STATE BOARD OF
WORKERS' COMPENSATION ~~~~~
GA
LJ.2 o . Al
). 000
2000 ANNuAL REPORT
~~~~~~~~ GEORGIA

Georgia State Board of Workers' Compensation
ANNUAL REPORT
This report consists of data taken from calendar year 1999 and fiscal year 2000. Statistical information was extracted on December 31, 2000.
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 4,088,008 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 SrATEMENT
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
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; and Manages resources effectively to achieve positive
results.

*Georgia Department of Labor Estimates

CONTENTS

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 .............................................. 8 Claims Processing Division................................ 9 Fraud/Compliance Division................................ I0 Legal Division........................................................ I I Licensure and Quality Assurance Division..... 13 Managed Care and Rehabilitation Division.... 14

Published by
State Board of Workers' Compensation
270 Peachtree Street N.W. tlanta, Georgia 30303-1 299
Director 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 INJURYTRUST FUND.. 17

PART IV STATISTICAL CHARTS & TABLES......... 21 PARTY APPENDICES ...............................................: 29

The "2000 Annual Report" is a presentation of calendar year
1999 claim information and fiscal year 1999 operntional statistics.

I-A-GLANCE

DECEMBER 31, 2000

1999

1998

1997

1996

AT-A-GLANCE provides a capsule look at statistics for lost time and medical only financial information and exception statistics. 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 for this Annual Report is as of December 31, 2000.

CREATED CLAIMS: . ... .... ... OPEN ....... .. .. . ..... . .......... CLOSED . . ............. . .........
WC-4 CASE PROGRESS REPORT TotalWeekly Benefits . . .... .... $ Physicians Benefits ...... . . ... .. Hospital .................... ... Pharmacy Benefits ...... . . . ... . . PhysicalTherapy ... . . . .......... Chiropractic .... ... . .. ....... . . Other .......... ..... .. .. .. .. .. Rehabilitation .............. . ... Late Payment Penalties ... .. .. .. Assessed Attorney Fees ....... Burial . . ............... . ........
TOTAL ................... . ........$

44, 155 14,994 29, 161

45,729 7,854 37,875

46,513 4,238
42,275

49,376 2,532
48,844

159,650,724 267,476,275 66,160,456 90,755,725 67,213,308 90,234,972 6,400,547 10,886,146 13,080,197 18,299,144
413,079 770,147 16,511 ,304 22,573,772 9,598,169 14,984,865
839,870 1,047,492 483,525 877,388 641 ,045 442,780 340,992,224 518,348,706

331 ,517,638 I03, I 16,687 I02,424,850 12,977,292 20,746,580
827,790 25,377,010 16,749,479
1, 127,674 1,201 ,285
612,694 616,678,979

364,461 ,491 120,I 13,837 I 09,691,516 14,919,804 20,306,859
1,011 ,792 29,353 ,247 19,129,652
1,271 ,459 1,374,545 456,574 682,090,776

AVERAGE COST OF A CLAIM ... $

7,723

11 ,335

13,258

13,814

AVERAGE LOST WORK DAYS

58

81

95

100

MEDICAL ONLY CLAIMS:

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

207,555

195,858

209 , 176

168,226

80,922,281 76,157,791 69,978,582 82,480,458

TOTALPAYMENTSALL CLAIMS ......... ............... $

421 ,914,505 594,506,497 686,357,561 764,571 ,234

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

1999 17,392 10,819 10,862 10,522
4,876
1,227
693 150 543

1998 16, 162 10,605 10,458 10,194
4,374
1,411
839 178 661

1997 16, 198 10,361 10,139 10,067
4,354
1,489
935 188 747

1996 16, 194 10,488 10,524 10,933
4,368
1,749
1, 114 178 936

44,1 55 files were created with a date of injury year of 1999. The number of lost time claims reported (22,858) is down approximately 10% from last year. Fifty three percent of the active claims indicate coverage provided by an insurance company rather than alternatives.

Stipulated Settlements Filed by

DOI Year . ... . ..... . . . .... . ...

12,633

13,126

13 ,241

13,454

Total . . . .. . .. . ... . . . ........ . . $ 217, 141 ,687 219,885,379 1214,757,087 1207,939,521

Average Settlement . .. .. . ..... $

17, 188

16,752

16,219

15,456

PART 1

INTRODUCTION

It has been 81 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 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

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 worker's 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.

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 $342 million from 1996 to 1999.The average cost of a claim decreased $8,390 during the same period. Despite growth in the state work force, the number of claims with lost time (22,858) is at the lowest 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 $14 million in additional workers' compensation premiums for 2000 that provided coverage to protect Georgia's workers.

