STATE BOARD OF
WoRKERS' CoMPENSATION ~~~~
1999
ANNUAL REPORT
~~~~~~~~ GEORGIA
Georgia State Board of Workers' Compensa
ANNUAL REPO
This report consists of data taken from calendar year 1998 and fiscal year 1999. Statistical information was extracted on December 31, 1999.
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 3,928,804 workers.* The State Board of Workers' Compensation is funded by assessments from insurance companies and self-insured employers. An employee that is injured on the job and is covered by the law may be 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 and to insure efficient processing and swift resolution of claims, while encouraging workplace safety and return to work and while protecting the employer from tort liability.
MISSION VALUES
The Board is 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; and Manages resources effectively to achieve positive
results.
* Georgia Department of Labor Estimates
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 .............................................. 9 Claims Processing Division................................ I0 Fraud/Compliance Division................................ 12 Legal Division ........................................................ 13 Licensure and Quality Assurance Division..... IS Managed Care and Rehabilitation Division.... 16
Published by
Georgia State Board of Workers' Compensation
270 Peachtree Street N.W Atlanta. Georgia 30303-1299
Chairman Carolyn C. Hall
Director Vicki L. Snow
Director Larry Smith
Executive Director Julie Y. John
Director Legal Division Viola S. Drew
Editor Pamela R. Carter
PART Ill: SUBSEQUENT INJURY TRUST FUND. 19 PART IV: STATISTICAL CHARTS & TABLES ......... 23 PARTV:APPENDICES................................................. 29
The "1999 Annual Report" is a presentation of calendar year
1998 claim information and fiscal year 1998 operational statistics.
T-A-G LANCE
1998
1997
1996
1995
DECEMBER 31. 1999
A T-A-GLANCE; provides a capsule look at statistics for lost time and medical only financial information and exceptions. Exceptions are those claims that, 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, 1999.
CREATED CLAIMS:
44,717
46,205
49,210
51 110
OPEN
12,928
6,366
3,555
2,283
CLOSED
31,789
39,839
45,655
48,827
WC-4 CASE PROGRESS REPORT
Total Weekly Benefits
$ 155,896,238 259,193,618 321,999,993 378,975,125
Physicians Benefits Hospital
64,307,823 92,307,456 115,393,843 117,854,514
I
65,259,490 93,580,805 105,854,477 113,487,054
Pharmacy Benefits
6,142,253 9,735,525 12,356,656 14,840,960
Physical Therapy
12,498,129 18,316,851 19,217,992 19,518,029
Chiropractic
508,572
731,022
984,805 1,048,400
Other
14,379,911 22,754,407 25,702,548 29,918,715
Rehabilitation
10,237,004 14,765,955 18,144,856 17,362,432
Late Payment Penalties
715,718 1,006,684 I 118,646 1,278,165
Assessed Attorney's Fees
457,575 925,457 1,157,647 1,335,900
Burial
388,148
591,248
428,852
623,322
TOTAL
$ 330,790,861 573,909,028 622,360,3 IS 696,242,616
AVERAGE COST OF A CLAIM $ AVERAGE LOSTWORK DAYS
7,397 57
II 122 80
12,647 92
13,622 102
MEDICAL ONLY CLAIMS:
WC-26 REPORT OF MEDICAL
ONLY
195,572 209,176
168,226
180,071
TOTAL AMOUNT PAID
$ 76,024,883 69,978,582 82,480,458 57,960,916
TOTAL PAYMENTS ALL CLAIMS
-----
$ 406,815,744 583,887,610 704,840,733 754,203,532
WC-14 NOTICE OF CLAIM/
REQUEST FOR HEARING BY
DOl
1998
1997
1996
1995
Total Received ALJ Referred ALJ Scheduled Disposed Prior to Hearing ALJ Held
ADR Disposed all DOl'S ALJ Hearings all DOl's
13,758 8,146 8,099 7,273
826
4,611 1,483
14,656 9,059 9,000 7,886 1,114
4,446 1,525
15,518 9,625 9,542 8,244 1,298
4,434 1,770
21,436 10,674 10,554 8,925
1,629
3,851 1,942
Appellate Review all DOl'S Submits Hearings
852
940
1,833
1,452
182
188
178
365
670
752
1,173
1,a1.7
Stipulated Settlements by DOl's
6,636
9,243
10,896
11,873
Total Amount of Settlements $ 64,557,643 I09,030,145 135,520,103 158,401,652
Average Settlement
$
9,728
11,796
12,438
13,341
44.717 cases were created with an injury date of 1998. The number of lost time claims reported is down approximately 11% from last year The open case count 1998 of 48,629 is approximately a 9% decline from last year's report. Fifty-nine percent of the active claims indicate coverage provided by an insurance company.
