S 0 ,---- .
Li:~tq2~0 TATE BOARD F
. WORKERS' COMPENSATION ~~~~
1998
ANNUAL REPORT ~~~~~~~ GEORGIA

ANNUAL REPOR
ThiS report consists of data taken from calendar year 1997 and fiscal year 1998. Statistical information was extracted on December 31, 1998.

Established in 1920 by the Georgia legislature, the State Board of Workers' Compensation serves over 187,000 employers and 3,928,804
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

* Georgia Department of Labor Estimates

CONTEN

AT-A-GLANCE

PART I ORGANIZATION
Introduction
The Three Member Board Organizational Structure

.. 2 3 4

PART II ACHIEVEMENTS & ACTIVITIES

Administrative Services Division

6

Appellate Division

9

Claims Processing Division

10

Fraud/Compliance Division

12

Legal Division

13

Licensure and Quality Assurance Division..... 15

Managed Care and Rehabilitation Division.... 16

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

PART III SUBSEQUENT INJURY TRUST FUND.. 19

PART IV STATISTICAL CHARTS & TABLES

23

PART V APPENDICES

29

The" 1998 Annual Report" is a presentation of calendar year
1997 claim information and fiscal year 1998 operational statistics.

T-A-GLANCE

1997

1996

1995 1994

DECEMBER 31, 1998
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, 1998.

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

45,260

48,918

50,962

54,306

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

11,141

5,890

3,538

2,356

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

34,119

43,028

47,424

51,950

WC-4 CASE PROGRESS REPORT

Total Weekly Benefits .......... $ 170,463,616 263,959,060 335,194,723 402,779,646

Physicians Benefits ............. 70,066,443 97,206,791 I 10,994,442 122,173,090

Hospital ....................... 72,755,936 99,478,156 109,923,851 119,489,915

Pharmacy Benefits .............. 6,333,548 9,673,444 12,831,357 16,803,216

Physical Therapy ................ 13,410,394 17,457,967 18,772,176 17,255,531

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

488,027 812,405

969,049 1,081,636

Other ......................... 16,395,460 23,260,472 27,544,764 33,206,637

Rehabilitation .................. 10,888,827 16,192,380 16,541,579 17,181,296

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

809,609 1,033,183 1,038,057 1,159,814

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

533,670 938,006 1,249,601 1,534,765

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

513,982 433,384

619,740

557,459

TOTAL .......................... $ 362,659,512 530,445,248 635,679,339 733,223,005

AVERAGE COST OF A CASE .... $ AVERAGE LOSTWORK DAyS ....

8,012 54

10,843 71

12,473 86

13,501 104

MEDICAL ONLY CASES:

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

209,176

168,226

69,978,582 82,480,458

180,071 57,960,916

168,862 46,104,788

TOTAL PAYMENTS ALL CASES ........................ $ 432,638,094 612,925,706 693,640,255 779,327,793

WC-14 NOTICE OF CLAIM/

REQUEST FOR HEARING BY

001 .........................

1997

1996

1995

1994

Total Received ................

13,773

15,177

21,259

27,847

ALJ Referred ... : .............

9,656

10,220

11,026

12,290

ALJ Scheduled ................

9,605

10,285

11,809

11,344

Disposed Prior to Hearing ....

8,246

8,589

9,909

9,604

ALJ Held .....................

1,359

1,696

1,900

1,740

........................................................................... ............................ ................................ ............................. ................................

ADR Disposed all DOl'S ..

4,072

4,233

3,753

3,007

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

997

1,290

363

407

634

883

1,456 280
1,176

1,958 131
1,827

Stipulated Settlements by DOl's

6,991

9,740

Average Settlement

$

9,476

10,891

Total Amount of Settlements $ 66,244,687 106,074,482

11,188

12,901

12,190

12,338

136,383,077 159,175,309

45,260 cases were created with an injury date of 1997. The number of lost time cases reported is down nearly 14% from last year. The open case count for 1997 of 53,202 shows a four percent decline over last years report. Fifty-eight percent of active files indicate coverage provided by insurance companies.

