The Defense Is in the Details: State Board Forms
By: Melissa Rickert
Filing State Board forms for Georgia workers’ compensation claims can seem overwhelmingly tedious given the detail and deadlines one must follow. However, following board form procedures can have a significant impact on a claim. Thus, it is beneficial to ensure board forms are used appropriately and filed correctly. This article addresses just a few of the most often-used board forms needed to process a claim effectively.
WC-1 First Report of Injury – “File the 1 in Every One”
The WC-1 First Report of Injury must be filed with the Board for every claim, whether the claim is an accepted medical-only claim, accepted as compensable including indemnity benefits, controverted claim or in a death claim. The employer is required to complete the WC-1, Section A “immediately upon knowledge of an injury.” An employer who does not send the WC-1 to the insurance company or claims office “immediately” can incur a penalty. Section A must include the worker’s name, address, date of birth and date of injury.
Once Section A of the WC-1 is completed and submitted to the insurer or claim handler, the insurer is responsible for completing either Section B, C or D. The WC-1 must also show the complete name and mailing address of the employer, the insurer, and the claims office.
The WC-1 must be filed within 21 days of the employer’s knowledge of disability, injury or death. It is the insurer’s responsibility to ensure the form is completed accurately and completely and a copy of the completed form is provided to the claimant and all attorneys of record (Board Rule 61(b)(1)).
WC-2 Notice of Payment or Suspension of Benefits – “Whatever You Do, File a 2”
When indemnity benefits are being commenced, suspended or modified, it is imperative to file a WC-2 Notice of Payment or Suspension of Benefits. While few claimants find fault when benefits are commenced (Section B of the WC-2), issues more commonly arise when benefits are suspended (see Section C of the WC-2). Failure to properly complete Section C of the WC-2 is a common pitfall with potentially costly repercussions.
In particular, the reason for suspending benefits must match the reason indicated in Section C. Depending on the basis for the suspension, any documents supporting the suspension (as specified on the form) must be attached to the WC-2 at the time of filing. Furthermore, copies of both the WC-2 and any attachments must be sent directly to the claimant and counsel. If any of these requirements are not met, the suspension can be deemed invalid.
One should also be aware that in order to suspend an injured worker’s benefits based on a full duty release without an actual return to work, a 10-day advanced notice is 10 days from the date the WC-2 is filed and not 10 days from the date the ATP issued the full duty release. As a best practice, we typically recommend a 13-day notice, allowing an additional three days for service by mail.
WC-PMT(b) Petition to Show Cause Regarding Medical Treatment – “PMT(b) Works for Me!”
One of the more frustrating scenarios that can occur is when the claimant is receiving TTD benefits but habitually cancels or no-shows authorized medical appointments. Whereas claimants and their attorneys will utilize the WC-PMT form seeking authorization of medical treatment, the employer/insurer can file a Petition for Medical Treatment WC-PMT(b) to address a claimant’s unreasonable delays and noncompliance with medical treatment. Filing a WC-PMT(b) will trigger the State Board to schedule a telephonic conference with an Administrative Law Judge within a few days of the filing. The claimant and the employer/insurer are required to attend the conference for the claimant to show cause as to why the appointments were missed. Often, with the right details and documentation, the judge can be persuaded to instruct the claimant to attend the next appointment or risk having their income benefits suspended. As a best practice, ensure there is documentation establishing the claimant was notified of the missed appointment with the requisite five business’ days advance notice. Likewise, contact the medical provider ahead of the telephonic conference to set up a follow-up appointment to take place after the conference.
As Georgia is a “form-filing” state, it is vital to ensure the proper forms are utilized correctly to help mitigate risk and potential claim exposure. The forms mentioned above account for a only a portion of those used in Georgia workers' compensation claims.
Attorney Contact Info
Melissa Rickert
melissa.rickert@swiftcurrie.com
404.888.6214