0RGANIZATI
PART 1
TRODUCTION
I t has been 80 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. The rights granted an employee under the law preclude any other legal remedies against an employer by an employee due to a workrelated 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 laborers, 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. If either party is dissatisfied with the hearing 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. In addition to a hearing, a party may also request mediation to attempt to resolve certain 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.
In Georgia, employers obtain workers' compensation coverage through private insurers or programs of self-insurance.The workers' compensation program is funded entirely by assessments from insurance companies and self-insured employers.
THE THREE-MEMBER Bo
of Directors
Carolyn C. Hall, Chairman Vicki L. Snow, Director Larry Smith, Director
The Board is pleased to report that the workers' compensation system in Georgia remains strong. Overall costs in the system decreased over $347 million from 1995 to 1998.The average cost of a claim decreased $6,225 during the same period. Despite growth in the state work force, the number of claims with lost time (23,668) is at the lowest level in years.These results are due, in part, to positive changes implemented within the system over the past few years.
The Board relies on the input of representatives in the industry and state government working together as an Advisory Council to improve workers' compensation in Georgia. Each year the Advisory Council makes recommendations of changes to rules
and regulations to clarify the administration of the system for all participants in Georgia. Modifications made to the system are based on a fundamental fairness to all parties and to insure that the injured employees receive quality medical care, the appropriate income benefits and then return to suitable employment, while protecting employers from tort liability.
We continue to see improvements within the operations of the Board as well. Mediations are still achieving a success rate of over 80%. The Fraud and Compliance Division generated over $12.5 million in additional workers' compensation premiums for 1999 that provided coverage to protect Georgia's workers.
The Board's web site f'NWW.GANET.ORG/SBWC) is an online source for information and resources available at the Board. Items such as current Board forms, the Board's education schedule, the Safety Library and other useful information are available electronically. Please visit our site and let us know what you think of the information you find or do not find there.
Our entire agency is committed to making the workers' compensation system one that is fair and responsive to workers and businesses throughout the state. We welcome any comments or questions you may have.
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GEORGIA STATE BOARD OF WORKERS' COMPENSATION
Total Budgeted Positions as of July I, 1999 164 Positions
ADMINISTRATIVE SERVICES DIVISION
APPEALS & SETTLEMENTS
DIVISION
151 I
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 Appellate Division
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 mail r o o m processes mail and forwards files and mail to divisions locates files and resolves problems caused by duplicate files .
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 presentations to various groups as requested assists the Board Members as needed peer review of medical services.
FRAUD/ COMPLIANCE
DIVISION
14
Investigates incidents of non-compliance
investigates incidents alleging fraud makes presentations to various groups regarding fraud/compliance.
INSURANCE CONSULTANT
I
Handles insurance related issues makes presentations to various groups as requested serves as liaison with D.O.I. and NCCI serves onWC/MCO Certification Committee serves on SelfInsured Review Committee .acts as information resource for state & local economic development agencies.
LEGAL DIVISION
65
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.
LICENSURE &
I QUALITY I ASSURANCE
MANAGED CARE & REHABILITATION
DIVISION
DIVISION
10 I
8
Certifies self-insurers and registers rehabilitation suppliers recruits insurance companies performs quality assurance reviews of insurers and self-insurers maintains information on employers' insurance coverage
maintains Safety Library. certifies workers' compensation professionals (CWCP).
Processes requests for rehabilitation services
performs quality assurance reviews of rehabilitation suppliers
holds conferences to resolve 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, and PC training and support.
The Accounting Section provides internal support services to the Atlanta office of the State Board ofWorkers' Compensation and ten 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 1999
Number of Positions Personal Services
164 $9,155,357
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 Year 2000 Projects
1,400 101,668 182,000 187,850 76,532
500 2,000 5,000 30,987 22,000 132,666 80,520 1,173,481 152,301 323,057 200,121 88,640
Total
$1 I,916,060
*July 1998 Assessment
Table 2 Assessment Figures
Fiscal Year
Premium Writings
Administrative
Funds
Premium
Collected Factor
1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 ** corrected
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 1,417,342,695
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 11,538,575
0.820 0.755 0.672 0.577 0.579 0.587 0.610 0.620** 0.640 0.658 0.813
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 Section 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.
In the new millennium, the Training Section is continuing to expand the educational efforts of Georgia's workers' compensation system. Five Regional Education Seminars were presented throughout the state during the spring of 1999. Over 900 participants had the opportunity to gain first hand knowledge from an outstanding faculty, staff members and the Directors. The agenda offered lectures, a question and answer session, and an open forum at the end of each seminar
The three-day Annual Educational Seminar held in August remains one of the most comprehensive workers' compensation conferences in the southeast.The 1999 seminar "Saluting The Century, Past Present and Future", consisted of five concurrent
workshops featuring 63 experts representing various components of workers' compensation. Over one thousand registered attendees and seventy-six vendors were on hand to salute the continuum of workers' compensation.