ORGANIZATI
PART 1

TRODUCTION

I t has been 78 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 encourage safety and assure 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 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 or mediator 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

Dear Fellow Georgians:

We are pleased to report that 1998 was a very productive year at the Board. The workers' compensation system in Georgia remains strong. Overall costs in the system decreased over $360 million from 1994 to 1997. The average cost of a case decreased $5,859 during that same period. Despite the state work force being at an all time high, the number of claims with lost time (28,882) is at the lowest level in years. We feel very strongly these results are due to numerous positive changes implemented within the system over the past few years. Each year we also work hard on planning and implementing statutory and rule changes, initiated by the Board's Advisory Council, to clarify the administration of the system for all participants in Georgia.
We continue to see improvements at the Board as well. Mediations are still achieving a

success rate of over 80%. The Fraud and Compliance Division generated over 2.6 million in additional workers' compensation premiums for 1998 and provided coverage to protect Georgia's workers.
This year, to further simplify the filing of forms at the Board, we created a Board Web site to provide form downloading. Our forms and other useful information about Board procedures are available at WWW.GANET.ORG/SBWC. Please visit our site and let us know what you think. We are currently working toward providing the opportunity to file Board forms electronically; our goal is full electronic data implementation in the upcoming .fiscal year.
We are constantly striving to improve workers' compensation in Georgia. All modifications made to the system have been

based on a fundamental fairness to all parties; ensuring injured employees receive the high quality medical care, and benefits they deserve, returning employees back to suitable employment, and protecting employers from tort liability. We encourage employers to discuss Georgia's Workers' Compensation with employers who operate in Georgia as well as other states. Although we realize we do not have a perfect system, it is certainly one which can stand up against any other in the country.
Our entire Board is committed to making the workers' compensation system in Georgia one that is fair and responsive to workers and businesses throughout the state, as well as a system of which we can all be proud. We welcome any comments or questions you may have.

Chairman Harrill L. Dawkins

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v~~_/. I J..faU-Director Carolyn C. Hall

Director Vicki L. Snow

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STATE BOARD OF WORKERS' COMPENSATION Total Budgeted Positions as of July I, 1998 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

J APPEALS &
SETTLEMENTS

CLAIMS PROCESSING

DIVISION

DIVISION

13

27

FRAUDI

COMPLIANCE

[SURANCE CONSULTANT I

DIVISION

14

LEGAL DIVISION
63

LICENSURE & QUALITY
ASSURANCE DIVISION
9

MANAGED CARE & REHABILITATION DIVISION 8

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 doeuments regarding appealed cases ... sets calendar for appellate hearings.

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

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

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

Screens requests for hearings ... holds formal hearings ... mediates changes of physicians and other issues ... makes presentations to various groups as requested ... copies case files for attorneys and higher courts.

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.

Process 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 Organizations.

ACHIEVEMENTS & ACTIVITI
PART 2

MINISTRATIVE SERVICES

The Administrative Services 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 pro-
vides 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 600 self-insured employers plus 373 insurance companies writing workers' compensation coverage in Georgia fund the administrative expenses of operating the Board.*

Table I Annual Operating Budget
FY 1998

Number of Positions Personal Services

162 $8,676,969

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

1,400 89,600 182,000 59,000 58,000
500 2,000 10,000 19,787 30,000 146,345 35,160 1,079,835 140,040 576,919 192,402

Total

$11,299,957

Table 2 Assessment Figures

Fiscal Year

Premium Writings

Administrative

Funds

Premium

Collected

Factor

1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 ** corrected

586,706,797 739,280,403 911,523,434 1,061,301,347 1,239,497,523 1,474,997,352 1,598,890,476 1,648,162,040 1,701,221,644 1,678,771,284 1,703,789,141 1,624,319,128

5,982,699 6,919,856 7,477,511 8,008,400 8,334,378 8,537,789 9,214,010 9,690,796 10,294,882 10,425,022** 10,896,407 10,704,105

1.02 0.924 0.820 0.755 0.672 0.577 0.579 0.587 0.610 0.620** 0.640 0.658

* July 1998 Assessment

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 the educational efforts on Georgia's workers' compensation system. Eight Regional Education Seminars were presented throughout the state during the spring. Over 1,300 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 remains one of the most successful workers' compensation conferences in the southeast. The 1998 seminar, "Workers' Compensation Conscientiousness-The Right Thing,The Right Way, at the Right Time", consisted of five concurrent workshops featuring 82 experts representing various components of

workers' compensation. The seminar concluded with an entertaining and educational skit that followed a claim from the hiring process through the hearing process. Over 1000 attendees were registered and 76 exhibitors displayed their 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 Specialists -
CWAVES Continuing Legal Education - CLE Continuing Medical Education - CME 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
Overall, the Training Section exceeded the goal to increase the number of employers who attend Board sponsored seminars by 5% , with an impressive satisfaction rating of 95% for program content. For fiscal 1999, 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.