The Board's web site WWW.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 syst_em one that is fair and responsive to workers and businesses throughout the state.We welcome any comments or questions you may have.

STATE BOARD OF WORKERS' COMPENSATION Total Budgeted Positions as of July I, 2000 I64 Positions

BOARD DIRECTORS
8
Executive Director's
Office
3

Promulgates workers' compensation regulations . .. develops workers' compensation policy ... hears appeals of Adm inistrative 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 Directors as needed . . . peer review of medical services.

ADMINISTRATIVE SERVICES DIVISION
16

APPEALS & SETTLEMENTS
DIVISION
13

CLAIMS PROCESSING
DIVISION
27

FRAUD/ COMPLIANCE
DIVISION
14

INSURANCE CONSULTANT

LEGAL DIVISION
64

LICENSURE & QUALITY
ASSURANCE DIVISION
10

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

Maintains file room and filing system ... reviews cases prior to closure ... operates mailroom . . . processes 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 . .. serves as liaison with Department of Insurance and the National Council on Compensation Insurance Incorporated ... serves on WC/MCO Certification Committee.. .serves on Self-Insured Review Committee. . . acts as information resource for state and local economic development agencies.

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

Certifies self-insurers and registers rehabilitation suppliers ... recruits insurance companies ... performs quality assurance reviews of insurers and self-insurers .. .maintains information on employer's insurance coverage . . .main tains Safety Library.. .certifies workers' compensation professionals (CWCP).

Processes requests for rehab ilitation 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 & ACTIVITIES , . PART 2

ADMINISTRATIVE SERVICES

The Administrative Services Division is responsible 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 575 self-insured employers plus 382 insurance companies writing workers' compensation coverage in Georgia fund the administrative expenses of operating the Board.*

Table I Annual Operating Budget
FY 2000

Number of Positions Personal Services

164 $9,380,810

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

1,400 139,000 165,000 66,850 75,000
500 2,000 5,000 22,787 44,278 149,600 31,539 1,328,575 100,302 259,320 241,930 24,730

Total

$12,038,621

* July 1999 Assessment

Fiscal Year
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Table 2 Assessment Figures

Premium Writings

Administrative

Funds

Premium

Collected Factor

1,061,301,347 1,m,491,m 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 1,312,756,281

8,008,400 8,334,378 8,537,789 9,214,0I0 9,690,796 I0,294,882 I0,425,022** I0,896,407 I0,704, I05 11,538,575 11,555,608

o.m
0.672 0.577 0.579 0.587 0.610 0.620** 0.640 0.658 0.813 0.879

** corrected

The Training Section contimues to expand the educational efforts on Georgia's workers' compensation system. Six Regional Education Seminars were presented throughout the state during the spring of 2000. Local area participants had the opportunity to gain first hand knowledge from an outstanding faculty, staff members and the Directors. The agenda offered lectures, a "teaching skit" and a question and answer session at the end of each seminar
In July 2000, Georgia was host for the s2nd Annual Southern Association ofWorkers' Compensation Administrators convention. Coordinated through the Training Section, the event drew 244 delegates, 148 companions, and 64 children who enjoyed an outstanding educational program as well as specialty events. SAWCA is comprised of workers' compensation agencies and associates from 17 states and one territory.
The three-day Annual Educational Seminar held in August of each year remains one of the most comprehensive workers' compensation conferences in the southeast. The seminar, Workers' Compensation 2000, Rise To The Challenge, consisted of three concurrent workshops featuring 65 experts representing various components of workers' compensation. Over one thousand registered attendees and eighty-six vendors were in attendance.

A major benefit 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 Court Reporters Training Council of Georgia - CRTC
Georgia Insurance Agents Georgia State Board of Chiropractors Georgia State Board of Occupational Therapy
Physical Therapy Association of Georgia - PTAG

For fiscal 200 I, the Training Section will continue to provide quality educational opportunities for the workers' compensation community as well as ensuring a quality 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-1 '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.
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.

APPELLATE DIVISION

8

The Appellate Division was created in 1997 to expedite and coordinate the quasijudicial 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 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 judges for the Appellate Divison. 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 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 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 the 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 self-insurers, and participating in programs to explain the functions of the Board to the general public.
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.

CLAIMS PROCESS!