A major benefit for the annual event is the 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
For fiscal year 2000, the training will continue to provide quality educational opportunities for the workers' compensation communities, as well as insure standard of service through continued staff development.
The Data Processing Services Section is responsible for the input of some of the thousands of forms received at the Board each year. This section is also responsible for the preparation of management reports, data analysis and presentation, and ad hoc reporting from the online database. Support for the computer network software and equipment is also handled within this section.
Data entry provides coding and quality input of the information from submitted WC-I's (Employer's First Report of Injury) and WC-14's (Notice of Claim/Request for Hearing or Mediation).These and other forms are the source documents for the database of information that allows the Board to serve the injured worker, employers, attorneys, and insurers in the Georgia workers' compensation system. Access to the more than 300,000 records in the database is provided to Board employees in Atlanta and in ten field offices throughout the state.
APPELLATE DIVIS!
The Appellate Division is comprised of the Stipulations Section, the staff attorneys, and the Appellate Division Directors. The Board's Directors are appointed by the Governor for a term of four years and serve as the judges for the Appellate Division. The Appellate Division clerks process all requests for appeal to the Appellate Division and any other filings or correspondence related to claims pending before the Board.The clerks also schedule cases for oral argument before the Directors.The staff attorneys assist the Directors 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 to determine whether all legal requirements are met and ensure that the interests of all parties are fairly represented.
The Directors have judicial, administrative, and regulatory responsibilities. In their judicial capacity, the Directors function as a three-judge appellate review panel. The panel hears and reviews those claims when there is an appeal from an award of an Administrative Law Judge of the legal division. The Directors issue a written decision, to adopt, amend, or reverse the award issued by the Administrative Law Judge. The decision of the Directors may 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 Directors also issue orders approving settlements which have been agreed upon and submitted by the parties to 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 administrative and regulatory functions of the Directors 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, approving applications of employers to act as selfinsurers, 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 Directors work with an Advisory Council to develop policies and laws affecting workers' compensation. Each year, with the advice of the council, the Directors promulgate and adopt rules and regulations affecting workers' compensation processes.
AIMS PROCESSING
The Claims Processing Division includes Document Processing, File Room , and Case Management Units.
The Document 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 offices in Albany, Augusta, Blairsville, Columbus, Covington, Dalton, Gainesville, Macon, Rome, and Savannah. During calendar year 1998 over 550,000 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 42,032 new records were created during calendar year 1998. The File Room maintained approximately 175,000 records at the Board's Atlanta office. In addition, the State Records Center housed approximately 450,000 records, which were closed during calendar years 1989 through 1996. 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. Audits and reviews are conducted to increase compliance with timely first payments and ensure payment of penalties. The Board continues to work with insurers to meet our goal of payment of 85% of undisputed claims within 21 days of the employer's knowledge of disability. During calendar year 1998, 85.3% of first payments were made on time compared to 84.9% in 1997, 84.7% in 1996 and 80.1% in 1995.
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 Form WC-4 (Case Progress
Reports). During calendar year 1998, 63% more cases were closed (76,269) than created (42,032).
Table 3 Claims Processed Per Calendar Year
Calendar Year
1993 1994 1995 1996 1997 1998
Medical Only Cases Reported
250,647 166,356 180,074 168,226 209,176 195,572
Reported as Indemnity Cases
Reviewed
113,012 161,773 154,584 183,311 163,315 176,278
Created
53,527 54,155 50,595 47,815 45,962
42~032
Closed
56,749 91,033 75,714 86,991 75,129 76,269
RAUD/CO MPLIAN CE
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 Georgia State Board of 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, 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 the law. To successfully accomplish this goal, the Division investigates and prosecutes both non-compliance and fraud 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, and to provide technical support to the investigators.
Since operations began, the Compliance Unit has conducted over 35,000 random compliance checks of businesses to insure that businesses with three or more employees have workers' compensation insurance coverage. As a result, over 4,500 additional businesses obtained workers' compensation insurance cov-
erage.The compliance checks resulted in insurance coverage for an additional 23,500 employees, generating over $12.5 million in additional new premiums.
The Legislature granted law enforcement powers to the Division in 1997 This legislation authorizes the Board's fraud agents, who are Certified Peace Officers, to execute search warrants and make arrests pursuant to workers' compensation investigations.To date, the fraud investigators have initiated 240 arrest warrants as a result of investigating over 735 cases referred to the Division.These arrests cleared over I59 cases with an estimated loss of $5.5 million.
The Division continues to annually make 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.
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, answers questions concerning the workers' compensation system and procedures, processes requests for change of physician, approves attorney fee contracts, provides legal research for the Board, monitors appeals to the courts, and coordinates continuing legal education programs.
To facilitate the performance of its duties and fulfillment of its responsibilities, the Legal Division is divided into three sections: Screening & Administration Section,Aiternative Dispute Resolution Section, and Trial Section.
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.
