed, between 200-300 files are copied at the request of parties (over 25,000 pages), and well over 4,500 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 several years ago to include mediation conferences on a number of issues. Because of the success of the pilot project, the ADR Section now includes four mediators in Atlanta and one mediator in the Columbus office. Requests for review are handled by telephone communications, conferences, or by issuance of an interlocutory order. The staff currently processes an average of 450 claims per month which would otherwise be assigned to the Trial Section and scheduled for hearings.

To facilitate the performance of its duties and fulfillment of its responsibilities, the Legal Division is divided into three sections: Screening & Administration Section, Alternative Dispute Resolution Section and Trial Section.
1

4

This unit provides a tremendous amount of relief to the Administrative Law Judges throughout the State because hearings are not required. Issues addressed by this Unit include requests for change of physician, approval of income benefits to an employee, provision of emergency medical treatment and resolution of the medical disputes and attorney fee lien disputes, as well as various other requests. The goal of this Section is to resolve claims which do not require an evidentiary hearing more rapidly, 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 between 35-40 days. Since the ADR Unit commenced on July I, 1994, trials and appeals have reduced as the number of mediations increased.
The Trial Section holds hearings for those claims which an evidentiary hearing was requested by the parties, and a mediation conference either could not be scheduled or could not resolve the issues. Hearings are held in the county where the injury occurs, a contiguous county or a county within 50 miles of the injury. There are several hearing offices located throughout the State for the convenience of the parties. Judges travel to locations provided by the counties to hear contested claims. There are currently 22 Administrative Law Judges, all of whom are 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, and the parties are generally represented by counsel. 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 45-55 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 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 90 days. Unless a continuance is requested by the parties, a claim will be scheduled, heard, and the award will be issued in less than 120 days.

LICENSURE &QuALITY Assu

The Licensure and Quality Assurance Division regulates and licenses 398 companies who selfinsure their Workers' Compensation liabilities; 422 insurance companies who write policies of Workers' Compensation, and 629 rehabilitation suppliers who handle Workers' Compensation cases.
The Quality Assurance Section of this Division performs audits on I00% 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.
1

NAGED CARE & REHABILITATION*

A s a result of a statutory provision, managed care was introduced into the Georgia Workers' Compensation System in 1994. A 12o/o 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.
6

This has been a busy year for the Managed Care and Rehabilitation Division. Four more managed care organizations (MCOs) have been certified by the Certification Committee. There are a total of 18 certified MCOs covering 82,000 employees in 137 of Georgia's 159 counties. Additionally, there are 13 applications in process to become certified as a managed care organization in Georgia's workers' compensation system. The cornerstones of the state's certified managed care organizations continue to be: I) Case Management, 2)Employee choice of network physicians, and 3) the Dispute Resolution Process.
Case management within the MCO guides the injured employee with 'first day' involvement in the access, care, and treatment by the network provider. The case manager makes sure the employee's questions are answered and maintains contact with the physician to ensure timely, appropriate, quality medical care is provided. Case managers help injured employees, physicians, and employers initiate return to work goals from the first day of medical care. A rule change effective July I, 1997 reinforces the cooperation of all parties with the certified MCO's case manager.
Surveys of 80% of the doctors, employers/insurers and employees who participated in the current certified organizations

reflect positively on the managed care system. Doctors and employers/insurers enjoyed the increased communication and feedback provided by the managed care organization. Employees seemed to be more pleased with their care when allowed to choose their authorized treating physician from the network. Also, employees found the managed care organization's medical care easier to access due to the proactive education process provided prior to any injuries occurring, and the 1-800 number.
Dispute Resolution continues to be the service that differentiates the certified managed care organization from individual managed care services. The dispute resolution process allows the certified MCO to handle disagreements that arise during the course of a workers' compensation claim from the employee, authorized treating physician, insurer or employer. Second change of physician, treatment issues, or case management concerns, for example, may all be handled by the MCO's 30 day dispute resolution process first, before referring the issue to the board for a hearing or mediation. The certified MCO acts as a third party mediator to resolve the problem "inhouse". The cost of a claim for both sides can be reduced when the dispute resolution process is utilized under the certified MCO.

