The State Board of Worker’ Compensation recently promulgated a new Board Rule, which took effect January 1, 2016.
Board Rule 200.2 provides some guidelines for the widely-used practice of medical case management by third party vendors in non-catastrophic claims. Employers and Insurers have long utilized third party medical case managers in order to maintain control over a claimant’s medical treatment and to facilitate medical care with an eye on the claimant’s return to work and resolution of the claim.
The State Board of Worker’ Compensation recently promulgated a new Board Rule, which took effect January 1, 2016. Board Rule 200.2 provides some guidelines for the widely-used practice of medical case management by third party vendors in non-catastrophic claims. Employers and Insurers have long utilized third party medical case managers in order to maintain control over a claimant’s medical treatment and to facilitate medical care with an eye on the claimant’s return to work and resolution of the claim. The manner in which Employer and Insurer utilize medical case management has been largely ungoverned by the State Board with the exception of the known rule that a medical case manager cannot attend medical appointments with the claimant over the objection of the claimant or his counsel. Board Rule 200.1.
Board Rule 200.2 sets forth specific guidelines for the both the qualifications of third party medical case managers and the manner in which they can assist with a claim. First, Rule 200.2 requires that all medical case managers must possess certification or licensure of at least one licensing agency contained in Board Rule 200.1(I)(A), which lists eight separate certifications or licenses: (1) Certified Rehabilitation Counselor (CRC); (2) Certified Disability Management Specialist (CDMS); (3) Certified Rehabilitation Registered Nurse (CRRN); (4) Work Adjustment and Vocational Evaluation Specialist (WAVES); (5) Licensed Professional Counselor (LPC); (6) Certified Case Manager (CCM); (7) Certified Occupational Health Nurse (COHN); or (8) Certified Occupational Health Nurse Specialist (COHN-S).
Additionally, Board Rule 200.2 provides that the consent of the claimant or the claimant’s counsel is required as a prerequisite for the case manager to work with the claimant. Furthermore, the claimant (or his attorney, if represented) must consent in writing for the medical case manager to attend any medical appointment. Moreover, the claimant must be notified in writing that consent may be refused and may be withdrawn at any time.
However, consent is not required for the medical case manager to contact the treating physician for the purpose of “assessing, planning, implementing and evaluating the options and services required to effect a cure or provide relief.” Medical case managers may also facilitate the approval of modified duty job descriptions pursuant to O.C.G.A. § 34-9-240 and Board Rule 240. Nonetheless, it is important to remember that all communications between the medical case manager and the treating physician(s) are subject to discovery. Furthermore, Board Rules require that a copy of all communications be made available to the claimant or his attorney and that a medical case manager must notify the claimant or his counsel ten days prior to a scheduled conference with the claimant’s physician in order to give the claimant’s counsel or a representative the option to attend the conference. Rule 200.1(II)(D).
Violations of Board Rule 200.2 will be referred to the State Board of Workers’ Compensation Rehabilitation Division for enforcement proceedings which could result in the imposition of fines or the revocation of privileges to act as a medical case manager in Georgia claims. Board Rule 200.1(IV).
Board Rule 200.2 is inapplicable to catastrophic claims and claims in which the Employer/Insurer utilizes a WC-MCO, and also does not apply to direct employees of the Employer, Insurer, or Servicing Agent.
The main takeaways from the Board Rule 200.2 are straightforward. Employers and Insurers must ensure that all third party medical case managers have one of the eight aforementioned licenses or certifications. Employers and Insurers must also remember to obtain written consent from the claimant or his counsel prior to a third party medical case manager’s attendance of a physician’s appointment with the claimant, and the claimant must notified in writing that consent may be refused or withdrawn at any time. Other than the fact that written and informed consent must be obtained to attend an appointment or directly contact the claimant, properly certified third party medical case managers may continue to contact the physician’s office in order to facilitate medical care and obtain the approval of job descriptions.
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