600-650 files are copied at the request of parties (over 45,000 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 Columbus. 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 521 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.
The Alternative Dispute Resolution Section provides assistance to the Administrative Law Judges throughout the state by reducing the number of hearings. Issues addressed by the ADR Section include: requests for change of physician; approval of income benefits to an employee; provision of emergency medical treatment; resolution of the medical disputes; and attorney fee lien disputes.
The Screening Section screens over I,250 files per month, which are referred to the Trial Section for further action. Each month between 20-25 Superior Court appeals are processed, between
The goal of the ADR 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 1999 was 45 days. Since the ADR Section commenced on July I, 1994, the number of trials and appeals have decreased as the number of mediations increased.
The Trial Section holds hearings for those claims in which an evidentiary hearing was requested by the parties, and a mediation conference either could not be scheduled or could not resolve the issues. Approximately 13,000 cases were referred to the Trial Section for a hearing during the 1999 calendar year Hearings are held in the county where the injury occurs, a contiguous county or a county within 50 miles of the injury. Judges hear contested claims in courthouses and other public facilities throughout the state. There are currendy 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 90% 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 between 60 and 90 days of the date the hearing notice is mailed as required by law, 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 1999 the average time for an Administrative Law Judge to issue an award was less than 60 days following the hearing date.
Awards consist of detailed 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. The Administrative Law 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 65 days, which compares favorably to the Board's goal of I00 days. The average time it takes a claim to be scheduled, heard, and the award issued is less than 125 days. Our objective is to continue to decrease the processing time for a claim in the Trial Section.
LICENSURE & QuALITY AssuRA
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 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 1999 this measurement increased to 88%.
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.
regulations than ever before.
The Division also 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 so 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.
In an effort to provide more up-todate information, the Division is now registering rehabilitation suppliers and case managers annually.
With the help ofthe 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 400 video tapes on a wide variety of safety subjects, many of which are translated into 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 regulates and licenses approximately 600 companies and governmental entities who self-insure their workers' compensation liabilities, 373 insurance companies that write policies of workers' compensation, and 395 rehabilitation suppliers who handle workers' compensation cases.
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-insurers have achieved a higher rate of compliance with Board rules and
NAGED CARE & REHABILITATION*
Three additional managed care organizations have been certified by the Board.There are now 21 certified MCOs covering 145,000 employees in 146 of the I59 counties in Georgia. There are 12 applications in process to become certified as managed care organizations under Georgia's workers' compensation system. The cornerstones of the state's certified managed care organizations continue to be: I) Case Management without the need for a written agreement; 2) Employee choice of network physicians; and 3) 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 ensures the employee's questions are answered and maintains contact with the physician to ensure that timely, appropriate, and quality medical care is provided. Case managers help injured employees, physicians, and employers initiate and coordinate return to work goals. Currently, CCMs, CRRNs and COHN and COHN-S (Certified Occupational Health Nurse) are certifications allowed for MCO case managers. Our surveys of 80% of the doctors, employers/ insurers and employees who participate 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 tollfree number
Dispute resolution continues to be the service that differentiates the certified managed care organizations from the 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 MCOs case management files, information systems, and MCO personnel. Additionally, physicians' credential files are verified, sales and educational materials examined, and the dispute resolution log is reviewed.
Specific data from the certified MCOs is listed in Table 4 as a total for all certified MCOs. The number of self-insured employ-
ers contracting with the MCOs has more than doubled from last year Although I5,000 additional employees are covered this year, the number of lost time injuries reported dropped by 4 cases, and the number of medical only injuries increased by only 238 cases.
Information on certified managed care organizations is available from the Division. This includes an educational brochure, lists of certified and applying managed care organizations, counties covered by the certified MCOs, case management guidelines, and the MCO application form with Board rules and procedures. The National Council on Compensation Insurance (NCCI) has recommended a 12% credit on workers' compensation insurance premiums 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 544 catastrophic rehabilitation cases monitored. The Coordinators reviewed 630 catastrophic rehabilitation plans and 3,700 submissions of file progress reports from the catastrophic suppliers. When a rehabilitation plan is ineffective, or needs more goal direction, or at the request of a case party, the Coordinators may schedule a rehabilitation conference.
*Formerly the Managed Care and Catastrophic Disability Division.
Table 4
Certified MCO Data
Employer Client (self/insured) Insurer/Insured Employers Number of Employees covered Number of Injuries
Lost Time Med Only. Number of Case Management Cases Lost Time Med Only.
24 17/6,393
145,000
424 2,491
344 1,060
The purpose of the rehabilitation conference is to ensure all parties are communicating and the catastrophically injured employee is receiving cost effective, timely, appropriate and necessary services. The Coordinators held I09 conferences and mediations of rehabilitation issues this year. They also attended 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. The timely reporting of case status by rehabilitation suppliers is very important to .the Board. The Division's goal for 1999 was to decrease the number of delinquent reports by I0% or more. The delinquency rate of reporting on catastrophic files was 46% in 1998. At the end of 1999, the delinquency rate was at 18%. We continue to refine and improve the process of decreasing the delinquency rate by rehabilitation suppliers who do not
file reports appropriately.