The Document Processing Unit is responsi ble for all incom-
ing and outgoing mail activities, processing correspondence, and the maintenance of the record charge-out system.The unit coordinates twice-weekly courier service between Atlanta and the Board's offices in Albany, Augusta, Blairsville, Columbus, Covington, Dalton, Gainesville, Macon, Rome, and Savannah. During the calendar year 1999 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 Cente r. A total of 43,582 new records were created during calendar year 1999.The File Room maintained approximately 175,000 records at the Board's Atlanta office. In addition, the State Record Center housed approximately 450,000 records which were closed during calendar year s 1990 through 1997.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 workdays 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 works with insurers to continually improve the percentage of undisputed claims paid within 21 days of the employer's knowledge of disability. During calendar year 1999, 84.7% of first payments were made on time compared to 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 t imely 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 the first quarter of

The Claims Processing Division includes Document Processing, File Room , and Case Management Units.
calendar year 1999, insurers and self-insurers with delinquent Form WC-4 percentages greater than 25% were contacted by claims examiners in an effort to improve compliance with reporting requirements. Failure to make satisfactory improvement during the second quarter resulted in the assessment of penalties against 60 companies totaling $38,000. The Board will continue quarterly management reviews and may assess additional penalties when needed to reach our compliance goals. During calendar year 1999, 60% more cases were closed (69,821) than created (43,582) .

Calendar Year

Table 3 Claims Processed Per Calendar Year

Medical Only Cases Reported

Reported as Indemnity Cases

Reviewed

Created

Closed

1997 1998 1999

209,176 195,572 207,555

163,315 176,278 164,287

45,962 42,032 43 ,582

75,129 76,269 6 9 ,821

FRAUD/COMPLIANCE

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

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 ach ieve a climate which will assure that legitimately injured workers receive benefits allowable under the law. To successfully accomplish th is goal, the Division investigates and prosecutes both non-compliance and fraud throughout the state.
Since operations began the Compliance Unit has conducted over 40,000 random and complaint based compliance checks of businesses to insure that businesses with three or more employees have workers' compensation insurance coverage. As a result 5,000 additional businesses were required to obtain workers' compensation insurance coverage. It is estimated over $14 million in premium loss has been recovered from these non-compliant employers resulting in insurance coverage for an additional 27,000 employees. In 2000, the Division collected over $365,000 in fines from employers for their failure to provide workers' compensation insurance coverage.

10

The General Assembly granted law enforcement powers to the Division in 1997. The legislation authorizes the Board's fraud investigators, who are Certified Peace Officers, to execute search warrants and make arrests pursuant

to workers' compensation investigations. To date, the Fraud Unit has investigated over 875 cases and initiated over 200 criminal arrests of persons suspected of committing workers' compensation fraud. The unlawful obtaining or denying of benefits, insurance fraud , and other theft by deception related charges are but a few of the type of cases investigated and prosecuted by the Fraud Unit. The cases investigated and prosecuted resulted in an estimated $6 million loss to the workers' compensation system.
In addition to the Fraud and Compliance Units, the Division is responsible for providing security to the Board's administrative courts as well as to the Board's staff and facility. A sworn law enforcement officer with the aid of modern magnetic screening devices insures a safe environment for all court participants and Board staff.

The Legal Division processes requests for Board intervention in the disposition and resolution of disputed issues. Additionally, the Division makes copies of files upon request, 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, coordinates continuing legal education programs and responds to inquiries from the public concerning the workers' compensation system and procedures.
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 reviews over 1,360 files per month, which are referred to the Trial Section for further action. Each month between 20-25 Superior Court appeals are processed, between 650-700 files are copied at the request of parties (over 45,000 pages), and well over 5,500 requests for assistance are han-

died, both in person and by telephone.

LEGAL

The Alternative Dispute Resolution (ADR) Section handles requests for legal action without the necessity of an evidentiary hearing. This Section issues rulings on motions and requests for changes of physician or medical treatment, as well as conducting mediation conferences on a number of issues. The ADR Section includes six mediators headquartered 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 650 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 ADR Section provides relief to the Trial Section by resolving disputes without a hearing. Issues addressed by this Section include requests for change of physician, approval of income benefits to an employee, provision of emergency medical treatment, resolution of 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. Claims are processed in this Section in as little as 45 days. Since the ADR Unit commenced on July I, 1994, the number of trials and appeals have reduced as the number of mediations increased. In addition, those matters which do require evidentiary hearings are disposed of more quickly.

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. Approximately 14,290 cases were referred to the Trial Division for hearing during the 2000 calendar year. Hearings are held in the county where the injury occurs, a contiguous county, or a county within 50 miles of the injury. There are ten field offices located throughout the State for the convenience of the parties. Judges travel to additional locations provided by the counties to hear contested claims.
