By Alissa Atkins
On October 19, 2010 the United Stated Department of Labor issued a regional news release concerning two Kansas City area employers after a worker fell to his death through a roof opening. OSHA found that the employers failed to protect and train the workers from fall hazards. The deceased worker fell 40 feet to his death through a roof opening, after which OSHA proposed $150,000.00 in penalties against one employer working on the site and $145,000.00 in penalties against the other employer.
OSHA’s website states that failure to provide fall protection is one of the ten most frequently cited safety problems. OSHA requires training on fall protection specifically designed to “enable each employee to recognize the hazards of falling.” 29 CFR 126.503(a)(1). They also require training on the correct procedures for erecting, maintaining, disassembling and inspecting fall protection systems, and the use and operation of guardrail systems and personal fall arrest systems including safety nets. Finally, OSHA has a public policy of protecting workers who report safety and health concerns, and accordingly prohibits the firing or retaliation of workers who voice safety or health issues to OSHA.
If you have questions or comments, please reply to this blog post or 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.
November 10, 2010
New SITF Settlement Policy for Claims With MSA Trusts
By Alissa Atkins
The Georgia Subsequent Injury Trust Fund (SITF) recently instituted a new policy pertaining to the settlement of SITF claims in cases requiring Medicare Set-Aside (MSA) trusts. A copy of this policy can be read here: http://www.davidandrosetti.com/newsletter/pdf/SITF.pdf
In short, the SITF has made changes in its business model pertaining to MSAs. Specifically, the SITF has now placed a cap on reimbursing MSA money as part of a workers’ compensation structured settlement. If the annuity quote including seed money is more than $150,000.00, the SITF will not reimburse any amount over $150,000.00 for the MSA. The SITF settlement manager suggests that in some cases the employer/insurer consider contributing the balance above the $150,000.00 threshold “if you have a case that is really one that needs to be settled.” Otherwise, the SITF recommends considering bifurcating settlements, and settling the indemnity portion of the claim while reassessing the medical component of the claim at a later time.
If you have questions or comments, please reply to this blog post or 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.
The Georgia Subsequent Injury Trust Fund (SITF) recently instituted a new policy pertaining to the settlement of SITF claims in cases requiring Medicare Set-Aside (MSA) trusts. A copy of this policy can be read here: http://www.davidandrosetti.com/newsletter/pdf/SITF.pdf
In short, the SITF has made changes in its business model pertaining to MSAs. Specifically, the SITF has now placed a cap on reimbursing MSA money as part of a workers’ compensation structured settlement. If the annuity quote including seed money is more than $150,000.00, the SITF will not reimburse any amount over $150,000.00 for the MSA. The SITF settlement manager suggests that in some cases the employer/insurer consider contributing the balance above the $150,000.00 threshold “if you have a case that is really one that needs to be settled.” Otherwise, the SITF recommends considering bifurcating settlements, and settling the indemnity portion of the claim while reassessing the medical component of the claim at a later time.
If you have questions or comments, please reply to this blog post or 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.
The Reduction of Income Benefits Under O.C.G.A. § 34-9-104
By Alissa Atkins
On October 18, 2010, the Court of Appeals of the State of Georgia revisited the case of Imerys Kaolin v. J. W. Blackshear (A10A1216). In Blackshear, the Court of Appeals addressed O.C.G.A. § 34-9-104 which allows an employer to unilaterally convert an injured worker from temporary total disability (TTD) benefits to temporary partial disability (TPD) benefits once the authorized treating physician releases the employee to return to work with restrictions. However, the employer can only do so if certain notice requirements are met, specifically:
Within 60 days of the employees’ release to return to work with restrictions or limitations, the employer shall provide notice to the employee . . . that he or she has been released to work with limitations or restrictions . . . . Whenever an employer seeks to convert an employee from benefits for total disability to benefits for partial disability as provided in this paragraph, such employer may convert the benefits unilaterally by filing the form indicating the reason for the conversion as prescribed by rule of the Board. O.C.G.A. § 34-9-104(a)(2).
In Blackshear, the claimant injured his hands at work in 2001. He began receiving TTD benefits and was released to return to work with restrictions in June 2001. Based on this release, the employer/insurer informed the claimant in January 2002 that his TTD benefits would be reduced to the TPD level effective June 4, 2002. However, this did not occur. Instead, the employer/insurer obtained a new release from a referral physician on December 31, 2002, based on an evaluation performed in August 2002. The employer/insurer notified the claimant on January 14, 2003 that his benefits would be reduced from TTD to TPD on December 31, 2003. The employer actually reduced benefits in January 2004.
