By: LeRyan Lambert, Associate, Atlanta

Georgia Partner George Waters serves on The Board of Directors of the American Bar Association’s Workers’ Compensation Section. At a recent meeting, the State Board addressed three main points that are applicable to claims handling.

First, the State Board is going to start requiring WC-1’s (Employer’s First Report of Injury) to be filed on all medical-only cases and intends to assess fines whenever WC-1’s are not timely filed. Because this is often before defense counsel is retained on cases, it is particularly important for claims representatives to place submission of a WC-1 at the top of their claim opening task lists — no matter how minor any incident or claim appears. According to the State Board, O.C.G.A. § 9-11-12, in conjunction with State Board Rule 61(b)(1), provide that employer/insurers must file a WC-1 immediately (within 10 days) upon knowledge of an injury. Failure to provide all information can result in the form being rejected. Each failure will be fined between $100.00 and $1,000.00. For claims with seven or less days of lost time, representatives must also file a WC-26.

Second, the State Board is concerned with employers/insurers refusing to timely authorize necessary treatment, especially diagnostics. To combat this issue and expedite authority, the State Board intends to broadcast to authorized providers the power of sending WC-205 pre-authorization forms to employers/Insurers. When a WC-205 form is delivered by a physician’s office to the employer/insurer by fax or email, the employer/insurer must complete Section 3 of the form and return it to the physician via email or facsimile within 5 days. If an employer/insurer fails to submit this denial to the physician within 5 days, it automatically assumes liability for the costs of that treatment. Even after timely denying treatment within 5 days, the employer/insurer must then either approve or formally controvert the treatment within 21 days of original receipt of the WC-205. As a practicality, claims representatives and their offices must be alert for these WC-205 forms and treat with urgency since mere failure to timely return refusal can result in unnecessary expense.

Finally, the State Board is mindful of the narcotic epidemic spreading the nation and is attentive to this consideration when pain management physicians are being sought as authorized treating physicians or when pain management is becoming long-term treatment rather than a short term treatment option. If you have a claim that appears to have excessive narcotic use or pain management treatment, now is the time to address these concerns with the State Board via Motions to Change physicians and other strategical actions.

Should you have any such issues arise in your Georgia claims, please do not hesitate to contact our Georgia office for assistance.