*Formerly the Managed Care and Catastrophic Disability Division.

On site inspections have been performed for four of the certified MCOs as part of their annual re-certification process this year. During the inspection visit, the MCO's case management files are reviewed, information systems are examined, and MCO personnel are met by the board's representatives. Additionally, physician credential files are verified, sales and educational materials examined, and the dispute resolution log is reviewed. After the on-site inspection, several of the contracted employers are visited to verify educational materials were distributed and that the appropriate panel card (WC-P3) and network listing is available to all employees.
This year the board began collecting more specific data from our certified MCOs. This information is listed in the table below as a total for all certified MCOs for 1997.

The data show that 6% of certified MCO covered employees have been injured on the job. Of the 6%, less than I% (0.5%) became lost time cases. Thirteen percent of the medical only cases have on going case management, and 65% of lost time cases are being handled by case managers.
Information on certified managed care organizations is available from the Division, including an educational brochure, developed in 1997, explaining the benefits of managed care in workers' compensation; a list of certified and applying managed care organizations, the counties covered by the certified MCOs, case management guidelines, and the MCO application form with board rules and procedures.

Table 4

Employer Client (self/insured) .................... 14 Insurer/Insured Employers ................. I I I 2,778 Number of Employees covered ................ 82,469 Number of Injuries
Lost Time ................................. 460 Med Only................................ 4,644 Nu:nber of Case Management Cases Lost Time ................................. 299 Med Only ................................. 593

1

8

Closure of long term rehabilitation files predominated the beginning of this year. In 1996, there were 224 rehabilitation file closures, in 1997 there have been 765 closures. In general, files that did not show goal directed rehabilitation, or had lack of rehabilitation activity for several years, were closed with agreement of all parties. Currently, there are still 887 active rehabilitation files with injury dates prior to July I, 1992. These files are continually monitored by the division's rehabilitation coordinators for appropriate closure.
Rehabilitation cases for post-July I, 1992 injuries are on a voluntary basis. No board reporting is required, however, all parties must agree in writing that the services of a rehabilitation coordinator are needed. All rehabilitation suppliers utilized in these cases must be registered with the board. The written agreement for rehabilitation is retained by the supplier.
The division's rehabilitation coordinators monitor all of the catastrophic rehabilitation cases in the state. There are currently 455 catastrophic rehabilitation cases. The coordinators provide frequent telephonic and in-person consultations (approximately 2,500 in 1997) for not only the catastrophic files, but also for pre-July 1992 and voluntary rehabilitation cases. Additionally, the coordinators held 60 formal conferences and 30 mediations of rehabilitation issues in the division's conference room.

In the course of reviewing catastrophic files, our coordinators identified a need for education among catastrophic suppliers supervising interns. As a result, a course was designed and offered to the supplier community to clearly explain the roles of each supplier and the boundaries of interaction for the intern. The course was held in October at the Board and was well attended. The division will continue to offer this course, along with CEUs in an effort to educate the Georgia rehabilitation community.
looking forward to 1998, the division expects to see more managed care activity in the workers' compensation area. We receive approximately one application for certification every five weeks. There will be more choices for employers and insurers encouraging the use of certified managed care organizations. Rehabilitation coordinators will continue their monitoring role in addition to helping define and shape the future of rehabilitation in Georgia's workers' compensation cases.

