In Georgia, the State Board of Workers’ Compensation is the governing body that makes the rules and regulations that are applied to Workers’ Compensation claims. One of these rules is Rule 205. This rule states that a doctor or medical provider does not have to get advanced permission to treat the injured worker before rendering services. The treatment does have to be injury related for the rule to apply.
In most cases, the doctor or medical facility will request authorization for treatment and testing. The Employer/Insurer has 5 days to respond to the request. Most medical providers send in a form to the insurance company asking for permission to give treatment. They do this so they can be sure to be paid. The rule states that the insurance company or the self-insured employer has to respond to the doctor or medical facility within 5 business days of receiving the form. If the insurance company or self-insured employer does not respond, the treatment by the doctor or medical facility is considered authorized and the doctor or medical facility must be paid by the Employer/Insurer.
Recently, the Georgia Supreme Court addressed Rule 205. One of the issues was the burden of proof. The burden of proof means which side has the obligation to prove a fact in court. The Court of Appeals held that the burden of proof was improperly shifted to the employer and insurer to prove that a claim was compensable or payable in situations regarding medical treatment and testing. In Georgia, proving whether or not a Workers’ Compensation claim is payable is always the burden of the employee. In other words, the worker must prove that his claim is payable in Georgia Workers’ Compensation claims.
The Georgia Supreme Court did not agree with the Court of Appeals. They said that Rule 205 clearly states that the medical treatment or tests have to be related to a payable injury. This meant that there was no shifting of the burden of proof from the injured worker to the employer or insurer; because the injury was already considered one for which medical benefits should be paid. The Court went on to say that the employer or insurer could be sanctioned or fined for failing to respond to a physician or medical facility’s request for pre-authorization within the 5 business days called for by Rule 205.
This case is a perfect example of why having legal representation is so important with any Workers’ Compensation claim. At J. Franklin Burns, P.C. we are trial lawyers experienced in arguing cases for our clients at every Court level, from the State Board of Workers’ Compensation all the way to the Georgia Supreme court if necessary.
For more information on getting authorization for treatment and making sure that the medical bills related to your Workers’ Compensation claim are paid, contact J. Franklin Burns, P.C., at 1-404-303-7770.