By:  Trisha Holland Lindsay, Associate, Georgia

 

On September 1, 2019, the Georgia State Board’s revised 2019 Board Rules went into effect.  The new Rules include a new process allowing Employers and Insurers to request a Teleconference to compel the Claimant to attend medical examinations using the same process recently created to allow Claimants to seek authorization of medical treatment.

While the Employer/Insurer cannot compel the Claimant to undergo medical treatment in Georgia, O.C.G.A. § 34-9-200 and Board Rule 200 have provided that the Claimant must submit at reasonable times to examinations requested by the Employer/Insurer with the authorized treating physician.  Previously, if the Claimant did not attend a medical appointment scheduled with the treating physician by the Employer/Insurer, the remedy was to file a Motion with the Board seeking an Order to compel the Claimant’s attendance, to which the Claimant would have 15 days to respond, and an ALJ would issue a decision some time thereafter.  There is no specific time limit for an Administrative Law Judge (“ALJ”) to respond, but this would typically be about 30 to 60 days after the Motion was filed.  Additionally, the first Order issued by an ALJ after such a Motion is usually just an Order telling the Claimant they must go or face suspension after they fail to attend again. This process typically requires a significant period of time to complete which is quite detrimental if income benefits are being paid to the Claimant. 

The new Board Rule specifies that a WC-PMT conference can be requested if the Claimant is given just five business days’ notice of an appointment with the authorized treating physician (as opposed to 10 days for IMEs) and subsequently does not attend.  The Employer/Insurer may then file a WC-PMT, after which a teleconference is scheduled within 5 business days.  The Claimant can avoid the conference call by completing the form indicating that the employee will attend an appointment with the authorized physician and providing the date that the next appointment is scheduled.  The form also warns that benefits may be suspended if the Claimant fails to attend.

If the WC-PMT is not completed, a teleconference would take place after which the ALJ may issue an Order requiring that the Claimant attend an appointment with the treating physician.

Thereafter, if the Claimant fails to attend the appointment again, either after completing the form indicating he or she will go, or after an Order from a teleconference, the Employer/Insurer may again file the form requesting a teleconference for the Claimant to explain why he or she did not attend or face suspension of income benefits.

The major benefit of this new process is that it forces the Claimant to respond much more quickly (7 total days versus 15 after the first missed appointment), and results in a faster response from the Board if the Claimant does not agree to attend to the appointment.  Further, an Order can be issued to suspend benefits within a period of about one month depending on when the second appointment is scheduled. 

However, this new process does have a potential downside.  The Order allowing suspension of income benefits can be “appealed” or objected to by requesting a hearing.  In that event, the entire process will have resulted in no substantive change.  Comparing this to the Motion process, if an ALJ issues an Order that benefits can be suspended if the Claimant does not attend an appointment after the filing of a Motion, the Claimant cannot avoid suspension of benefits simply by requesting a hearing.  Thus, while the Motion process would take significantly longer, its effect could be greater.

Particularly since Claimants might avoid changes in work restrictions and work status – and thus suspension of benefits – by avoiding returning to physicians in Georgia, it is good to see the Board attempting to provide a method to speed return evaluations.  While this new process, arguably, is not perfect, it is a new tool and should be considered and weighed against the traditional “Motion” option when a Claimant is not attending scheduled medical examinations with the authorized treating physician.