Catastrophic Injury Cases Are Exempt From The Time They Are Allotted

In a voluntary rehabilitation claim, the Rehabilitation Fee Schedule applies when the payer wants to use it. Certainly, rehabilitation suppliers should stay within the time allotments allowed per the Fee Schedule (Catastrophic Injury cases are exempt from the time allotments). The payer and the rehabilitation supplier can agree on a higher per hour fee. All rehabilitation suppliers/case managers should realize that the payer might conform rehabilitation charges in any Georgia workers’ compensation case to the Fee Schedule.

Do case managers have to be registered with the Board?

Case managers employed by a Board Certified MCO, and working with the MCO’s contracted employer, do not have to be registered, but must have one of the following credentials: CCM, CRRN, or COHN, COHN-S, LPC, CWAVES, CDMS or CRC. The MCO must file with the Board the name of the proposed case manager.  The MCO must attest that all of their case managers have the appropriate credentials.  Rehabilitation Suppliers who are employees of insurance companies, TPAs, or self-insured employers do not have to register with the Board, but when involved in a claim, must identify themselves as employee’s of their respective companies.

Can I talk to the employee’s authorized treating physician without a written agreement of all parties if I am acting as a Rehabilitation Consultant on behalf of the employer/insurer?

You may not speak with, discuss, fax or write to the authorized treating physician without the written consent of the injured employee or his/her attorney, if represented. When working as a Rehabilitation Consultant you work only with the employer/insurer who hired you.  Any written job descriptions, recommendations or reviews go directly to the claims adjuster.

If the employer/insurer does not pay my rehabilitation services bill for 90 days, can it still be reviewed and reduced?

All payments for rehabilitation services are due and payable within thirty (30) days of receipt of the bill. Bills not paid within thirty (30) days from date of receipt by the payer may be subject to penalties as prescribed by the Board. Except for the hourly rate, catastrophic injuries as defined in O.C.G.A. §34-9-200.1(g) are exempt from the fee schedule. O.C.G.A. §34-9-200.1(d) specifies that the reasonableness of fees and necessity of services are subject to review by the State Board of Workers’ Compensation. The Board may require, or any party or supplier may request, a review by a panel of peers to determine whether fees were reasonable. The process for requesting peer-review is detailed in the forward to the Rehabilitation Fee Schedule.

If a case manager is not a party to the claim, and he/she does not have written permission from the injured employee for voluntary rehabilitation, then may the case manager contact the authorized treating physician or IME physician by letter or telephone?

In the situation described, the rehabilitation supplier/case manager may not have any contact with the authorized treating or IME physicians to discuss the injured employees’ treatment, outcomes, return-to-work status, or job descriptions.   This includes all methods of contact: telephonic, correspondence, e-mail, fax, or face-to-face interaction.  A rehabilitation supplier may help to set up the time and place of an IME and coordinate record transfer. Any questions asked of the authorized treating physician or the IME regarding the injured employee must come from the employer/insurer or a party to the claim. 

If I receive a psychological evaluation, may I send it to the State Board or quote anything in the evaluation in a letter or report?

According to Board Rule 200.1 (a)(3)(iii): "Rehabilitation reports do not include psychiatric or psychological reports." However, if the psychological evaluation is requested by the employer/insurer or is done in relation to the employee’s injury (i.e., before surgery, a neuro-psychological evaluation for a head injury) then this information may be attached.

If I write a job description, and the claims adjuster submits it to the doctor, can I call    the doctor’s office after several weeks to determine if the doctor has reviewed it or signed off on it?

It is assumed that the case manager in this scenario does not have a written agreement for case management services. In this case, you would not be allowed to speak to the doctor or his office regarding the job description.   That provides too much opportunity to discus s the employee’s care with the doctor. If the adjuster has sent a job description to the doctor, the adjuster can call the doctor to determine the status of the job description.

What may a registered case manager/rehabilitation supplier do in a non-catastrophic claim, with an injury date of 7/1/92 or later, if there is not a written agreement for voluntary rehabilitation?

A registered case manager or rehabilitation supplier may review records, conduct job analyses, and provide technical assistance to an employer/insurer.   A case manager/rehabilitation supplier may not contact the injured employee, his/her attorney or the authorized treating physician either in person, in writing, or by telephone or fax. (See above question). If the case manager is a direct employee (not a consultant) of the employer, insurer, or third-party administrator, the case manager has the same standing that an adjuster would (i.e., a party to the claim), and may have contact with the treating physician. This case manager also must keep all parties informed of any correspondence and conversations with the authorized treating physician concerning the injured employee Board Rule 200.1(a)(1)(iii).