Closure of rehabilitation occurred on 425 cases. The Division encouraged closure of rehabilitation files that did not show goal-directed rehabilitation, or showed Jack of rehabilitation activity for several years. Additionally, the Board Coordinators closed 138 files with dates of injury prior to July I, 1992, because the supplier failed to maintain reporting requirements with the Board. There are I 16 non-catastrophic rehabilitation cases the Board Coordinators follow. The total of all open rehabilitation cases in 1998 was 731 , the total for 1999 is 670.
Rehabilitation services for noncatastrophic 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
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 two occasions in 1999. This course explained the roles of each supplier and the boundaries of interaction for the intern.The Division will continue to offer this course, along with CEUs in an effort to educate Georgia's registered rehabilitation and case management community. In 1999, the Board's Rehabilitation Division worked closely with Roosevelt Warm Springs Institute for Rehabilitation to develop a week-long training course for catastrophic interns to assist in achieving the needed hours of training for certification. The program started in November 1999 and is an ongoing training opportunity for all catastrophic interns. For 2000, we are working toward including the training at Warm Springs as continuing education credits.
Additional assistance for all catastrophic suppliers is found in the Procedure Manual.This year a paper discussing housing needs for catastrophically injured employees was added to the Manual.
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
Julie Y John Executive Director State Board ofWorkers' Compensation
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 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
Year
1998 1999
Cases Received*
6,825 7,489
Cases Accepted
1,016 1,125
Cases Denied
81 126
Cases Closed
6,608 8,706
*This information reflects actual cases received each calendar year
Cases Remaining Open at Year End
11,921 9,998
Amount Reimbursed
63,391,171 75,545 ,751
The Fund's administrative costs and reimbursements are funded through a nonlapsing public trust fund. The Fund's revenue consists of assessments from self-insured employers and insurers. In addition, interest received on investments is deposited in the Fund.
The initial assessment was in fiscal year 1978 and was based on a one-half percent premium tax against each insurer and selfinsurer Future assessments will be levied when the Fund's net assets are less than 175% of disbursements made in a calendar
year
For more information about the Subsequent Injury Trust Fund visit our website: http://www.ganet.org/sitf
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
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
1999
$ 49,068,047
64,710,389 0
2,252,092 9
163,247
1,186,696 528,763
75,545,751 77,261,210
0
$ 38,932,574
1998 STATISTICAL CHARTS &TAB
PART 4
DUSTRY
Chart I presents the distribution of all reported cases and lost time cases by industry. Of the 23,668 lost time cases reported for accident year 1998, the Services industry outpaced the Manufacturing industries for the greatest number of reported incidents of lost time. 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
Manufacturing
Serv1ces
Retail
Transportation/Communication
4,360
Construction
Government
Wholesale Trade -1.537
. . 933
Agri/Fish/Forestry/Mining .489
.314
Finance/Insurance/Real Estate .628
280
9,880
all reported cases
losttime cases
0
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 I0% of all reported cases and in I I% of the cases reporting lost time.
Face/Nose/Multiple I
303 123
Head/Skull/Multiple
-807 1346
Ears
I 91 1 25
Neck
597 1298
Eyes I
- Multiple Upper Extremeties
Arms/Elbows
Hands/Wrists
368 144
2090 1196
2899 1715
3643 2039
Fingers
2114 1238
Thumb
601 363
Multiple Trunk
4458 2523
Back
4104 2477
-493
Chest 217
Heart
1159 6
Pelv1s/lnternal -850 1596
Multiple lower Extremeties
1374
-935
Hip/Th1gh/leg
-802 -517
Knee
3224
2124
Ankle
1439
1040
Feet/Toes
1850 1265
Multiple Body Parts
5521 2996
Non-Body Parts Is
I
Unclassified
2273
. _ . 1009
All Reported Injuries lost Time Injuries
I
I
I
I
I
0
2000
4000 6000
8000 10000
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.
! Amputation 1284
Burn
Cancer
Carpal Tunnel -581
Contagious Disease/Aids
Contusion/Concussion
Crushing 1366 Dislocation 1269
Dermatitis 1114
Electric Shock 50
Foreign Body ;I 178
Fracture
Hearing/Vision Loss 137 Heart/ Vascular 1130
Heat Prostration 166 Hernia .657
Infection
Inflammation
638
Laceration
Mental Stress
Poison/Chem/Hetai/Radiation
Puncture/Rupture/Sever 612
Respiratory/Oust Disease
Sprain
Strain
All Other/Cumulative
Ill Oefined/Unclass
2360 2745 2158
3089
0
2000
4000
6000
2252
9390
13630
8000 10000 20000
REPORTED CASES BY Cou
TABLE 7
The table below shows the number of actual reported injuries in each Georgia county for 1998.