For the next several years the claimant continued to draw TPD benefits. Once those benefits expired in 2008 by operation of law, the claimant requested a recommencement of TTD benefits, indicating that he had never been properly notified of the unilateral reduction of benefits from TTD to TPD pursuant to O.C.G.A. § 34-9-104(a)(2). Finding that the employer did not notify the claimant of the anticipated reduction within 60 days of the original release on June 11, 2001, the administrative law judge reinstated the claimant’s TTD benefits and awarded them back to the date of the reduction in January 2004. The Court of Appeals found the notice provided by the employer was invalid “because it was issued more than 60 days from the time the restrictions were ‘determined.’” Accordingly, the Court of Appeals found that the reduction from TTD benefits to TPD benefits was improper.
This ruling makes it clear more than ever that employers and insurers need to follow the precise rules of O.C.G.A. § 34-9-104 and Board Rule 104. Specifically, (1) a WC-104 must be completed no later than 60 days of the authorized treating physician’s release of the claimant to work with restrictions; (2) the medical report establishing the claimant was released to light-duty work must be attached to the WC-104; (3) a copy of the WC-104 and medical report must be served upon the claimant and his attorney, if represented; and (4) once the claimant remains out of work for 52 consecutive weeks/78 aggregate weeks the employer/insurer must file a WC-2 reflecting the reduction of benefits and attach the WC-104 at that time.
If you have questions or comments, please reply to this blog post or 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.
On October 18, 2010, the Court of Appeals of the State of Georgia revisited the case of Imerys Kaolin v. J. W. Blackshear (A10A1216). In Blackshear, the Court of Appeals addressed O.C.G.A. § 34-9-104 which allows an employer to unilaterally convert an injured worker from temporary total disability (TTD) benefits to temporary partial disability (TPD) benefits once the authorized treating physician releases the employee to return to work with restrictions. However, the employer can only do so if certain notice requirements are met, specifically:
Within 60 days of the employees’ release to return to work with restrictions or limitations, the employer shall provide notice to the employee . . . that he or she has been released to work with limitations or restrictions . . . . Whenever an employer seeks to convert an employee from benefits for total disability to benefits for partial disability as provided in this paragraph, such employer may convert the benefits unilaterally by filing the form indicating the reason for the conversion as prescribed by rule of the Board. O.C.G.A. § 34-9-104(a)(2).
In Blackshear, the claimant injured his hands at work in 2001. He began receiving TTD benefits and was released to return to work with restrictions in June 2001. Based on this release, the employer/insurer informed the claimant in January 2002 that his TTD benefits would be reduced to the TPD level effective June 4, 2002. However, this did not occur. Instead, the employer/insurer obtained a new release from a referral physician on December 31, 2002, based on an evaluation performed in August 2002. The employer/insurer notified the claimant on January 14, 2003 that his benefits would be reduced from TTD to TPD on December 31, 2003. The employer actually reduced benefits in January 2004.
For the next several years the claimant continued to draw TPD benefits. Once those benefits expired in 2008 by operation of law, the claimant requested a recommencement of TTD benefits, indicating that he had never been properly notified of the unilateral reduction of benefits from TTD to TPD pursuant to O.C.G.A. § 34-9-104(a)(2). Finding that the employer did not notify the claimant of the anticipated reduction within 60 days of the original release on June 11, 2001, the administrative law judge reinstated the claimant’s TTD benefits and awarded them back to the date of the reduction in January 2004. The Court of Appeals found the notice provided by the employer was invalid “because it was issued more than 60 days from the time the restrictions were ‘determined.’” Accordingly, the Court of Appeals found that the reduction from TTD benefits to TPD benefits was improper.
This ruling makes it clear more than ever that employers and insurers need to follow the precise rules of O.C.G.A. § 34-9-104 and Board Rule 104. Specifically, (1) a WC-104 must be completed no later than 60 days of the authorized treating physician’s release of the claimant to work with restrictions; (2) the medical report establishing the claimant was released to light-duty work must be attached to the WC-104; (3) a copy of the WC-104 and medical report must be served upon the claimant and his attorney, if represented; and (4) once the claimant remains out of work for 52 consecutive weeks/78 aggregate weeks the employer/insurer must file a WC-2 reflecting the reduction of benefits and attach the WC-104 at that time.
If you have questions or comments, please reply to this blog post or 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.
October 28, 2010
Communications With Doctors
by Mike Rosetti
Another topic gaining momentum is whether defense attorneys are permitted to meet with treating doctors. Questions concerning privacy and legal ethics are raised by such meetings.
The claimant’s bar has relied on the Moreland v. Austin case, decided by the Supreme Court of Georgia, to argue that “ex parte” communications are not permissible in workers’ compensation cases. The Moreland case, however, is not binding since it involves a medical malpractice claim, which is subject to the provisions of HIPAA. Since workers’ compensation is not subject to HIPAA rules associated with the release of information, the case has limited application.