The Data Processing Services Section is responsible for the quality input of the thousands of forms received by the Board each year. This section is also responsible for the preparation of management reports, data analysis, ad hoc reporting, and support for the computer applications in use at the Board.The staff also supports the Board's web page (WWWGANET. ORG/SBWq and Local Area Network (LAN).
Data Entry provides quality input of the information from WC-I's (Employer's First Report of Injury) and WC-14's (Notice of Claim/Request for Hearing or Mediation). Over three hundred thousand forms were received in 1997. These forms are the source documents for the database of information which allows the Board to serve the injured worker, their employer, and insurers in the workers' compensation system.
Access to the more than 352,000 claims is provided with Year 2000 compliant personal computer workstations through the (LAN). Currently, over one hundred employees in Atlanta and eight field offices throughout the state are on-line users of the Claims Processing system.
In accordance with O.e.G.A. 34-9-61, information about the Board's past year operation is formally presented in an annual report. The Unit is responsible for preparation of this report. The report is published to share this information with the General Assembly, insurers and other

interested parties. Extracts of this information are provided to appropriate agencies of government as needed.
With over one hundred and fifty personal computers, laptops and associat.ed peripherals and software at the workstations of Board staff, operations support for them is critical. The Unit provides both hardware and software problem determination and resolution. It also coordinates the introduction, testing and training of new applications and hardware.
As the millennium approaches, the State of Georgia continues its program to address Year 2000 issues. This statewide effort began in 1996 with the development of a current condition assessment, followed by a statewide assessment of mission critical projects and the establishment of the State of Georgia Year 2000 Project Office. The Data Processing Services staff participated in the statewide Year 2000 Readiness Initiative.A copy of the Year 2000 Readiness Disclosure Statement for the State of Georgia along with the status of the Board's Year 2000 projects is available at the State of Georgia web site (WWW.STATE.GA.US).

ApPELLATE DIVISI

The Appellate Division is comprised of the Stipulations Section, the Staff Attorneys, the Appellate Court Clerks and the three member Board.The Board members are appointed by the Governor for a term of four years. 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 lump 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.
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 Legal Division. The Appellate Division issues a written decision either adopting, amending, or reversing the decision issued by the Legal 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 orders 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 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 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 regulations affecting workers' compensation processes.

IMS 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 twiceweekly courier service between Atlanta and the Board's field offices. During calendar year 1997 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 45,962 new records were created during calendar year 1997. The File Room maintained approximately 190,000 records at the Board's Atlanta office. In addition, the State Records Center housed approximately 450,000 records that were closed during calendar years 1988 through 1995. 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 claims 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. Audits and reviews are conducted to increase compliance with timely first payments and to ensure payment of penalties. The Board continues to work with insurers to meet our goal of 85% of undisputed claims paid within 21 days of the employer's knowledge of disability. During calendar year 1997,84.9% of first payments were made on time compared to 84.7% in 1996 and 80.1% in1995.

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. The Board's claims examiners continue their joint efforts with insurers, self-insurers and third party administrators to eliminate delinquent filings of lorm WC-4 (Case Progress

Reports). However, since I 1.8% of open cases were not in compliance with WC-4 reporting requirements at the end of December 1997, the Board considered the assessment of penalties against insurers and selfinsurers with excessive delinquency rates. During calendar year 1997, 63% more cases were closed (75,129) than created (45,962).

Calendar Year
1992 1993 1994 1995 1996 1997

Table 3 Claims Processed Per CalendarYear

Medical Only Cases Reported

Reported as Indemnity Cases

Reviewed

Created

Closed

255,074 250,647 166,356 180,074
"'''-'<':;.'~''~'' -'. ~'\..\ ....
168,226 209,176

114,413 113,012 161,773 154,584 183,311 163,315

52,906 53,527 54,155 50,595 47,815 45,962

54,596 56,749 91,033 75,714 86,991 75,129

ODIC 0MPLIANCE

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 of Workers' Compensation authority to create the Fraud/ Compliance Division, with full staffing 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. To successfully accomplish this goal, the Division investigates and prosecutes both fraud and non-compliance throughout the state.
The Division is divided into an Investigations Unit and Compliance Unit. The investigators are primarily 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.

Each compliance officer conducts an average of 15 random or complaint generated compliance checks a day. This is a 10% increase in checks over the previous year or approximately 1,300 additional compliance checks.