Appling
59
Atkinson
65
Bacon
67
Baker
5
Baldwin
252
Banks
46
Barrow
147
Bartow
414
Ben Hill
162
Berrien
78
Bibb
1,138
Bleckley
41
Brandey
31
Brooks
42
Bryan
42
Bulloch
186
Burke
73
Butts
82
Calhoun
24
Camden
167
Candler
18
Carroll
428
Catoosa
148
Charlton
38
Chatham
1395
Chattahoochee 18
Chattooga
77
Cherokee
418
Clarke
485
Clay
9
Clayton
1215
Clinch
66
Cobb
2530
Coffee
338
Colquitt
189
Columbia
219
Cook
106
Coweta
472
Crawford
16
Crisp
150
Dade
77
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
55 !16 3031 81 93 55i 413 45
4 67 90 104 48 79 281 605 362 122 7094 84
4
584 303
76 62 2791 176 737 23 139 86 86 35 471 420
47
200 51 50 75 36
Johnson Jones Lamar Lanier Laurens Lee liberty Lincoln long lowndes lumpkin Macon Madison Marion McDuffie
Mclnt~sh
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
26 57 107 16 196 60 97 IS
9 584
56 86 39 64 82 50 70 12 175 114 18 77 166 911 231 57 19 164 133 91 81 20 148 23 127
2 83 31 1015 342 20
Screven Seminole Spalding Stephens 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
39 28 325 108 30 171 II
5 94 27 82 35 384 264 163 20 17 320 42 28 56 152 170 160 297 29 112 108
I 13 86 709 18 37 48 63 988 2335
ST TIME CASES BY CouNTY
TABLE 8
The table below shows the number of actual reported lost time cases in each Georgia county for 1998.
Appling
38
Atkinson
31
Bacon
31
Baker
3
Baldwin
153
Banks
18
Barrow
70
Bartow
193
Ben Hill
78
Berrien
45
Bibb
568
Bleckley
21
Brantley
21
Brooks
23
Bryan
28
Bulloch
96
Burke
47
Butts
so
Calhoun
14
Camden
Ill
Candler
10
Carroll
213
Catoosa
83
Charlton
26
Chatham
810
Chattahoochee 16
Chattooga
45
Cherokee
245
Clarke
265
Clay
6
Clayton
623
Clinch
48
Cobb
1347
Coffee
173
Colquitt
103
Columbia
107
Cook
57
Coweta
211
Crawford
13
Crisp
87
Dade
34
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
33 70 1556 42 52 287 234 33
I 32 64 56 18 26 141 336 196 60 3812 48
I 322 120 45
31 1474
83 389
17 75 40 46 18 266 241 30 114 35 28 45 IS
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
13 Screven
18
36 Seminole
22
38 Spalding
143
10 Stephens
68
119 Stewart
14
35 Sumter
84
64 Talbot
9
6 Taliaferro
I
2 Tattnall
65
314 Taylor
20
27 Telfair
45
48 Terrell
19
24 Thomas
196
21 Tift
126
40 Toombs
77
30 Towns
II
34 Treutlen
8
7 Troup
137
106 Turner
24
60 Twiggs
20
10 Union
31
48 Upson
65
59 Walker
84
411 Walton
73
126 Ware
168
24 Warren
13
17 Washington
65
98 Wayne
68
56 Webster
I
61 Wheeler
6
56 White
52
9 Whitfield
281
62 Wilcox
II
10 Wilkes
18
82 Wilkinson
26
0 Worth
28
33 Out of State 591
21 Unknown
1,297
561
169
14
APPENDIC
PART 5
PPENDIX 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 claim - a claim which qualifies the injured or occupationally ill worker or dependent 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 claim - a claim in which an indemnity payment was made.
