MEDICAL CASE MANAGEMENT IN GEORGIA WORKERS’ COMPENSATION CASES

Georgia Workers’ Compensation Blog, October 2016
Nathan E. Woody, CORALES & WOODY, LLC

Medical Case Management in Georgia Workers’ Compensation Cases

On January 1, 2016, the Georgia State Board of Workers’ Compensation created Board Rule 200.2.  This new rule governs medical case managers’ involvement in non-catastrophic injury claims.  Medical case managers, also known as nurse case managers (or “NCM’s” for short), are required for catastrophic cases.  However, they are not required for non-catastrophic cases.  The basic principle is that in non-catastrophic cases, the Employers/Insurer can elect to use a medical case manager if the Claimant does not object.

Board Rule 200.2 limits when a nurse case manager may be involved in non-catastrophic cases and what role they can play in the Claimant’s treatment.  In order to be involved in an injured worker’s case, the nurse case manager must:

  • Receive the Claimant’s or the Claimant’s attorney’s consent;
  • Inform the Claimant in writing that consent may be refused or withdrawn; and
  • Receive written consent to attend any of the Claimant’s medical appointments.

The requirement that the Employer/Insurer obtain the Claimant’s consent prior to assigning a NCM to a non-catastrophic claim has been the norm in Georgia workers’ compensation for some time.  However, the new rule establishes two situations where the Claimant’s consent is not required.

  • First, the medical case manager does not need consent 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.” This means that the medical case manager can work, with or without consent, with the treating physician to get the Claimant released from medical care or sent back to work.
  • Second, consent is not required for the medical case manager to work with the treating physician to help them understand and approve a light duty job description that will be offered to the Claimant. Thankfully, even with the new rule, case managers are still required to follow the communication procedures set forth by Rule 200.1 (II)(D). Under that rule, case managers must provide copies of their correspondence with the treating physician to all parties involved.

Board Rule 200.2 makes a significant change to the Workers’ Compensation Rules. The rule essentially allows the nurse case managers to work with the treating physician without the Claimant’s or the Claimant’s attorney’s consent.  The likely end result of this is that the Employer/Insurer will be more active than ever in trying to get the opinion they want from your treating workers’ compensation doctor (usually saying that you do not need more treatment or that you can go back to work).  With so much working against you, this change underscores the necessity of having a workers’ compensation specialist working in your corner.

Call Corales & Woody today to discuss any issues you are having with nurse case management or the handling of your workers’ compensation claim.  We are ready to get to work.

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