Since operations began, the Compliance Unit has conducted over 29,000 random compliance checks of businesses. As a result over 3,550 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 19,300 employees, generating over $10.6 million in additional new premiums. The Division continues to annually conduct over 25 public appearances that are designed to educate and promote public awareness of workers' compensation. These seminars have proven to be successful in publicizing ways to deter and prevent fraud in the workers' compensation system.
The Legislature granted law enforcement powers to the Fraud Unit in 1997. This legislation authorizes those Fraud Agents who are Certified Peace Officers to execute search warrants and make arrests pursuant to workers' compensation investigations.
To date, the Fraud Unit has initiated 190 arrest warrants as a result of investigating over 562 cases referred to the Division. These arrests cleared over 108 cases with an estimated loss of $4.9 million.

LEG

The Legal Division is responsible for reviewing and processing requests for hearings and 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 and directing all notices of claims and requests for hearings for resolution. In addition, this Section offers claims assistance to injured employees, employers, insurers, and attorneys concerning procedural matters. 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.
The Screening Section screens over 1550 files per month which are referred to either the Trial Section qr Alternative Dispute Resolution Section for further action. Each month between 20-30 Superior Court appeals are processed, between 300-350 files are copied at the request of par-

ties (over 30,000 pages), and well over 5,500 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 six mediators in Atlanta and one mediator in the Columbus office. Mediations are held in seventeen locations throughout the state. Requests for review are handled by telephone communications, conferences, or by issuance of orders. The staff currently processes an average of 485 claims per month which would otherwise be assigned to the Trial Section 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.

This Section provides relief to the Administrative Law Judges throughout the State because hearings are not required. Issues addressed by this Section 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 quickly resolve claims without the need for an evidentiary hearing. The average length of time for a claim to be processed in this Section for 1998 was 41 days, which is below the goal of 45 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 occured, 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 and 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. 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. Medical evidence tendered at the trial, which must be reviewed, and the parties' requests for the transcript

and submission of briefs to the judge delay an immediate award. However, for 1998 the average time for an Administrative Law judge to issue an award was 53 days compared to the Board's standard of 60 days following the hearing. Awards will state the findings of fact and conclusions of law of the Administrative Law judge, and may be appealed to the Appellate Division of the Board within 20 days of issuance. Trial judges 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, which compares favorably to the Board's goal of 100 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.Although many positive changes have occurred in the System in recent years, our objective for the coming year is to speed the hearing process and issue awards within I 10-1 15 days.

LICENSURE & QUALITY ASSURAN

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 self-insurers. 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. Our goal is to continually improve the percentage of timely payments. In 1995 80% of injured workers received their benefits within the mandated 21 days. In 1998 this measurement increased to 85%.The Quality Assurance Claims Examiners work with the insurers and self-insurers 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. 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 continues to manage and review the delinquent case progress reports. As a result of.this review, the insurers and self-msurers have achieved a higher rate of

compliance with Board rules and regulations than ever before.

The Division provides 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 mainframe 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.

The Licensure and Quality Assurance Division regulates and licenses approximately 600 companies and gov-

In an effort to provide more up-todate information, the Division is now registering rehabilitation suppliers and case managers annually.
With the help of the self-insurers and insurers in Georgia w:ho 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 400 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.

ernmental entities who self-insure their Workers' Compensation liabilities, 373 insurance companies who write policies of Workers' Compensation, and 380 rehabilitation suppliers who handle Workers' Compensation cases.

The Division, in conjunction with the Licensure and Self-Insurance Advisory Council Committee, has developed a Workers' Compensation Claim Management Training Program. This is a comprehensive training course specific to workers' compensation. Our goal is to improve the system for injured workers' and employers by providing specialized training.

ANAGED CARE & REHABILITATION*

Three additional managed care organizations have been certified by the Board. There are now a total of 19 certified MCOs covering 130,000 employees over 137 of the 159 counties in Georgia. There are 12 applications in process to become certified as managed care organizations under Georgia's workers' compensation system.
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 ensures 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 and coordinate return to work goals. In 1998, the Board added COHN and COHN-S (Certified Occupational Health Nurse) as certifications appropriate for MCO case managers.
Our 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 employer/insurers enjoyed the increased communication and feedback provided by the

managed care organization. Employees were pleased with their care when allowed to choose their authorized treating physician from the network. 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 toll free number.
Dispute Resolution continues to be the service that differentiates the certified managed care organizations from use of individual managed care services. Second change of physician, treatment issues, or case management concerns, for example, must 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 cost of a claim for both sides can be reduced when the dispute resolution process is utilized under the certified MCO.
Annual re-certification inspections are made to review the MCO's case management files, information systems, and MCO personnel. Additionally, physicians' credential files are verified, sales and educational materials examined, and dispute resolution log is reviewed.
Specific data from our certified MCOs is listed in the table below as a total for all certified