SuBSEQUENT INJURY TRUST Fu
PART 3

Board ofTrustees
Edward J. Bartlett, Chair Management Representative
James C.Thompson,Vice Chair 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
Jennifer A. Green Executive Director Workers' Compensation Board
Anne D. Burnett Administrator

1

BSEQUENT 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 ofTrustees appointed by the governor for six-year terms. The actual administration of the Fund is conducted by an administrator and staff consisting of 27 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 I04 weeks, for 50% of all medical and rehabilitation expenses between $5,000 and $1 0,000, and for I00% of all medical and rehabilitation expenses in excess of $1 0,000. 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 ofWorkers' 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
1992/93 1993/94 1994/95 1995/96 1996/97

Cases Received*
3507 4446 5371 5602 6210

Cases Accepted
691 625 987 1029 801

Cases Denied
178 80 123 102 96

Cases Closed
2213 3079 4081 5321 5984

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

6427 8266 9847 10,440 10,969

40,247,803 41,840,983 57,333,270 63,422,887 62,510,238

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

Administrative costs and reimbursements are funded through a non lapsing 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 when the Fund's net assets are less than 175% of disbursements made in a calendar year.

Table 6 Subsequent lnjuryTrust 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 PRIOR YEAR ADJUSTMENTS
FUND BALANCE

FY 1993/94 $977,362

FY 1994/95 $1,539,271

FY 1995/96 $2,256,689

FY 1996/97 $1,677,307

42,777,253 12,780
197,730 701,397
11,407
43,699,767

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

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

70,623,113 0
25,000 I,941.175
4,114
74,270,709

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

I ,037,405 412,359
62,510,238
63,813,289 146,713
$1 0,3 I0,707

2

THIS PAGE LEn BLANK

1996 STATISTICAL CHARTS & TABL
PART 4
2

DUSTRY
Chart I represents the percent distribution of processed cases by industry. Of the 43,945 lost time cases processed for accident year 1996, the manufacturing segment reported the largest number with lost time. (Figures are rounded).

Chart I Percent distribution of processed indemnity cases,
by major industry division/total employees
25%
Manufacturing

Construction

Transportation/ Communication/Utilities Wholesale Trade

--6%
-7%

Retail Trade

cases (total + 43,945) employees (total + 3,380,724)

Agri/Forest/Fishing!Mining

Government

Services
24%
Finance/Insurance/Real Estate 2%
-5%
Other less than I%
I 1%

0

10

20

30

40

4

PERCENT

Chart 2 Part of body injured in work place accidents
Injuries to the BACK (8%) continue to be the most reported single injury on the Employers First Report of Injury
involving lost time cases; the KNEE (7%) follows a close second in number of reported injuries. Injuries which
involve multiple body parts make up 39% of reported lost time cases.

Eyes .408

Head (except) eyes .402

Respiratory/Chest -828

Arms

2150

Hands

1851

Fingers

2220

Thumb .590

Back

3763

Hip 32?

Pelvis 164

Thigh/leg .397

Knee

3186

r:er Ankle Feet/Toes ExtreHmeicayd

1438 2001
1519 -792

Multiple

pper Extremity

2308

Trunk

L_

Parts

5352 5654

Internal Organs

1893

Unclassified 0

4418

I

I

I

2000 4000 6000

I

I

I

8000 10000 20000

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

Carpal tunnel syndrome .466

Sprain

1810

Strain

Fall from a different level

Foreign Body in Eye .235

Lifting

Pushing or Pulling

2211

Robbery or assault -655

Motor Vehicle Collision

1892

Struck by a Moving Object

3014

Collision with Stationary Object

2155

All Others

2129

Unknown or unclassified

0

2000 4000

8139 6105
6853

6000

8000 10000

2

Chart 4 Employment - Reported injury
During the last ten years the ratio of reported lost time injuries to employment has remained relatively constant, between I% and 2%. Employment estimates were obtained from the Georgia Department of Labor.

DOl YEAR
6

1986 148,500

1987

1988 1989

1990

1991 1992

1993 1994

1995

1996

0

1,000,000

. . Lost Time Injuries . . . Total Employment

2,600,000

2,800,000

2,900,000 2,900,000
3,000,000 3,200,000 3,300,000 3,422,000

2,000,000

3,000,000

REPORTED CAsEs BY Cou
TABLE 7
The table below shows the distribution of reported lost time cases in each county for 1996.