This is an issue which has grown momentum in recent years. The ability of the employer/insurer’s legal representative to meet with treating physicians and provide all information relevant to a claim, instead of their reliance on limited information from a claimant, has allowed parties to successfully move cases forward. The claimant’s bar’s stated concern is that allowing defense attorneys to speak with doctors skews the resulting medical opinion(s). The reality, however, is that most employers/insurers want to ensure that when doctors issue opinions, it is based on all the facts. Simply put, the best way to confirm that all the facts are known is to meet with or speak to the doctor.
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.
Another topic gaining momentum is whether defense attorneys are permitted to meet with treating doctors. Questions concerning privacy and legal ethics are raised by such meetings.
The claimant’s bar has relied on the Moreland v. Austin case, decided by the Supreme Court of Georgia, to argue that “ex parte” communications are not permissible in workers’ compensation cases. The Moreland case, however, is not binding since it involves a medical malpractice claim, which is subject to the provisions of HIPAA. Since workers’ compensation is not subject to HIPAA rules associated with the release of information, the case has limited application.
This is an issue which has grown momentum in recent years. The ability of the employer/insurer’s legal representative to meet with treating physicians and provide all information relevant to a claim, instead of their reliance on limited information from a claimant, has allowed parties to successfully move cases forward. The claimant’s bar’s stated concern is that allowing defense attorneys to speak with doctors skews the resulting medical opinion(s). The reality, however, is that most employers/insurers want to ensure that when doctors issue opinions, it is based on all the facts. Simply put, the best way to confirm that all the facts are known is to meet with or speak to the doctor.
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.
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.
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.
Honorable Richard S. (Rick) Thompson’s State of the Board address
by Mike Rosetti
Chairman Thompson delivered a “State of the Board” address to the attendees, addressing some legislative changes as well as important trends.
A. Appellate Division Award to be Published
The most significant legislative update was the requirement that the Board publish Appellate Division awards. While these awards are not necessarily binding precedent, they are persuasive authority and give parties an opportunity to see how the Board is addressing recurring issues.
B.Settlements approved with greater speed; fewer settlements generally
Chairman Thompson referenced the statistics kept by the Board documenting the increased speed with which settlements are approved. In calendar years 2008 and 2009, there were no months in which 90% of settlement were approved within 10 days. By contrast, in every month of this year, at least 90% of settlements were approved within 10 days. Of note, the statistics demonstrated there are fewer settlements being submitted to the Board. In 2009, there were an average of 1,335 settlement submitted to the Board for approval per month. For the first seven months of 2010, there was an average of 1,115 settlement submitted.
C. ALJ Awards issued with greater speed
The speed with which ALJ awards are issued has increased dramatically. In October 2009, only 44% of awards were issued within 60 days. By contrast, in June 2010 (the last month statistics were available), 97% of awards were issued within 60 days of the hearing.
***
The theme of Judge Thompson’s report was that the Board is operating with greater efficiency, and the statistics bear this out. This is beneficial for all parties as quicker resolutions usually lead to decreased costs.
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.
Chairman Thompson delivered a “State of the Board” address to the attendees, addressing some legislative changes as well as important trends.
A. Appellate Division Award to be Published
The most significant legislative update was the requirement that the Board publish Appellate Division awards. While these awards are not necessarily binding precedent, they are persuasive authority and give parties an opportunity to see how the Board is addressing recurring issues.
B.Settlements approved with greater speed; fewer settlements generally
Chairman Thompson referenced the statistics kept by the Board documenting the increased speed with which settlements are approved. In calendar years 2008 and 2009, there were no months in which 90% of settlement were approved within 10 days. By contrast, in every month of this year, at least 90% of settlements were approved within 10 days. Of note, the statistics demonstrated there are fewer settlements being submitted to the Board. In 2009, there were an average of 1,335 settlement submitted to the Board for approval per month. For the first seven months of 2010, there was an average of 1,115 settlement submitted.
C. ALJ Awards issued with greater speed
The speed with which ALJ awards are issued has increased dramatically. In October 2009, only 44% of awards were issued within 60 days. By contrast, in June 2010 (the last month statistics were available), 97% of awards were issued within 60 days of the hearing.
***
The theme of Judge Thompson’s report was that the Board is operating with greater efficiency, and the statistics bear this out. This is beneficial for all parties as quicker resolutions usually lead to decreased costs.
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.
Georgia Workers' Compensation Annual Seminar
The annual Georgia workers’ compensation seminar sponsored by the Institute of Continuing Legal Education concluded on October 2, 2010. Nearly 500 lawyers practicing Georgia workers’ compensation law attended the conference. Mike Rosetti co-chaired the event and Ken David presented on “Medicare Madness.” There were several items of note from the conference.
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.
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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