Georgia State Board of Workers’ Compensation Updates Rules to Define the Role of Nurse Case Managers

Written by: Michael Memberg, Esq.

On January 1, 2016, the Georgia State Board of Workers’ Compensation put into effect Board Rule 200.2 to clarify the rights of Employers/Insurers/TPAs to utilize a nurse case manager. Prior to this Rule, there technically was not a Rule in place defining the role of nurse case managers in workers’ compensation claims in Georgia.

A key element of the Rule is that written consent is now required when a nurse case manager wants to attend a medical appointment with the Claimant. However, consent is not required if the nurse case manager is a direct employee of the Employer/Insurer/TPA or their attorney. Thus, if a third-party nurse case manager wants to attend medical appointments, the Rule requires that the Claimant must give written consent, and the Claimant must be informed that such consent may be refused and may be withdrawn at any time. As a practical matter, most Claimants’ attorneys write to us to refuse nurse case management when they begin representation of the Claimant. However, that is not always the case, and that does not apply to direct employees under the Rule. To get out in front of this issue, we would recommend sending the Claimant a nurse case management consent form at the outset of any claim, and we would be more than happy to assist in preparing such a form.

Fortunately, the Rule also establishes two key elements of a nurse case manager’s role where consent of the Claimant is not required. Consent is not required for a nurse case manager to contact doctors to assist in assessing, developing, and implementing the treatment plan being put in place to help effect a cure or provide relief to the Claimant. As such, nurse case managers do not need the Claimant’s consent to proactively work with the authorized treating physician to help steer the treatment toward getting the Claimant released to work and released from medical care.

Consent is also not required for a nurse case manager to work with the authorized treating physician to obtain approval of a light duty job description to be offered to the Claimant pursuant to O.C.G.A. § 34-9-240. As such, the nurse case manager can serve as a go-between to help the authorized treating physician understand the light duty job description so that it can be approved to be offered to the Claimant.

If you have any questions about implementing this Rule, please do not hesitate to contact Hall Booth Smith’s workers’ comp attorneys.