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

Injuries
71 50 59 13 360 41 136 409 143 115 1247 34 33 54 53 164 92
77
27 190 31 556 202 43 1487 21 90 396 575 17 1344 81 2738 322 215 203 100

County
Coweta Crawford Crisp Dade Dawson Decatur Dekalb Dodge Dooly Dougherty 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

Injuries
431 14 159 38 65 140
2999 75 66 706 410 57 2 91 81 112 69 59
334 573 370 98 8010
Ill
4 613 325 79 64 2692 192 726 23 132 76 82 24

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
8

Table 7 (continued)

Injuries
424 397 54 152 43
72
106 40 48 51 120 9 203 73 120 22
II
551 69 95 32 39 93 33 76 18 226 106 8
72
140 1013 233
72
30 139 107 88 67 30 169 44 123
3

County
Rabun Randolph Richmond 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
81 39 1176 434 33 43 25 341 122 16 191 19
I
108 30 71 46 392 319 165 29 24 362 42 33
72
115 238 215 368
31 107 112
9 12 79 834
IS
37 34 75 1103 2585

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 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 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 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.

EXECUTIVE DIRECTOR
Ms. Jennifer A. Green 270 Peachtree Street, NW Atlanta, Georgia 30303-1299 404-656-2048
ADMINiSTRATIVE lAW JUDGES
ATLANTA
Judge J. Dixon Beik, Director Legal Division
Judge Judith Blackwell Judge Brenda Bono Judge Ronald Conner Judge Viola Drew Judge Johnny Mason Judge Charles Mobley Judge Carolyn S. Weeks
Alternate Dispute Resolution Unit: Judge Elizabeth Lammers
Judge Meg T. Hartin
270 Peachtree Street, NW Atlanta, Georgia 30303-1299 404-656-3875
AlBANY Judge Gordon R. Zeese Suite 203,AibanyTowers 235 Roosevelt Avenue Albany, Georgia 3170 I 912-430-4280
AUGUSTA Judge T. Raworth Williamson I056 Clausson Road Suite 224 Augusta, Georgia 30907 706-66 7-4062
COLUMBUS Judge Tasca Badcock Judge Claude Bray Judge William S. Cain I02-A Second Avenue Columbus, Georgia 3190 I 706-649-7520

APPENDIX
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 IOOC 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 30 161-3059 706-295-6781
SAVANNAH Judge Leesa Bohler
Judge Jerome J. Stenger
Suite 60 I Seven East Congress Street Savannah, Georgia 3140 I 912-651-6222
3

~

SUMMARY OF WORKERS' COMPENSATION PROVISIONS

GEORGIA WORKERS' COMPENSATION Aa AMENDED ON:

7/1/86

7/1/90

TOTAl DISABILITY CODE '114-404 O.C.G.A. '34-9-261

Waiting period

7 days

7 days

Waiting period recoverable after (consecutive from disability date) 28 days

21 days

Maximum weekly benefit

$175

$225

Percent of average weekly wage (13 weeks prior to accident)

66 2/3%

66 2/3%

Minimum weekly benefit

$25

$25

Maximum weekly duration from date of disability and

not date of accident

Unlimited

Unlimited

TEMPORARY PARTIAl DISABILITY CODE '114-405 O.C.G.A. '34-9-262

Maximum weekly benefit

$117

$150

Maximum weekly duration from date of injury

350 weeks

350 weeks

Percent of difference in wages before and after injury 66 2/3%

66 2/3%

Total maximum compensation

$40,950

$52,500

PERMANENT PARTIAl DISABILITY CODE '114-406 O.C.G.A. '34-9-263

Maximum weekly benefit

$175

$225

Percent of difference in wages

66 2/3%

66 2/3%

SPECIFIC MEMBER lOSS OR lOSS OF USE OF:

Weeks

Weeks

Thumb

60

Arm

225

1st (index) finger

40

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)

H~d

IW

Total hdustrial

150

Disfigurement

None

Disability/Body as a whole 300

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

Maximum weekly benefit

$175

$225

Maximum duration from injury date

Various

Various

Burial expense

$1000

$5000

Total maximum benefit

$65,000*

$65,000*

All others

All others

Various

Various

PARTIAl DEPENDENTS

According to the ratio that the contribution bears to wages,

times the amount due a spouse - Maximum.

Various

Various

MEDICAl BENEFITS

Medical Allowance

Unlimited

Unlimited

MISCEllANEOUS

Interest in lump sum payment

7% per annum

7% per annum

Statute of limitations:

For reporting accidents to the Board

I or 2 yrs see

I or 2 yrs see

O.C.G.A. '34-9-82

OCGA '34-9-82

OCGA '34-9-82

For appeal to Three Member Board

30 days f/award

20 days f/award

For appeal to Superior Court

30 days f/award

20 days f/award

For appeal to Court of Appeals

30 days f/award

30 days f/award

Number of employees required to come under law

3

3

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

7/1/92 7 days 21 days $250 66 2/3% $25 400 weeks** $175 350 weeks 66 2/3% $61,250 $250 66 2/3%
$250 Various $5000 $100,000* All others Various
Various Unlimited 7% per annum I or 2 yrs see OCGA '34-9-82 20 days f/award 20 days f/award 30 days f/award 3

711/94 7 days 21 days $275 66 213% $25 400 weeks** $192.50 350 weeks 66 2/3% $67,376 $275 66 2/3%
$275 Various $5000 $100,000* All others Various
Various Unlimited 7% per annum I or 2 yrs see OCGA '34-9-82 20 days f/award 20 days f/award 30 days f/award 3

711/96 7 days 21 days $300 66 2/3% $25 400 weeks** $192.50 350 weeks 66 2/3% $67,375 $300 66 2/3%
$300 Various $5000 $100,000* All others Various
Various Unlimited 7% per annum I or 2 yrs see OCGA '34-9-82 20 days f/award 20 days f/award 30 days f/award 3

7/1/97
7 days 21 days $325 66 2/3% $32.50
400 weeks**
$216.67 350 weeks 66 2/3% $75,834.50
$325 66 2/3%

~ ~
zt:rJ
0
><!ooo--1
L)

$325 Various $5000 $100,000* All others Various
Various
Unlimited
7% per annum
I or 2 yrs see OCGA '34-9-82 20 days f/award 20 days f/award 30 days f/award 3

APPENDIX

FORM tl
WC-1 WC-2 WC-2(a) WC-3 WC-4 WC-6 WC-7
WC-10 WC-11 WC-12 WC-14 WC-20(a) WC-25 WC-26 WC-PI WC-P2 WC-P3 WC-102 WC-102(g) WC-102(i) WC-1020) WC-104
WC-108(a) WC-108(b) WC-121 WC-200(a) WC-200(b) WC-206
WC-207 WC-208(a)
WC-240 WC-243 WC-244
WC-RI WC-R2 WC-R2A WC-R3

REVISION DATE
97 97 97 97 97 95 95
96 97 96 97 97 96 96 97 97 97 96 97 97 95 95
95 96 97 95 97 95
95 95
95 96 95
97 97 97 97

BOARD FORMS/JULY 1997

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

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 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 Notice of Representation 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 or Third Party Administrator 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 & Rehabilitation Division (404) 656-3784 Notice to Employee of Offer of Suitable Employment Reduction in Benefits Reimbursement Request of Group Insurance Carrier/Disability Benefits Provider Request for Rehabilitation Rehabilitation Transmittal Report Individualized Rehabilitation Plan Request for Rehabilitation Closure

3