There are currently 24 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, the Georgia Rules of Evidence, and the parties are generally represented by counsel. Approximately 90% of those claims referred to the Trial Section are resolved by the parties without a hearing, many with some judicial intervention. Cases are scheduled to be heard between 60 and 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. There is a delay between the date of the hearing and the date the Administrative Law Judge issues a decision, or Award, in a claim. This delay is due to the time required to prepare the hearing transcript, time
12

for briefs to be submitted for the consideration of the Administrative Law Judge and time for medical evidence tendered at trial to be reviewed by the Administrative Law Judge. However, during 2000, the average time for an Administrative Law Judge to issue an award was less than 56 days following the hearing.
All judges are responsible for scheduling their hearings, handling all motions and pre-trial conferences, presiding over hearings, and issuing awards in a timely manner. 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. These decisions may be further appealed to the Superior Court, Georgia Court of Appeals and the Supreme Court of Georgia.
After a claim is referred to an Administrative Law Judge, the average length of time for the case to be resolved is I I3 days. The average time it takes a claim to be processed in the Legal Division, i.e., referred to ALJ, scheduled, heard, and the Award issued, is approximately six months.Although many positive changes have occurred in the system in recent years, the Trial Section continues to strive to decrease the time it takes for a case to be processed.
It is the objective of the Legal Division to provide a forum for impartial and expeditious resolution of disputes in workers' compensation claims.

LICENSURE & QUALITY ASSURANCE

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 2000, 86% received their benefits within 21 days .
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 workdays, timel iness of payments, and review of medical reports. Medical reports are reviewed in accordance with American Med ical 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 selfinsurers have achieved a higher rate of compliance with Board rules and regulations than ever before.

The Coverage Section provides coverage information on selfinsu red and group fund employers in the State of Georgia. In addition , the Board has Internet access to the National Council on Compensation Insu rance database so operators can access information on dates of coverage for all policies of insurance bought by employers in Georgia. Over 15,000 requests for coverage information are handled each year.
In an effort to provide more upto-date info rmat ion, the Division is now registering rehabilitation suppl ie rs and case manage rs annually.
With the help of the self-insurers and insure rs in Geo rgi a who recogn ized the importance of safety in the wo rkplace, the Division initiated the Georgia Workers' Compensation Safety Library in 1992. The library no_w consists of over 430 videotapes on a wide variety of safety subjects, many of which are translated into Spanish. Hundreds of Georgia employe rs 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 414 companies and governmental entities who self-insure their workers' compensation liabilities, 421 insurance companies that write policies of workers' compensation, and 450 rehabilitation suppliers who handle workers' compensation claims.

MANAGED CARE & REHABILITATION*

There are now 22 certified MCOs covering 194,191 employees in 152 counties in Georgia. The cornerstones of the certified managed care organizations continue to be: I) Case Management without need for written agreement; 2) Employee choice of network physicians; and 3) a 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 timely, appropriate, and quality medical care is provided. Case managers help injured employees, physicians, and employers initiate and coordinate return to work goals. Our surveys 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 enjoy the increased communication and feedback provided by the managed care organization.

Employees are 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 occuring, and the toll-free number.
Dispute Resolution continues to be the service that differentiates the certified managed care organizations from other 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 before referring the issue to the Board for a hearing or mediation. The cost of a claim for either party 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. The physicians' credential files are verified, sales and educational materials are

examined, and dispute resolution log is reviewed.
Specific data from the certified MCOs is listed in Table 4 as a total for all certified MCOs.
Information on certified managed care organizations is available from the Division and at the Board's website. This includes an educational brochure, lists of certified and applicant managed care organization s, 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) 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 692 catastrophic rehabilitation cases monitored. The coordinators reviewed 971 catastrophic rehabilitation plans and 3,691 submissions of file

14

*Formerly the Managed Care and Catastrophic Disability Division.

Table 4 Certified MCO Data
Employer Client (self insured) ..... . . . ... .. ...... . 25 Insurer/Insured Employers . .. . . .. .. ..... . .. 13 I 6,785 Number of Employees covered ....... . ....... 194,191 Number of Injuries
Lost Time .. . . . ... .. .. .. .. ... . ..... . .... ... 448 Med Only.......... . ... . ......... . ....... 2,098 Number of Case Management Cases Lost Time . . .. ... .. . .... . ..... . ......... ... 432 Med Only . . ........ .. ... . .. . . . .... . ....... 650
progress reports from the catastrophic suppliers. If the rehabilitation plans are ineffective or need more goal direction, or a case party requests it, a conference is scheduled. 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 65 conferences and mediations of rehabilitation issues t r is ye ar.
There are 46 non-catastrnphic rehabilitation cases that the Rehabilitation Coordinators follow.The total of all open rehabilitation cases in 1999 and 2000 is 670 and 738 respectively.Total closed cases for year 2000 is 324.
Additional assistance for all catastrophic suppliers can be found in the Workers' Compensation Procedure Manual.

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SUBSEQUENT INJURY TRUST FUND
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 of Workers' Compensation
Anne D. Burnett Administrator

17

SUBSEQUENT 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.