Lost time claim - a claim 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 claim - 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 claim - a claim 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 claim - a claim, 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 claim 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
Judge Julie Y. John 270 Peachtree Street, NW Atlanta, Georgia 30303-1299 404-656-2048
ADMINISTRATIVE LAW JUDGES ATLANTA
Judge Viola S. Drew, Director Legal Division Judge Judith Blackwell Judge Ronald Conner Judge Mark Dickerson Judge Carl McCalla 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 706-667-4062
BLAIRSVILLE Judge Murphy C. Miller 421-B Blue Ridge Highway Blairsville, Georgia 305 12 706-781-2343
COLUMBUS Judge Tasca Badcock Judge Claude A Bray Judge William S. Cain I02-A Second Avenue Columbus, Georgia 3 190 I 706-649-7520
APPENDIX
COVINGTON Judge Harrill L. Dawkins 6253 Highway 278 Covington, Georgia 300 14 770-784-3133
DALTON Judge J. Dixon Belk Judge Stephen K. Fain Suite 315 41 5 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 912-471-205 I
ROME Judge R. David Whittenburg 607 Broad Street Suite SO Rome, Georgia 30 161-3059 706-295-6781
SAVANNAH Judge Leesa A Bohler Judge Jerome J. Stenger Suite 601 Seven East Congress Street Savannah, Georgia 3140 I 912-65 1-6222
SUMMARY OF WORKERS' COMPENSATION PROVISIONS
GEORGIA WORKERS' COMPENSATION AG AMENDED ON:
7/1/90
7/1192
TOTAL DIIABilm CODE 114-404 O.C.G.A. 34-9-261
Waiting period
7 days
7 days
Waiting period recoverable after (consecutive from disability date) Maximum weekly benefit
21 days
sm
21 days $250
Percent of average weekly wage (13 weeks prior to accident)
66 2/3'/o
66 2/3'/,
Minimum weekly benefit
$25
$25
Maximum weekly duration from date of disability and
not date of accident
Unlimited
400 weeks**
TEMPORARr PARTIAL OIIABilm CODE 114-405 O.C.G.A. 34-9-262
Maximum week~ benefit
$150
$175
Maximum weekly duration from date of injury
350 weeks 350 weeks 350 weeks 350 weeks
Percent of difference in wages before and after injury 66 2/3%
66 2/3%
Total maximum compensation
$52,500
$61,250
PERMANENT PARTIAL DISABilm CODE 114-406 O.C.G.A. 34-9-263
Maximum weekly benefit
$225
$250
Percent o/ difference in wages
66 213%
66 213'/o
SPECIFIC HEMBER 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
ISO
4th (little) finger
25
Loss of Hearing (one ear)
Great toe
30
Total Industrial
75
Other toes
20
Loss of Hearing (both ears)
Hand
160
Total Industrial
ISO
Disfigurement
None
Disability/Body as a whole 300
DEATH BENEFITS CODE 114-413 O.C.G.A. 34-9-265
Maximum week~ benefit
$225
$250
Maximum duration from injury date
Various
Various
Burial expense
$5000
$5000
Total maximum benefit
$65,000*
$100,000*
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
OCGA 34-9-12
OCGA 34-9-82
7/1/94
7 days 21 days $275 66 2/3'/o $25
400 weeks**
$192.50 350 weeks 66 2/Wo $67,375
350 weeks
$275 66 213'/o
$275 Various $5000 $100,000* All others Various
Various
Unlimited
7% per annum
lor2yrssee OCGA 34-9-82
7/1/96 7 days 21 days $300 66 2/3% $25 400 weeks** $191.50 66 2/3% $67,375 $300 66 213'/o
$300 Various $5000 $100,000* All others Various
Various Unlimittd 1'/o per annum I or 2 yrs see OCGA 34-9-82
For appeal to Three Member Board For appeal to Superior Court For appeal to Court of Appeals Number of employees required to come under law
30 days f/award 30 days f/award 30 days f/award 3
20 days f/award 20 days f/award 30 days f/award 3
20 days f/award 20 days f/award 30 days (/award 3
20 days f/award 20 days f/award 30 days f/award 3
*Surviving spouse only after one year
**Except for catastrophic injures which are unlimittd
7/1/97 7 days 21 days
sm
66 2/3% $31.50 400 weeks** $216.67 66 2/3/o $75,834.50
sm
66 2/3'/o
sm
Various $5000 $100,000* All others Various
Various Unlimited 7% per annum lor2yrssee OCGA 34-9-82 20 days f/award 20 days f/award 30 days f/award 3
7/1/99 7 days 21 days $350 66 1/3% $35 400 weeks** $233.33 66 213% $81,665.50 $350 66 2/W.
$350 Various $7500 $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
~ ~
zt:rJ
0
><t---1
~
FORM tl.