MCOs. The number of covered employees has increased by almost 50%.
Information on certified MCOs is available from the Division. This includes an educational brochure, lists of certified and applying MCOs, counties covered by the certified MCOs, case management guidelines, and the MCO application form with Board rules and procedures. 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.
Closer monitoring of catastrophic rehabilitation was the goal of the Board's Rehabilitation Coordinators this year. There are currently 477 catastrophic rehabilitation cases monitored. The coordinators reviewed 467 catastrophic rehabilitation plans and 403 submissions of file progress from the catastrophic suppliers. When the Board's Rehabilitation Coordinators see that intervention is needed, or a case party requests it, a conference is scheduled. The purpose of these conferences is to make sure all parties are communicating and the catastrophically injured employee is receiving cost effective, timely, appropriate and necessary services.

*Formerly the Managed Care and Catastrophic Disability Division.

Table 4
Employer Client (self/insured) Insurerllnsured Employers Number of Employees covered Number of Injuries
Lost Time Med Only Number of Case Management Cases Lost Time Med Only

10 15 / 4,324
130,000
428 2,253
256 753

Our goal this year was to increase the number of conferences or mediations by 25% in an effort to decrease the number of cases requiring litigation. The Coordinators held 120 conferences and mediations of rehabilitation issues this year showing an increase of 25% over last year's number of 90 conferences and mediations. They also attend mediations held by the Legal Division when rehabilitation issues were part of the case. The Coordinators monitor very closely the required submission of plans and information updates by registered suppliers. Our goal for 1999 is to decrease the number of delinquent reports by 10%.
Closure of rehabilitation occurred on 395 cases. Our goal in 1998 was to close 25% of rehabilitation files which showed a lack of rehabilitation activity for several years, with agreement of all parties. Additionally, the Board Coordinators closed files with dates of injury prior to July I,

1992. In 1997 there were 432 of these 'old law' cases. In 1998 we closed 178 of these files, a 42% closure rate. Overall, the Division achieved an 18% rate of closure of files. The total of all open cases in 1997 was 887; the total for 1998 is 73 I.
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 supplier or case manager are needed. All rehabilitation suppliers and case managers utilized in voluntary cases must be registered with the Board. Rehabilitation Coordinators provided technical assistance to suppliers and parties to the case in voluntary rehabilitation.

Last year our Coordinators identified a need for education among catastrophic suppliers who supervise principal suppliers acting as catastrophic interns. The Board developed and taught a course for the supplier community on three occasions in 1998 which clearly explained the roles of each supplier and the boundaries of interaction for the intern. The Division will continue to offer this course, and hopes to increase the number of course opportunities by two in 1999, along with CEUs in an effort to educate Georgia's registered rehabilitation and case management community.
Looking forward to 1999, the Division has prepared an informational presentation with handouts for those parties or groups interested in learning more about Georgia's Workers' Compensation Managed Care Program. Our goal is to present this program a minimum of three times in 1999. Contact the Division for more information about the presentation. With a change in the rules this year regarding annual registration of rehabilitation suppliers and case managers, the Division hopes to be able to provide current information to the rehabilitation and case management community on a regular basis during 1999.

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 Peggy Rosser
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

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 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 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 104 weeks, for 50% of all medical and rehabilitation expenses between $5,000 and $10,000, and for 100% of ali 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 InjuryTrust Fund Claim Activity

Cases

Cases

Year

Received*

Accepted

Cases Denied

Cases Closed

1997

6,128

942

1998

6,825

1,016

83

6,341

81

6,608

*This information reflects actual cases received each calendar year.

Cases Remaining Open at Year End

Amount Reimbursed

11,144 11,921

$ 62,706,605 63,391,171

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 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 Income from no dependency cases Interest Miscellaneous TOTAL REVENUE
EXPENDITURES Personal Services Operating Expenses Reimbursement Paid TOTAL EXPENDITURES PRIOR YEAR ADJUSTMENTS
FUND BALANCE

1997
$ 36,440,360
85,071,615 25,000
2,360,735 7,343
87,464,693
1,082,422 781,805
62,391,171 64,255,398
0
$ 59,649,655

1998
$ 59,649,655
51,729,596 0
2,958,383 7
54,687,986
1,112,137 565,667
63,391,171 65,068,975
200,619
$ 49,068,047