18

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 selfinsured, 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 that 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 $ I0,000, and for I00% of all medical and rehabilitation expenses in excess of $10,000. If the subsequent injury was not caused by or related t o a prior impairment, the reimbursement for medical expenses may be reduced or denied completely.
The employer/insurer file a claim for reimbursement directly with the Fund; the Fund _investigates the claim to determine eligibility for reimbursement. When a reimbursement agreement is reached between the Fund and the employer or insurer, it must be approved by the State Board of Workers' Compensation. If an agreement cannot be reached, either party may request a hearing with the Board.

Fiscal Year
1999 2000

Cases Received*

Table 5

Subsequent Injury Trust Fund Claim Activity

Cases

Cases

Cases

Cases Remaining

Accepted

Denied

Closed Open at End of FY

Amount {$) Reimbursed

7,489 8,192

1,125 817

126

8,706

140

8.498

9,998 10,822

75,545,751 71,389,638

*This information reflects actual cases received each calendar year.

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 invest-

ments 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 it's web site at www.ganet.org/SITF.

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

1999

BEGINNING BALANCE REVENUES
Assessment Interest Miscellaneous TOTAL REVENUE

$49,068,047
64,710,389 2,252,092
9
$66,962,490

EXPENDITURES Personal Services Operating E;xpenses Reimbursement Paid
TOTAL EXPENDITURES PRIOR YEAR ADJUSTMENTS FUND BALANCE

1,186,696 528,763
75,545,751 $77,261,210
(163,247) $38,932,574

2000
$38,932,574
95,584,743 2,629,794 51
$98,214,588
1,315,050 531,223
71,389,638 $73,235,911
(439,725) $64,350,976

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2000 STATISTICAL CHARTS & TABLES
PART 4
21

INDUSTRY Chart I
Chart I presents the distribution of reported lost time claims by industry. Of the 22,858 lost time claims reported for accident year 1999, 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.

Distribution of processed cases by major industry

Manufacturing Service Retail
Transportation/Communication Construction Government Wholesale

4424

4958

3559 4579
3067

3067

4624

3538 2221

1561

6266

9086 9124

Agri/Fish/Forestry/Mining

Finance/Insurance/Real Estate

0

2000

4000 6000

8000 10000

All Reported Injuries Lost Time Injuries

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 claims. In claims reporting lost time, injuries to the back account for 21 %.

face/Nose/Multiple

Head/Skull/Multiple

Ears

Neck/Spine/Multiple

Eyes Multiple Upper Extrem
Arms/Elbow Hands/Wrist
Fingers Thumb Multiple Trunk
Back
Chest

1895 1096
1868
2062 2103 1151 591

3084 3668

2049 2529

3747 4382

Heart Pelvis/Internal Multiple Lower Extremity Hip/Thigh/Leg
Knee Ankle Feet/Toes Multiple Body Parts Nori-Body Part

1624 830
1257 893 849
3388 2186 1555 1104
1779 1219
5469 3026

Unclassified/Other

5909

793

0

2000

4000 6000

All Reported Injuries Lost Time Injuries

8000 10000

24

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 Burn 556

Carpal Tunnel 641 Contagious Diseases/AIDS
Contus ion Crushing 388 Dislocation Dermatitis Electric Shock foreign Body fracture
Hearing/Vision Loss I 42 Heart/Vascular I 128
Heat Prostration I 56
Hernia Infection Inflammation Laceration Mental Stress Poison Chem/Metal/Radiation Puncture/Rupture/Sever Respiratory/Dust Disease
Sprain Strain All Other/Cumulative Ill Defined/Unclass

2634 2993
2149 2528
3443

2000 4000 6000

10,029
10,803
8000 10000 20000

REPORTED CLAIMS BY COUNTY

TABLE 7

The table below shows the distribution of reported lost time claims in each county for 1999.

