Georgia workers’ compensation cases are controlled by two different types of rules. One set of rules is the statutes that are passed by the Georgia Legislature. The second set of rules is the Rules of the Georgia State Board of Workers’ Compensation which are passed by the Directors of the State Board.
The new Board Rule regarding case management
Recently, a change was made to the Rules of the Georgia State Board of Workers’ Compensation. The Directors of the State Board created a new rule. That rule is Board Rule 200.2. It went into effect on January 1.
Board Rule 200.2 focuses on case management in workers’ compensation claims. Case managers are people who provide services to injured workers to help them recover from their injuries. Their services often include medical case management and vocational rehabilitation.
What is case management?
Case management by a catastrophic rehabilitation supplier is mandatory in catastrophic workers’ compensation cases. Many years ago, it was also mandatory in all Georgia workers’ compensation cases. However, the law was changed more than 20 years ago to provide that case management only occurred in noncatastrophic cases when both the injured worker and the insurance company agreed.
This law meant that injured workers could not always get vocational rehabilitation assistance. An injured worker who could not go back to her job because of her injury might benefit from retraining. With the change in the law, this retraining did not have to occur unless the injured worker’s case was designated as catastrophic. Since most cases are not designated catastrophic, many injured workers did not get retraining.
Does the new Board Rule 200.2 help injured workers with job retraining?
No. The new Board Rule only focuses on “medical case managers”. It provides that insurance companies may use medical case managers in some situations even when the injured worker does not want a medical case manager on the case.
This means that insurance companies can hire medical case managers to contact an injured worker’s doctors regarding the injured workers care and to try to get “light duty jobs” approved. The insurance company has to pay the cost of these medical case managers.
Medical case management is limited under new Board Rule 200.2
While medical case managers can be hired without an injured worker’s agreement, they have limitations on what they can do. An injured worker must agree before the medical case manager can actually work with the injured worker. Also, a medical case manager must have written consent to actually attend a doctor’s appointment.
What should an injured worker do about this new Board Rule?
Medical opinions are very important in a workers’ compensation case. Statements made by a doctor affect your weekly workers’ compensation benefits. These statement also affect what medical treatment you receive. Because a medical case manager will contact your doctor, the insurance companies decision to hire one could ultimately cause your weekly benefits to stop or needed medical treatment to be denied.
You need to make sure that the insurance company and any medical case manager follow the rules so that you receive the benefits you should. An attorney specializing in workers’ compensation can help make sure your rights are protected.