Navigational Tips for the Legislative Changes and “240 Process”

A misunderstood area of workers’ compensation defense exists in the notorious “240 process.” As we often see, an employee’s Facebook pictures, or perhaps his comments to a physical therapist, may be inconsistent with his complaints to the ATP, who has the employee on work restrictions. Given this suspicion, the employer and adjuster then put their heads together to create a light duty job using the ATP’s restrictions and request the ATP to “sign off” on the proposed job. If the employee then attempts the light duty job for less than eight hours or one scheduled work-day (whichever is greater), or refuses to attempt the job altogether, than the employer may suspend income benefits. Board Rule 240 contains the steps one must follow to successfully navigate the “240 process.” While it seems simple enough, many employers, insurers, and defense attorneys alike stumble over a key element-when submitting the initial job description to the ATP for approval, a copy must simultaneously be mailed to both the employee and his attorney. Claimant’s attorneys are known for scrutinizing the carrying-out of the “240 process” to find any missteps (such as this one!), at which point the employer/insurer will have to begrudgingly recommence income benefits.

In the past, Board Rule 201 has required employers using traditional posted panels of physicians to list a minimum of six (6) non-associated physicians. For example, if Dr. John and Dr. Doe both worked for “Orthopaedics XYZ,” an employer was unable to count both as valid panel physicians on the same panel. The recent “House Bill 412” revised this rule to eliminate the requirement that panels consist of only non-associated physicians. Therefore, for accidents occurring after July 1, 2015, multiple physicians from a single facility are now valid physicians for the purposes of judging panel-validity. Importantly, “House Bill 214” did not impact the other panel requirements, such as the need for an orthopaedic physician and minority physician.

House Bill 412 also rewrote and reorganized Board Rule 200.1. Georgia’s rule regarding rehabilitation services does not currently cover “case management” (despite claimants’ attorneys clamoring otherwise). That being said, rehabilitation services in a catastrophic claim can still be supplied by a “certified case manager,” who can also assist with voluntary rehabilitation situations in non-catastrophic claims (by agreement of parties, of course). The Board’s Advisory Council is currently discussing rules and parameters concerning medical case management. A new Board Rule (i.e. “Board Rule 200.2”) could be on the horizon, which would help eliminate any confusion.

Written by: Sam Crochet, Esq.