County

Injuries

County

Injuries

County

Injuries

Applin g Atkins Bacon Baker Baldwin Banks Barrow Bartow Ben Hill Berrien Bibb Bleckley Brantley Brooks Bryan Bulloch Burke Butts Calhoun Camden Candler Carroll Catoosa Charlton Chatham Chattahoochee Chattooga Cherokee Clarke Clay Clayton Clinch Cobb Coffee Colquitt Columbia Cook Coweta Crawford Crisp Dade Dawson Decatur Dekalb Dodge Dooly Dougherty Douglas Early Echols Effingh a m Elbert Emanuel Evans

85 60 66 6 248 43 149 413 166 111 1094 32 34 61
32
169 107 74 20 182 23 472 148 48 1364 15 98 441 422
6 1154
62 2532 371
178 191 94 397 20 146 40 54 121 2765 72 99 589 410 49
9 81 69 82 66

Fannin Fayette Floyd Forsythe Franklin Fulton Gilmer Glascock Glynn Gordon Grady Greene Gwinnett Habersham Hall Hancock Haralson Harris Hart Heard Henry Houston Irwin Jackson Jasper Jeff Davis Jefferson Jenkins Johnson Jones Lamar Lanier Laurens Lee Liberty Lincoln Long Lowndes Lumpkin Macon Madison Marion Mcduffie Mcintosh Meriwether Miller Mitchell Monroe Montgomery Morgan Murray Muscogee Newton Oconee

69 282 546 314 108 7178 93
2 512 226 66 70 2646 164 819
14 117 98 105 29 510 464 63 191 43 62 75 30 37 48 85 21 219 48 111 11 12 523 78 74 51 61 73 25 86
8 130 95 20 86 133 888 210 62

Oglethorpe Paulding Peach Pickens Pierce Pike Polk Pulaski Putnam Quitman Rabun Randolph Richmond Rockdale Schley Screven Seminole Spalding Stevens Stewart Sumter Talbot Taliaferro Tattnall Taylor Telfair Terrell Thomas Tift Toombs Towns Treutlen Troup Turner Twiggs Union Upson Walker Walton Ware Warren Washington Wayne Webster Wheeler White Whitfield Wilcox Wilkes Wilkinson Worth Out of State Unknow,1

22 165 155 93 89 22 142 32
IOI
3 73 38 956 354 12 23 31 290 138 16 169 15
I
91 24 72 33 273 247 164 29 18 338 35 39 62 130 222 160 284 28 80 118 10 14 69 708 17 31 48 56 964 2698

25

Lost Time CLAIMS BY CouNrY

26

TABLE 8

The table below shows the number of actual lost time claims in each county for 1999.

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

Injuries
53 24 36 2 130 19 67 194 90 61 538 15 25 37 23 79 63 41 14 119 11 214 79 29 728 9 48 235 211 2 593 28 1335 159 91 95 49 170 7 81 20 30 59 1392 50 48 324 214 32 7 45 47 51 33

County
Fannin Fayette Floyd Forsythe Franklin Fulton Gilmer Glascock Glynn Gordon Grady Greene Gwinriett Habersham Hall Hancock Haralson Harris Hart Heard
Henry Houston Irwin Jackson Jasper Jeff Davis Jefferson Jenkins Johnson Jones Lamar Lanier Laurens Lee Liberty Lincoln Long Lowndes Lumpkin Macon Madison Marion Mcduffie Mcintosh Meriwether Miller Mitchell Monroe Montgomery Morgan Murray Muscogee Newton Oconee

Injuries
34 128 294 182 55 3727 43
0 328 112 35 24 1377 84 398
7 77 53 47 14
278 257 40 104 24 33 48
11 23 30 43 13 135 26 76 5 6 305 43 42 26 34 41 15 46 4 63 55 12 41 55 381 98
34

County
Oglethorpe Paulding Peach Pickens Pierce Pike Polk Pulaski Putnam Quitman Rabun Randolph Richmond Rockdale Schley Screven Seminole Spalding Stevens Stewart Sumter Talbot Taliaferro Tattnall Taylor Telfair Terrell Thomas Tift Toombs Towns Treutlen Troup Turner Twiggs Union Upson Walker Walton Ware Warren Washington Wayne Webster Wheeler White Whitfield Wilcox Wilkes Wilkinson Worth Out of State Unknown

Injuries
15 98 51 50 60
II
69 16 60 3 27 18 457 168 7 13 19 125 64 13 88 9
I
60 15 29 20 137 118 73 18 9 152 19 23 42 56 95 84 157 17 49 74 6 4 41 321 13 12 31 35 554 1523

SETTLEMEN
Table 9 summarizes the number of stipulated settlements received by the Appellate Division of the State Board ofWorkers Compensation in 1999.These settlements were reviewed for compliance with O.C.G.A. 34-9-15 and Board Rule 15. Stipulated settlements may be rejected for non-compliance; however, they are often corrected and approved at a later date. No-liability settlements certify that the employee's injury did
not occur in the course of his or her employment.

TABLE 9 Stipulated Settlements
Processed 1999

Liability No-Liability
Total

Approved I 0,388 2,245 12,633

Amount Paid $200,617,347
16,524,340 $21 7, 141,687

Average Settlement= $17,188

TABLE 10 Subsequent Injury Fund Agreements
Processed 1999
Approved

SITF Agreements

1,061

Subsequent Injury Trust Fund (SITF) Agreements are submitted to the Appellate Division for approval. These agreements are made between the SITF and t he employer and outline the SITF's reimbursement to the employer as set forth in O.C.G.A. 34-9-350.The settlements help to facilitate the rehire of injured workers because employers may be reimbursed in the event of an employee's re-injury. This enables the injured worker to re-enter the work force.