WC-1 WC-2 WC-2a WC-3 WC-4 WC-6 WC-7
WC-10
WC-11 WC-12 WC-14 WC-20(a) WC-24 WC-25 WC-26 WC-PI WC-P2 WC-P3 WC-BOR WC-102 WC-102g WC-102i WC-102j WC-104
WC-108a WC-108b WC-121 WC-200a WC-200b WC-206
WC-207 WC-208a
WC-240 WC-243 WC-244
WC-RI WC-R2 WC-R2a WC-R3
APPEND I
REVISION DATE
BOARD FORMS/jULY 1999
COLOR
TITLE
99
White
Employer's First Report of Injury
99
White
Notice of Payment or Suspension of Benefits
99
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 ofWorkers'
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
99
White
Medical Report
99
White
Fraud and Compliance Division Request for Board Intervention
98
White
Application for Lump Sum/Advance Payment
99
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 Physician/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 available 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
Carrier/Disability Benefits Provider
98
White
Request for Rehabilitation
98
White
Rehabilitation Transmittal Report
98
White
Individualized Rehabilitation Plan
98
White
Request for Rehabilitation Closure
SU""AKT OF WOUEIS CO"PEISATIOI PIOYISIOIS
GEORGIA WORKERS' COI1PEHSATIOH ACT AttENDED ON:
111190
7/1/92
TOTAL DISABIUTT CODE 114-404 O.C.G.A. .1+9-26 I
WailiR& period
7 days
7 days
Wailio& period recoverable lifter (tvtSK11tin from cisability date) i'tarinwm week~ buefit
21 days
ms
21 days S2SO
Percnt of ;rmace week~ Wll&' (IJ weeks prior to aaidnt)
66 213%
66 213%
tliRinwm week~ btufit
S2S
S2S
"uinwm week~ dmlioa from date of disahity aad
aot date of IICciclut
Ualilited
400 weeks**
TEHPORART PAATIAL DISABIUTT CODE 114-40S O.C.G.A. 34-9-262
Huinwm week~ btaefit
SISO
$175
llalinwm week~ d11ratioa from date of iljry
3SO weeks
350 weeks
Perct1t of dierence ill waces before ud lifter iljlry 66 213%
Tobl malinwm compeualioa
m.soo
66 213% $61.250
PERI'tANENT PARTIAL DISABIUTT CODE 114-406 O.C.G.A. 34-9-263
HaliRNm wee~ btaefit
S22S
S2SO
Perceat of difltrtlct il waces
66 21W
66 213%
SPEOFIC 11EHBER LOSS OR LOSS Of UIE Of:
Weeks
Weeks
TJ.rril
60
Arm
m
1st (ildu) fcer
40
foot
BS
2ad (nidclt) filcer
JS
Leg
m
3rd (rile) fcer
30
Eye
ISO
4~ (ittlt) fcer
2S
Loss of Henc (oae ur)
Great toe
30
Totalladutrial
75
Otller toes
20
Loss of Hearillg (bot~ ears)
Hd Disliflrtmtlt
160
Total ladustrial
ISO
Moat
Disability/Body as a whole 300
DEATH BENEFITS CODE 114-413 O.C.G.A. 34-9-265
i'taliRNm week~ buefit
S22S
S2SO
i'talinwm dlration from iljlry date
Yarim
Yarioms
B1rial expuse
SSOOO
SSOOO
Tobl malimlm btufit
$65.000*
$100,000*
Alothrs
AI ot~n
Variou
Yario1s
PARTIAL DEPENDEHTI
Accordilg to tM ratio ~t ~ coatmllioa bean to wars.
times tM amo11t du a !pOIII Harinwm.
Yariou
Yariovs
11EDICAL BENEFITS
ltedical AloWMce
Unlimited
Unlimited
11tSCELlANEOUS
Interest in lulrf sum payment
7% per Mnmm
7% per annum
Stalllte of limitatiou:
for reporting acciduts to the Board
lor2ynsee
lor2yrssu
OCGA 34-9-82
OCGA 34-9-82
1/1/94 7 days 21 days S27S 66 213'/o S2S 400 weeks** SI92.SO JSO weeks 66 213% S67.m S27S 66 213%
S27S Yarioms SSODO $100,000* AI otMn Yariou
Yarim Unlimited 7% per Mnum lor2yrssee OCGA 34-9-82
7/1/96 7 days 21 days $300 66 213'/t S2S 400 weeks** $192.50 3SO weeks 66 2/J% S67J7S $100 66 213%
$300 Various
ssooo
$100.000*
Alo~n
Yariots
Yariovs Ualinited 7% per Mnmm lor2yrssee OCGA 34-9-82
for appeal to Tine llenH Board for appeal to Svptrior Coart for appeal to Cmt of Appeals Htrmer of elrfloyees reqtired to come 11der law
30 days !/award 30 days !/award 30 days !/award 3
20 days !/award 20 days !/award 30 days !/award 3
20 days fhward 20 days !/award 30 days !/award 3
20 days !/award 20 days Vaward 30 days !/award 3
*SmiYilg spouse oa~ lifter oae year
**Except for catastrop~ic iljures w~ic~ are ~nlinited
7/1/97 7 days 21 days
sm
66 213%
m.so
400 weeks** $216.67 3SO weeks 66 213% $75,834.50
sm
66 213%
sm
Various
ssooo
$100.000*
Alo~n
Yariou
Variou Unlinited 7% per annum lor2yrssee OCGA 34-9-82 20 days !/award 20 days !/award 30 days !/award J
7/1/99 7 days 21 days $350 66 213% S3S 400 weeks** S2H .H JSO weeks 66 213% SBI,66S.SO SJSO 66 213%
S3SO Varioms
moo
$100,000* AW ot~en Yariou
Yariou Unlinited 7% per annum I or 2 yrs see OCGA 34-9-82 20 days !/award 20 days !/award 30 days !/award J
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