By: George Waters, Partner, Atlanta

Board Rule 200.2 was introduced on January 1, 2016.  It finally allows partial case management in Georgia.  Prior to this board rule, the Employer/Insurer was not allowed to use a case manager to speak with either the doctor or the claimant without consent from the claimant.  Now a case manager can speak to the doctors.   In many instances, a case manager can often facilitate expedited medical treatment which would help the claimant get better and return to work, but unfortunately, consent was almost never provided.   In light of this dilemma, as of January 1, 2016, the State Board has issued a Board Rule allowing the Employer/Insurer to “utilize qualified medical case managers to provide telephonic or field medical case management services.”  Basically this allows a case manager to communicate with any treating doctor directly (but NOT with the injured worker unless permission is given by the Claimant – in writing).  It also specifically allows the case manager to assist with the approval of light duty job descriptions pursuant to 34-9-240.  This will be extremely useful in obtaining information from the doctors more quickly in these cases.  With luck, it will also allow the Employer/Insurer to obtain approval of light duty jobs from the doctor faster, as well. 

A positive change is that it will now be easier to obtain medical information faster and there will be some oversight regarding referrals.   It is not uncommon for a Claimant to ask for a specific doctor for a referral which is recommended to them by their attorney.  Hopefully, when someone with a medical background speaks to a treating physician then that doctor will be more likely to provide information necessary to help make the Claimant better, which is, after all, the point of the workers’ compensation system.   Also, instead of waiting weeks or longer for the medical records, we will be able to have access to the doctors’ thoughts almost immediately.  Additionally, assistance with scheduling, direction of referrals, and facilitating diagnostic tests can all be utilized to further encourage medical treatment at a faster pace.   This will also likely cut down on allegations from Claimants that the Employer/Insurer purposefully refuses to authorize medical treatment.  Ultimately, having a nurse case manager actively involved in treatment will provide someone with medical training to offer advice on what medical treatment is likely to grant relief, effect a cure, or return to the claimant to suitable employment and, on the other hand, they can assist in helping flag what medical treatment seems to be unnecessary, experimental or redundant.  

Naturally, I still expect that some Claimant’s attorneys may try to fight this issue.  Several have already alleged that it only applies to injuries occurring after January 1, 2016.   However, it is likely that the Board will apply this to all current cases and will allow case managers to consult with doctors without issue.  Hopefully this new Board rule will be utilized to provide proper and expedient care to the injured workers so they can heal quickly and get back to work.  

 George Waters, Partner, Atlanta