Advance Awards Lump Sum Awards

TABLE 11 Advances & Lump Sum Awards
Processed 1999
Appproved 371 23

Denied 37 0

Totals

394

37

Requests for advance or lump sum payments are submitted to the Board for approval. Advance awards provide for a part of the injured employees' permanent partial disability rating to be paid in advance.A lump sum award provides for the entire permanent disability rating to be made in a single payment. Requests are reviewed for compliance with O.C.G.A. 34-9-222 and Board Rule 222. Advances are often modified by the Board before approval. The Board reserves the right to adjust the amount of the requested advance based on its determination of employee circumstances and actual need.

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APPENDICES
PART 5

lPPENDIX 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 necess11ry services, in accordance with the workers' compensation law, based upon occurrence of a work-related injury or illness.
Closed claim - a workers' compensation claim in which all benefits due have been paid.
Compensable claim - a workers' compensation claim 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 claim - a workers' compensation claim in which an indemnity payment was made.
Lost time claim - a workers' compensation claim in which more than seven days of disability have occurred.
Lost work days - actual days the employee was away , from work because of occupational injury or illness. The number of lost work days (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 bq_dily motion which directly produced or inflicted the irtj ury or illness described; for example: chemicals, machines, and ladders.
Stipulated settlement - final resolution of a contested 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 Ronald Conner Judge Mark Dickerson Judge Johnny Mason Judge Carl McCalla Judge Carolyn S.Weeks 404-656-7772
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 229-430-4280
AUGUSTA Judge T. Raworth Williamson I056 Claussen Road Suite 224 Augusta, Georgia 30907 706-66 7-4062
BLAIRSVILLE Judge Murphy C. Miller 421-B Blue Ridge Highway Blairsville, Georgia 305 12 706-781-2343
COLUMBUS Judge Tasca Badcock Judge Claude Bray Judge William S. Cain I02-A Second Avenue Columbus, Georgia 3 190 I 706-649-7520

APPEND!
COVINGTON Judge Harrill L. Dawkins 6253 Highway 278, NE Covington, Georgia 30014 770-784-3133
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 I00C 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 478-471-2051
ROME Judge R. David Whittenburg 607 Broad Street Suite SO Rome, Georgia 30161-3059 706-295-6781
SAVANNAH Judge Leesa Bohler
Judge Jerome J. Stenger
Suite 601 Seven East Congress Street Savannah, Georgia 3 140 I 912-651-6222

31

GEORGIA WORKERS' COMPENSATION ACT AMENDED ON:

TOTAL DISABILITY - CODE 114-404 - 34-9-261

Waiting period

Waiting period recoverable after (consecutive from disability date)

Maximum weekly benefit

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

Minimum weekly benefit

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

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

Maximum weekly benefits

Maximum weekly duration from date of injury

Percent of difference in wages before and after injury

Total maximum compensation

PERMANENT PARTIAL DISABILITY - CODE 114 - O.C.G.A. 34-9-263

Maximum weekly benefit

Percent of difference in wages

SPECIFIC MEMBER LOSS OR LOSS OF USE OF:

WEEKS

Thumb

60

Arm

!st (index) finger

40

Foot

2nd (middle) finger

35

Leg

3rd (ring) finger

25

Eye

4th (little) finger Great toe

25

Loss of Hearing (one ear)

30

Total Industrial

Other toes

20

Loss of Hearing (both ears)

Hand Disfigurement

160 None

Total Industrial Disability/Body as a whole

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

Maximum weekly benefits

Maximum duration from date of injury

Burial expense

Total Maximum benefit

PARTIAL DEPENDENTS Maximum weekly benefits Maximum duration from injury date Burial expense Total maximum benefit

PARTIAL BENEFITS
According to the ratio that 'the contribution bears to wages,
times the amount due a spouse - Maximum MEDICAL BENEFITS
Medical allowance MISCELLANEOUS
Interest on lump sum payment Statue of limitations:
For reporting accidents to the Board

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

SUMMARY OF WORKERS' COMPENSATION CLAIMS

7/1/92

7/1/94

7/1/96

7 days 21 days $250 66 213% $25 400 weeks""

7 days 21 days $275 66 213 % $25 400 weeks..

7 days 21 days $300 66 213% $25 400 weeks..

