What Is a Catastrophic Rehabilitation Supplier?
In most workers’ compensation cases people never even hear about catastrophic rehabilitation suppliers. They only work in he most serious of workers’ compensation injuries where someone’s injury is designated as ‘catastrophic’.
The part of Georgia’s Workers’ Compensation law that covers catastrophic designation is known as O.C.G.A. 34-9-200.1(g). That law discusses six different types of injuries that can qualify for a catastrophic designation.
It includes five specific injury types.
- Certain spinal cord injuries
- Certain amputations
- Severe brain or closed head injuries
- Certain burn injuries
- Total or industrial blindness
It also includes a “catch-all” provision which is (g)(6). If you want to learn about whether your case could qualify for a catastrophic designation, I would recommend you take a look at this article.
How does a catastrophic rehabilitation supplier get assigned to my case?
When your cases receives a catastrophic designation, the Georgia State Board of Workers’ Compensation should assign a catastrophic rehabilitation supplier. Often, the employer or insurance company picks the catastrophic rehabilitation supplier. But, the injured worker can sometimes have input into the selection.
Not just anyone can be appointed to serve as a catastrophic rehabilitation supplier in a case. Catastrophic rehabilitation suppliers have registered with the State Board to work on catastrophic cases. The State Board’s rules require them to have certain licensing and training.
What does a catastrophic rehabilitation supplier do?
State Board Rule 200.1 discusses the supplier’s duties. Basically, the supplier assesses the injured worker’s needs and helps with coordinating care and services to meet the injured worker’s rehabilitation needs. This work often fits into two basic categories.
- Vocational rehabilitation
- Assistance with medical treatment and testing
Within 30 days of appointment, the catastrophic supplier should meet with the injured worker. Through discussion and reviewing the records, the catastrophic rehabilitation supplier develops a rehabilitation plan.
Catastrophic rehabilitation suppliers create several different types of plans including the following:
- Medical Care Coordination
- Independent Living
- Extended Evaluation
- Job Placement
These plans lay out the goals of rehabilitation over a certain time frame. Some of the most common plans focus on helping the injured worker get appropriate medical treatment. Also, many workers need independent living plans as a result of serious injuries which alter their lifestyles at home.
What is vocational rehabilitation?
Vocational rehabilitation focuses on rehabbing someone to get back to work. Catastrophic injuries alter people’s lives. They usually make it very difficult to work.
Some people can work after suffering a catastrophic injury. But, they may need job modification or retraining. The vocational rehabilitation part of a catastrophic supplier’s job focuses on those issues.
A catastrophic rehabilitation supplier or another expert will consider the possibility of an injured worker returning to work. They will consider the skills that the injured worker has. In some situations, returning to school to get additional training could be part of a rehabilitation plan.
Does the insurance company have to pay for vocational rehabilitation if my case is not catastrophic?
Unfortunately, the answer is no. Rehabilitation is not mandatory in Georgia workers compensation cases unless they are designated catastrophic.
The insurance company can provide rehabilitation in non-catastrophic cases. But, they do not have to.
Before 2016, both the injured worker and the insurance company had to agree to have a rehabilitation supplier assigned in a non-catastrophic case. But, new Board Rule 200.2 allows the insurance company to assign a rehabilitation supplier on a case without the injured worker agreeing. Unfortunately, this means the insurance company can assign a rehabilitation supplier to your case only when it thinks it is beneficial.
These rehabilitation supplier are often called nurse case managers in non-catastrophic cases. While Board Rule 200.2 does allow the insurance company to assign them, Board Rule 200.1 and 200.2 limit what these rehabilitation suppliers can do without your consent. However, the law still does not allow you to get vocational rehabilitation in a non-catastrophic case without the consent of the insurance company.
How does the catastrophic rehabilitation supplier help with medical treatment?
The other thing catastrophic rehabilitation suppliers focus on is your medical treatment. They should help you get the medical treatment you need for your injury.
Catastrophic rehabilitation suppliers may attend medical appointments. They may speak with your treating doctors.
Part of what they work on is making sure you get the basic medical treatment you need. This could include medications, physical, therapy, and surgery among other things.
They also expand outside of basic medical treatment as well into the Independent Living Plan category. This focuses on what you need to live and/or work independently.
- Do you need modifications in your house to function better?
- Does a wheelchair make it difficult to get around your house or to use your vehicle?
Many catastrophically injured individuals need assistive devices to reach their full potential. Often, they need modifications to their homes and vehicles as well.
Does the catastrophic rehabilitation supplier file workers compensation forms?
Yes. Georgia State Board rules require catastrophic rehabilitation suppliers to file forms and reports. The supplier should file the initial plan within 90 days of appointment. Progress reports should be filed at least every 90 days.
The initial plan will lay out the period of time it covers. When that plan is expiring, the supplier should complete and submit a new plan.
Both the injured worker and the insurance company have an opportunity to object to rehabilitation supplier plans. If no objections are filed, the plan goes into effect and should be binding.
Can I change my catastrophic rehabilitation supplier?
Yes, but you have to do it by agreement or by order of the Georgia State Board of Workers’ Compensation. You can change rehabilitation suppliers by agreement or by filing a request to change.
To do so, you file a Form WC-R1 and mark the appropriate sections. The Form WC-R1 contains a section to supply the reasons for the request and also a section to complete if the request is by agreement.
What if I have other questions about catastrophic rehabilitation suppliers?
The Georgia State Board of Workers’ Compensation has good materials on the Managed Care and Rehabilitation Division’s section of its website. You may find these materials helpful.
If you have specific questions about catastrophic rehabilitation or any Georgia workers compensation topic, you can schedule a free consultation with one of our firm’s workers compensation attorneys. This article I wrote describes how a free consultation works and what you can learn. Just let us know if you want to set one up by calling (770) 214-8885.