by Jennifer M. Smith, Esq.

During many sessions, the legislature makes revisions to the Workers’ Compensation Act. The rules and legislative changes go into effect every year on July 1st. This year, SB 7 sought to revise the Act by limiting the receipt of benefits by illegal immigrants, but the bill did not make it out of committee. Therefore, there were no legislative changes this year. However, the State Board of Workers’ Compensation considered raising the average weekly wage, but did not do so. Also, the Board discussed requiring social security (or “Hartman”) language in every stipulation and agreement. Federal Law allows for an offset for workers’ compensation benefits against social security disability benefits. Hartman language projects the portion of settlement proceeds that represent income benefits over the claimant’s remaining life expectancy. At this point, Hartman language “may” be included in a settlement if the parties agree. There is discussion of changing the language from “may” to “shall.”

Change to Board Forms:

    • There is a new WC-207 Board form which the claimant signs allowing the employer/insurer to obtain medical records. In years past, claimants’ attorneys have provided their own releases or written directly on the WC-207 that the release does not apply to conversations with doctors. They would often direct claimants not to sign the WC-207 and instead have them sign a similar, more restrictive document of their own making. The attorneys argued that the release did not give defense attorneys or adjusters the right to communicate directly with heath care providers. The Board attempted to address this issue by removing language stating the Board form complies with HIPAA. Instead, it cites the HIPAA law directly. The change was made as a compromise to appease the claimants’ bar. Currently, ex parte communications are not prohibited by law in a workers’ compensation claim in Georgia. Although, the Board form is not the appropriate vehicle to prevent ex parte communications between the doctors and defense counsel or employers and adjusters in a workers’ compensation setting, the Board apparently made the change in an effort to reduce litigation over this issue.

 

  • The WC-14 adds language quoting O.C.G.A. § 34-9-18(b) which allows for the assessment of a civil penalty against any person who knowingly and intentionally makes a false or misleading statement or representation for the purpose of facilitating the obtaining or denying of any benefit or payment under the Workers’ Compensation Act.

Changes to Board Rules:

    • Since 2009 the State Board of Workers’ Compensation of Georgia has required all new lost time claims with a date of injury after June 30, 2009 be submitted via the Electronic Data Interchange (EDI). The Board no longer accepts paper filing of WC-1s, WC-2s, WC-2a, WC-3s, or WC-4s from Insurers, Self-Insurers, Group Funds and Third Party Administrators who are registered as EDI Trading Partners with the State of Georgia. The requirement has not come without glitches. Case in point: there is not an effective way to file an attachment with the WC-2, (known electronically as the SROI) through EDI. In order to be effective, there are times when the WC-2 requires an additional document be attached to the filing (i.e. a medical record or a WC-104). The rule has been changed so when a supplemental document must be attached then the insurer has the opportunity to either file the supplemental document by paper before or simultaneously with the EDI filing.

 

  • An exception to the requirement for electronic filing is when a document or form requires a Social Security number and the number is not known. Because both WC online and the EDI require a valid tracking number or a valid Social Security number to allow filing, any Board form requiring a Social Security number must be filed by paper until the Board issues a “BTN,” or Board Tracking Number. After a BTN is issued then the First Report of Injury may be filed with EDI. All filings thereafter can be done through EDI as usual.