1997 STATISTICAL CHAI~TS & T,t\13LES
PART 4
23

INDUSTRY
Chart I presents the distribution of all reported cases and lost time cases by industry. Of the 28,882 lost time cases reported for accident year 1997, the manufacturing industry accounted for the greatest number of incidents, followed closely by the services industry. During the last ten years the ratio of reported injuries to employment has remained relatively constant, between I and 2%. Employment estimates are from the Georgia Department of Labor.
Chart I Distribution of Processed Cases by Major Industry

24

Manufacturing Services

9.065 7.829

Retail Transportalion/Co mmu nicalion
Conmuction

all reported cases
lost time cases

Government

Wholesale Trade _

1,462

_908

Agri/Fish/Forestry1M ini ng .492
.328

Finance/Insurance/Real Estate 612
.310

I

I

I

a

2000

4000

6000

8000

10000

Chart 2 Part of body injured in work place accidents
Injuries to the BACK continue to be the most reported injury on the Employer's First Report of Injury at 20% of all reported cases. In cases reporting lost time, injuries to the back account for 21 %.

Head (except) eyes Neck Eyes
Respi rata ry/Ches t Arms/Elbow Hands/Wrist Fingers Thumb
Back

790 435

486 237

392 180
611 246

2691 1727

3539 2155 2183

1277 644 387

Hip/Pelvis

ThighlLeg Knee Ankle
Feet/Toes

366 259
3279 2276
1363 989
1882
1332

Multiple Body Parts Internal Organs Unclassified
0

1677 918
1743
I 2000

3107
3528
I 4000

5186
5413
I 6000

8305
I 8000 10000

All Reported Injuries Lost Time Injuries

25

Chart 3
Most common occurring injuries in the workplace. This chart lists the type (nature) of injuries reported on the Employer's First Report of Injury.

26

Amputation

Burn Carpal Tunnel
Contusion Crushing Dislocation

611 542
1699 348

Dermatitis

foreign Body

fracture

2356

Hernia Inflammation
laceration Mental Stress

614 523
2009

Myocardial Infarction

Puncture

461

Respiratory

Sprain

1699

Strain

All Other

488

III Defined/UncialS

I

0

2000

4000

6000

7729
161 13
8000 10000 20000

REPORTED CASES By COU

TABLE 7
The table below shows the number of actual reported injuries in each Georgia county for 1997.

Appling

73

Atkinson

48

Bacon

44

Baker

9

Baldwin

316

Banks

38

Barrow

105

Bartow

337

Ben Hill

137

Berrien

95

Bibb

965

Bleckley

42

Brantley

33

Brooks

44

Bryan

50

Bulloch

135

Burke

63

Butts

78

Calhoun

18

Camden

151

Candler

33

Carroll

44-

Catoosa

121

Charlton

31

Chatham

1317

Chattahoochee II

Chattooga

91

Cherokee

308

Clarke

415

Clay

7

Clayton

1108

Clinch

70

Cobb

2341

Coffee

273

Colquitt

187

Columbia

177

Cook

97

Coweta

377

Crawford

21

Crisp

142

Dade

39

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 Henry Houston Irwin jackson jasper jeff Davis jefferson Jenkins

42 101 2741 83 42 553 363 45
7 81 82 107 62 56 281 529 370 III 6249 94
3 506 241
55 51 2412 138 616 27 103 85 77 17 372 451 45 185 36 46 67 34

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 Rockdale Schley

32 Screven

27

31 Seminole

25

69 Spalding

320

II Stephens

108

170 Stewart

17

49 Sumter

145

131 Talbot

14

20 Taliaferro

2

6 Tattnall

74

491 Taylor

30

73 Telfair

78

83 Terrell

37

31 Thomas

331

44 Tift

286

64 Toombs

131

26 Towns

26

57 Treutlen

15

9 Troup

244

150 Turner

41

72 Twiggs

28

14 Union

45

73 Upson

124

114 Walker

162

848 Walton

140

221 Ware

255

57 Warren

27

18 Washington

89

120 Wayne

114

107 Webster

4

63 Wheeler

7

69 White

62

28 Whitfield

615

112 Wilcox

8

28 Wilkes

30

98 Wilkinson

31

3 Worth

49

87 Out of State 987

19 Unknown

2066

886

338

15

ST TIME CASES By COUNTY

TABLE 8

The table below shows the number of actual reported lost time cases in each Georgia county for 1997.

