October 28, 2010

The future of the WC-205 - - the continuing debate

by Mike Rosetti

Although it was only an official topic for one session, several of the panels addressed the issues associated with this controversial provision. Board form WC-205 allows an authorized treating physician to request pre-authorization for a proposed test or treatment. The form must be signed by the authorized treating physician and sent to the adjuster, who then has five business days to authorize or deny the requested treatment. According to Board Rule 205, the failure to respond to the form within five days renders the requested treatment automatically approved. The recent Court of Appeals of Georgia decision in Mulligan raised doubts about a claimant’s ability to enforce this provision. As noted in our previous newsletter, the Court in Mulligan found the WC-205 could not be used to shift the burden of proof for appropriate medical treatment to the employer/insurer.

A primary concern by claimant’s attorneys is that reasonable and necessary medical treatment is delayed without the WC-205. From the employer/insurer perspective, allowing five business days is not a fair opportunity to evaluate a proposed treatment to determine whether it meets the requirements of O.C.G.A. 34-9-201.

The consensus was that the WC-205 can still be used in certain circumstances, primarily for treatment to compensable body parts being recommended by the authorized treating physician. As such, it remains imperative to respond to a WC-205 request for pre-authorization within five business days. If the proposed treatment is denied, a WC-3 must be filed within 21 days of the date the WC-205 was submitted.

If you have questions or comments, please contact your David & Rosetti attorney at 404-446-4488 or by visiting our website at www.davidandrosetti.com. Nothing contained in this blog should be construed as legal advice or opinion on specific facts. For editorial comments or suggestions, please contact David W. Willis at (404) 446-4491 or at david.willis@davidandrosetti.com.

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