CASE MANAGEMENT IN GEORGIA WORKER'S COMPENSATION
The monstrous Rule 200.1 of the Rules and Regulations was compared to the US Tax Code in its breadth due to the fact that over the years, every problem, real or imagined dealing with “rehabilitation” was grafted onto 200.1. The problem is that this section was intended only to deal with Catastrophic injuries. The SBWC has now fixed the problem and seemingly simplified the issue. Rule 200.1 once again deals with Catastrophic Injuries and with Peer Discipline of misconduct by Rehabilitation providers. That rule became effective July 1, 2015. Effective New Year’s Day, 2016, the remainder of the recommendations from the Chairman’s Advisory Committee became effective with the adoption and publication of Rule 200.2, governing Medical Case Management Services.
Since approximately 1992, Medical Case Management (also known as Nurse Case Management) was severely limited such that MCM/NCM could only be performed by those case managers employed by the Employer or the Insurance Carrier. Outside contactors needed to have the permission of the injured worker to perform any case management services. Typically, the first contact that an Employer/Insurer received from an attorney on behalf of the injured worker, notified the Employer/Insurer of representation, demanded documentation and advised the Employer/Insurer that no consent would be given to nurse case management services. This left many injured workers who’s cases needed the additional assistance without recourse.
The new Rule 200.2 removes the artificial distinction between a case manager employed by an Employer/Insurer and an outside contactor. The new Rule focuses on the conduct of the case manager provides:
“Consent of the employee shall not be required for such qualified medical case manager to contact the treating physician for purposes of assessing, planning, implementing and evaluating the options and services required to effect a cure or provide relief.”
Consent IS required, even under the new rule when the case manager is to work directly with the injured worker or when the case manager is attending a medical appointment.
Medical Case Managers violating this rule will be subject to the same Peer Disciplinary Procedures as set forth in Rule 200.1.
So, when you get the “introductory” letter from Opposing Counsel, please remember that your Medical Case Management Services may continue. We hope that you find this update to be helpful in your practices.
Skedsvold & White, LLC
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