$175 350 weeks 66 213% $61 ,250

$192.50 350 weeks 66 213% $67,375

$192 .50 350 weeks 66 2/3% $67,375

$250 66 213%

$275 66 213%

$300 66 213%

WEEKS 225 135 225 I SO

75

ISO 300

$250 Various $5000 $100,000"/ All others vary

$275 Various $5000 $100,000"/ All others vary

$300 Various $5000 $100,000"/ All others vary

$250 Various $5000 $ I00,000"/ All others vary

$275 Various $5000 $100,000"/ All others vary

$300 Various $5000 $100,000"/ All others vary

Various
Unlimited
7% per annum
I or 2 yrs see OCGA 34-9-82 20 days I/award 20 days I/award 30 days f/award 3

Various
Unlimited
7% per annum
I or 2 yrs see OCGA 34-9-82 20 days I/award 20 days f/award 30 days I/award 3

Various
Unlimited
7% per annum
I or 2 yrssee OCGA 34-9-82 20 days I/award 20 days I/award 30 days I/award 3

*Surviving spouse only after one year

'*Except for catastrophic injuries which are unlimited

7/1/97
7 days 21 days $325 66 213% $32.50 400 weeks""
$216.67 350 weeks 66 213% $75,8334.50
$325 66 213%
$325 Various $5000 $100,000*/ All others vary
$325 Various $5000 $100,000*/ All others vary
Various
Unlimited
7% per annum
I or 2 yrs see OCGA 34-9-82 20 days I/award 20 days f/award 30 days I/award 3

7/1/99
7 days 21 days $350 66 2/3% $35 400 weeks..
$233.33 350 weeks 66 2/3% $81,665.50
$350 66 213%
$350 Various $7500 $100,000*/ All Others vary
$350 Various $7500 $ I00,000"/ All others vary
Various
Unl imited
7% per annum
I or 2 yrs see OCGA 34-9-82 20 days I/award 20 days I/award 30 days f/award 3

7/1/00
7 days 21 days $375 66 213% $37.50 400 weeks""
$250 350 weeks 66 213% $87,500
$375 66 2/3%

~
zur~n
n>~ <

$375 Various $7500 $125 ,000*/ All others vary
$375 Various $7500 $125,000"/ All others vary
Various
Unlimited
7% per annum
I or 2 yrs see OCGA 34-9-82 20 days I/award 20 days I/award 30 days I/award 3

FORM#
WC-I WC-2 WC-2a WC-3 WC-4 WC-6 WC-7
WC- 10
WC- II
WC- 12 WC- 14 WC-20(a) WC-24 WC-25 WC-26 WC-Pl WC-P2 WC-P3 WC-BOR WC-BORSp WC-102 WC- 102g WC- 102i W C- 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

APPENDIX D

GEORGIA STATE BOARD OF WORKERS ' COMPENSATION FORMS

JULY 2000

REVISION

COLOR

TITLE

00

White

Employer's First Report of Injury

00

White

Notice of Payment or Suspension of Benefits

00

White

Notice of Payment or Suspension of Death Benefits

00

White

Notice to Controvert

98

White

Case Progress Report

00

White

Wage Statement

98

White

Appl ication for Self Insurance

* Packet Avai lab le through Licensure & Quality Assurance

Division (404) 656-4893

98

White

Notice of Election or Rejection of Workers'

Compensati on Coverage

98

White

Standard Coverage Form Group Self-Insurance Fund

Members

98

White

Request for Copy of Board Records

98

White

Notice of C laim/Reques t for Hearin g/Request for Mediation

99

White

Medical Report

99

White

Fra ud and Compliance Division Request for Board Intervention

00

White

Application for Lump Sum/Advance Payment

00

White

Yea rly Report of Med ical Only Cases

97

Pink

Pane l of Physici ans

98

Pink

Conformed Panel of Physicians

97

Pink

WC/ MCO Panel

00

Pink

Bill of Ri ghts for the Injured Worker

00

Pink

Bill of Ri ghts for the Injured Work er (Spanis h)

98

White

Requ est for Doc uments lo Parties

98

White

Motion/Obj ection to Moti on

98

White

Notice of Represent ati on

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

00

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

Authori zation and Consent to Release Information

98

White

Application for Certification ofWC/MCO

*Packet availab le 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

00

White

Request for Rehabilitation

98

White

Rehabilitation Transmittal Report

00

White

Individuali zed Rehabilitation Plan

98

White

Request for Rehabilitation C losure