Appling

40

Atkinson

21

Bacon

27

Baker

6

Baldwin

244

Banks

20

Barrow

57

Bartow

166

Ben Hill

75

Berrien

53

Bibb

499

Bleckley

20

Brantley

26

Brooks

26

Bryan

32

Bulloch

70

Burke

43

Butts

55

Calhoun

9

Camden

105

Candler

23

Carroll

211

Catoosa

76

Charlton

22

Chatham

807

Chattahoochee 5

Chattooga

38

Cherokee

166

Clarke

235

Clay

4

Clayton

606

Clinch

38

Cobb

1258

Coffee

126

Colquitt

100

Columbia

92

Cook

58

Coweta

234

Crawford

12

Crisp

90

Dade

22

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 Henry Houston Irwin jackson jasper jeff Davis jefferson jenkins

26 62 1517 52 22 345 215 26 6 42 45 60 23 37 165 298 207 61 3601 60 3 340 119 30 29 1327 69 336 18 56 42 44 9 199 236 17 104 21 25 38 19

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 Rockdale Schley

24 Screven

16

17 Seminole

16

34 Spalding

164

7 Stephens

64

96 Stewart

10

26 Sumter

89

85 Talbot

7

14 Taliaferro

2

5 Tattnall

51

298 Taylor

23

50 Telfair

38

53 Terrell

23

24 Thomas

197

15 Tift

139

31 Toombs

73

18 Towns

17

34 Treutlen

9

5 Troup

125

79 Turner

26

37 Twiggs

20

9 Union

30

43 Upson

65

51 Walker

75

377 Walton

73

124 Ware

149

34 Warren

12

10 Washington

51

60 Wayne

81

51 Webster

I

36 Wheeler

7

44 White

34

18 Whitfield

270

59 Wilcox

6

14 Wilkes

14

59 Wilkinson

22

I Worth

30

41 Out of State 623

13 Unknown

1,069

581

183

5

ApPENDIC
PART 5

PENDIX A - GLOSSARY

Advance payment - a partial lump sum payment.
Average weekly wage - the wage upon which indemnity paym~nts 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.

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 Ronald Conner judge Viola Drew judge julie john judge johnny Mason 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,AlbanyTowers 235 Roosevelt Avenue Albany, Georgia 3 170 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 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 100C 30 I Green Street Gainesville, Georgia 30501 770-535-5713
MACON judge Robert Gerson judge Sallie Rich jocoy Suite 235, Building D 3312 Northside Drive Macon, Georgia 31201 912-471-2051
ROME judge R. David Whittenburg 607 Broad Street Suite 50 Rome, Georgia 30161-3059 706-295-6781
SAVANNAH judge Leesa Bohler
judge jerome J. Stenger
Suite 601 Seven East Congress Street Savannah, Georgia 31401 912-65 1-6222

SUMMARY OF WORKERS' COMPENSATION PROVISIONS

GEORGIA WORKERS' COMPENSATION ACT AMENDED ON:

7/1/86

TOTAL DISABILITY - CODE (114-404 - O.e.G.A. (34-9-161 Waiting period Waiting period recoverable after (consecutive from disability date)

7 days 18 days

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

$175 66 113%

Minimum weekly benefit

$15

Maximum weekly duration from date of disability and not date of accident

Unlimited

TEMPORARY PARTIAL DISABILITY CODE (114-405 - O.e.G.A. (34-9-161

Maximum weekly benefit Maximum weekly duration from date of injury

$117 350 weeks

Percent of difference in wages before and after injury 66 113%

Total maximum compensation

$40,950

PERMANENT PARTIAL DISABILITY - CODE (114-406 - O.e.G.A. (34-9-163

Maximum weekly benefit

$175

Percent of difference in wages

66 1/3%

SPECIFIC MEMBER - LOSS OR LOSS Of USE Of:

Weeks

Weeks

Thumb Ist (index) finger

60

Arm

40

foot

lnd (middle) finger

35

Leg

3rd (ring) finger

30

Eye

4th (little) finger

15

Loss of Hearing (one ear),

Great toe

30

Total Industrial

Other toes

10

Loss of Hearing (both ears)

Hand Disfigurement

160

Total Industrial

None

Disability/Body as a whole

DEATH BENEfITS - CODE (114-413 - O.e.G.A. (34-9-165

Maximum weekly benefit Maximum duration from injury date
Burial expense

$175 Various $5000

Total maximum benefit

$65,000' All others

Various

PARTIAL DEPENDENTS

According to the ratio that the contribution bears to wages,

times the amount due a spouse - Maximum.

