Claims Kit

Penalties for Late Reporting    34-9-18

Any person who willfully fails to file any form or report, follow any order required by the Board, or violates any rule or regulation of the Board will be assessed a civil penalty of $100.00-$1,000.00 per violation.

Effective April 1, 2020, the Georgia State Board of Workers’ Compensation has adopted the new codes: DN0083 Cause of Injury Code (83 – Pandemic); and DN0035 Nature of Injury Code (83 – COVID-19). Trading partners may begin sending the new codes as needed.

Should you have any questions, please contact the SBWC EDI department.

Phone: (404) 656-3818 or (800) 533-0682 (toll free)

Email: EDI@sbwc.ga.gov

The Chief Justice’s ordergrants relief from deadlines which can be applicable to workers’ compensation claims such as the following: statutes of limitations, time within which discovery or any aspect thereof is to be completed, time within which to serve a party, time within which to appeal or to seek the right to appeal any order, ruling, or other determination.

The statutory requirements and Board rules relating to payment of benefits or provision of authorized medical treatment are not affected by this order.

The Board will continue to handle Petitions for Medical Treatment (PMTs), motions, conference calls and any emergency situation.

Posting Requirements   Rule 61 

All employers operating under the Georgia Workers' Compensation Law must post notice on durable material publicly and permanently in a conspicuous place in each business location. Upon request, the Board will furnish suitable notices free of charge. The notice must be in a form that it can be understood by all employees and read as follows: This business operates under the Georgia Workers' Compensation Law.

WORKERS MUST REPORT ALL ACCIDENTS IMMEDIATELY TO THE EMPLOYER BY ADVISING THE EMPLOYER PERSONALLY, OR AN AGENT, REPRESENTATIVE, BOSS, SUPERVISOR OR FOREMAN OF THE EMPLOYER. 

The insurance company's name must be posted, or if self-insured, the certificate of self-insurance must be posted in a prominent place. 

Any person who fails or refuses to comply is subject to an administrative fine not to exceed $1,000.00. 

Panel of Physicians Posting requirement: 

The employer must post the appropriate posting notice with the Panel of Physicians, completely filled out, in a conspicuous place in every location. Must be printed and posted on legal size (8 1/2 x 14) paper. 

Panel of Physicians 

Panel of Physicians in Spanish 

Physician Selection  34-9-201, Rule 201 

The employee must choose from a list maintained by the employer. An employee may obtain the services of any physician from the panel and may thereafter elect to change to another physician on the panel without prior authorization from the Board. The physician selected will become the primary treating physician in control of the employee's medical care.  

The employer may satisfy the requirements for furnishing medical care in one of the following manners: 

a. A   traditional posted panel of physicians shall consist of at least six physicians or professional associations or corporations of physicians who are reasonably accessible to the employees, but is not limited to  the minimum of six. However, should a physician on the panel of physicians refuse to provide treatment to an employee who previously has received treatment from another panel physician, the employer/insurer, as soon as practicable, shall increase the panel for that employee by one physician for each such refusal. The Board may grant exceptions to the required size of the panel where it is demonstrated that more than four physicians or groups of physicians are not reasonably accessible. The minimum panel shall include an orthopedic physician, and no more than two industrial clinics should be included on the panel.

b. An employer or the workers' compensation insurer of an employer may contract with a workers' compensation managed care organization. An employer utilizing a WC/MCO may satisfy the notice requirements by posting a notice in prominent places upon the business premises which includes the following information:   
(A) The employer has enrolled with the specified WC/MCO to provide all necessary medical treatment for workers' compensation injuries. 
An employee with an injury prior to enrollment may continue to receive treatment from the non-participating authorized treating physician until the employee elects to utilize the WC/MCO;  
(B)   The effective date of the WC/MCO;   
(C)   The geographical service area (by counties);   
(D)   The telephone number and address of the administrator for the employer and/or WC/MCO who can answer questions about the managed care plan;   
(E)   How the employee can access care with the WC/MCO and the toll-free 24-hour telephone number of the managed care plan that informs employees of available services.   

An employee may obtain the services of any physician from the panel and may make one change to another physician on the panel without approval of the employer.or without prior authorization from the Board. The physician so selected will become the primary treating physician in control of the employee's medical care. Further changes require approval of the employer/insurer or the Board.

Posting of Panel

The employer must post in prominent places the type of panel chosen. Employers must fully explain the purpose of the panel to all employees and must assist employees in obtaining medical care when an injury occurs.

Failure to comply with this regulation results in the employee's freedom to select any physician to provide them with care for his or her injuries, and may result in an assessment of penalties and attorneys' fees against the employer.

Reporting of Claim by Employer  34-9-12

Immediately upon knowledge of an injury, an employer must complete and file with its insurer's or self-insurer's claims office an Employer's First Report of Injury or Occupational Disease (Form WC-1). Injuries involving 7 or more days of lost time must be reported to the Board within 10 days of the employer's knowledge of disability. Failure to file timely reports with the Board and/or make timely payment of income benefits will result in late payment penalties and may result in late filing penalties and the assessment of attorney's fees.