Various

MEDICAL BENEfITS

Medical Allowance

Unlimited

MISCELLANEOUS Interest in lump sum payment

7% per annum

Statute of limitations:

for reporting accidents to the Board

I or 1 yrs see

7/1/90
7 days 11 days $115 66 113% $15
Unlimited
$150 350 weeks 66 113% $51,500
$115 66 113%
115 I3S 115 150
75
150 300
$115 Various $SOOO $65,000' All others Various
Various
Unlimited
7% per annum
1 or 1 yrs see

7/1/92 7 days 11 days $150 66 113% $15 400 weeks" $175 350 weeks 66 113% $61,150 $150 66 1/3%
$150 Various $SOOO $100,000' All others Various
Various Unlimited 7% per annum I or 1 yrs see

7/1/94 7 days 11 days $175 66 113% $1S 400 weeks" $191.50 350 weeks 66 1/3% $67,376 $175 66 1/3%
$175 Various $SOOO $100,000' All others Various
Various Unlimited 7% per annum I or 1 yrs see

for appeal to Three Member Board for appeal to Superior Court For appeal to Court of Appeals Number of employees required to come under law 'Surviving spouse only after one year

OCGA (34-9-81

OCGA (34-9-81

30 days flaward

10 days flaward

30 days flaward

10 days f/award

30 days f/award

30 days f/award

3

3

"Except for catastrophic injures which are unlimited

OCGA (34-9-81 10 days f/award 10 days f/award 30 days f/award 3

OCGA (34-9-81 10 days f/award 10 days f/award 30 days flaward 3

7/1/96 7 days 11 days $300 66 113% $15 400 weeks" $191.50 350 weeks 66 1/3% $67,375 $300 66 113%
$300 Various $SOOO $100,000' All others Various
Various Unlimited 7% per annum I or 1 yrs see OCGA (34-9-81 10 days f/award 10 days f/award 30 days f/award J

7/1/97 7 days 11 days $315 66 213% $31.S0 400 weeks" $116.67 350 weeks 66 213% $75,834.50 $315 66 113%
$315 Various $SOOO $100,000' All others Various
Various Unlimited 7% per annum I or 1 yrs see OCGA (34-9-81 10 days f/award 10 days f/award 30 days f/award J

~ trj
Z
0
><t---I
0

ApPENDIX

FORM 'Ii.
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-BOR WC-102 WC-102(g) WC-102(i) WC-102(j) 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

BOARD FORMS/JULY 1997

COLOR

TITLE

98

White

Employer's First Report of Injury

98

White

Notice of Payment or Suspension of Benefits

98

White

Notice of Payment or Suspension of Death Benefits

98

White

Notice to Controvert

98

White

Case Progress Report

98

White

Wage Statement

98

White

Application for Self Insurance (*Packet Available through

Licensure & Quality Assurance Division) (404) 656-4893

98

White

Notice of Election or Rejection of Workers' Compensation

Coverage

98

White

Standard Coverage Form Group Self-Insurance Fund Members

98

White

Request for Copy of Board Records

98

White

Notice of Claim/Request for Hearing/Request for Mediation

98

White

Medical Report

98

White

Application for Lump Sum/Advance Payment

98

White

Yearly Report of Medical Only Cases

97

Pink

Panel of Physicians

98

Pink

Conformed Panel of Physicians

97

Pink

WC/MCO Panel

98

Pink

Bill of Rights for the Injured Worker

98

White

Request for Documents to Parties

98

White

Motion/Objection to Motion

98

White

Notice of Representation

98

White

Attorney Leave of Absence

98

White

Notice to Employee of Medical Release to Return to

Work with Restrictions or Limitations

98

White

Attorney Fee Approval

98

White

Attorney Withdrawal/Lien

98

White

Notice of Use of Servicing Agent or Third Party Administrator

98

White

Change of Physician/Additional Treatment by Consent

98

White

Request/Objection for Change of Physic!an/Additional Treatment

98

White

Reimbursement Request of Group Health Insurance

Carrier/Healthcare Provider

98

White

Authorization and Consent to Release Information

98

White

Application for Certification ofWC/MCO (*Packet av<).ilable

through Managed Care & Rehabilitation Division (404) 656-3784

98

White

Notice to Employee of Offer of Suitable Employment

98

White

Reduction in Benefits

98

White

Reimbursement Request of Group Insurance

CarrierlDisability Benefits Provider

98

White

Request for Rehabilitation

98

White

Rehabilitation Transmittal Report

98

White

Individualized Rehabilitation Plan

98

White

Request for Rehabilitation Closure