Source: https://thebaderlawfirm.com/board-rule-2001-provision-of-rehabilitation-services/
Timestamp: 2019-04-21 00:40:05+00:00

Document:
(i) Rehabilitation services by a Board registered rehabilitation supplier are required in claims where the injury is catastrophic and for non-catastrophic claims with dates of injury prior to July 1, 1992. Services of a Board registered rehabilitation supplier may be utilized in all other non-catastrophic claims only upon written agreement of all parties. Consistent with O.C.G.A. § 34-9 and Board Rules, a rehabilitation supplier delivers and coordinates services under an individualized Rehabilitation Plan; facilitates coordination of medical care; provides vocational counseling, exploration, and assessment; performs job analysis, job development, modification, and placement, evaluates social, medical, vocational, psychological, and psychiatric information; and may provide additional services upon agreement of the parties or Board order. The rehabilitation supplier shall comply with the professional standards and code of ethics as set forth by his or her certification or licensure board. Neither rehabilitation suppliers nor case managers operating under O.C.G.A. § 34-9-208 shall provide services in a workers’ compensation claim until and unless registered with, or certified by, the Board.
(ii) Case managers may be involved in cases where the employer/insurer has contracted with a certified workers’ compensation managed care organization (WC-MCO). These case managers shall operate pursuant to the provisions of O.C.G.A. § 34-9-208 and Board Rule 208.
(iii) Other than the appointed rehabilitation supplier as defined by O.C.G.A. § 34-9-200.1 and Board Rule 200.1, or a case manager as defined by O.C.G.A. § 34-9-208 and Board Rule 208, only a direct employee of the insurer, third party administrator, or employer may communicate with an injured employee and/or the authorized treating physicians to assess, plan, implement, coordinate, monitor, and evaluate options and services relative to an injured employee’s condition and/or vocational needs. The individual shall identify himself to others as an employee of the insurer, third party administrator, or employer and shall not identify himself as a case manager, rehabilitation supplier, or with any other term suggesting a fiduciary relationship with the injured employee. Nothing contained in this portion of the Board Rule shall apply to an attorney representing a party.
Rehabilitation suppliers and case managers not registered with the Board or any person performing any of the activities described in subsections (a)(1) of this Board Rule who is not a direct employee of the insurer, third party administrator or employer, shall be subject to civil penalties in accordance with O.C.G.A. § 34-9-18. Complaints pertaining to unregistered or unauthorized rehabilitation suppliers and case managers should be directed in writing to the Director of the Managed Care & Rehabilitation Division of the Board, with copies to all case parties and the rehabilitation supplier. Upon receipt of a complaint, the Director shall investigate the alleged violation and may refer the issue to the Enforcement Division and/or the Legal Division of the Board for further investigation or for the scheduling of an evidentiary hearing for a determination of whether or not penalties are warranted.
(i) In all catastrophic injury claims, within forty-eight hours of accepting the injury as compensable, or notification of a final determination of compensability, the employer/insurer shall appoint a Board registered catastrophic rehabilitation supplier. The employer/insurer shall file a Form WC-R1 with the Board simultaneously with the Employer’s First Report of Injury (WC-1), or by filing a WC-R1 within twenty days of notification of an administrative decision that rehabilitation services are required.
(ii) If the employer/insurer does not timely appoint a registered catastrophic rehabilitation supplier as required pursuant to subsection (a)(3)(i), the employee shall file a WC-R1CATEE to request appointment of a registered catastrophic supplier with service to all parties and the requested supplier.
(iii) For non-catastrophic claims with date of injury prior to July 1, 1992, unless excused by the Board, any party may file a WC-R1 at any time requesting the appointment of a registered rehabilitation supplier subject to the opposing party’s right to file an objection within twenty days. If the Board deems rehabilitation is appropriate, the Board may appoint a rehabilitation supplier.
(iv) Absent written objections filed with the Board within fifteen days of the date of the certificate of service on the WC-R1 or WC-R1CATEE, the request for rehabilitation services will be approved if, in the judgment of the Board, the appointment is appropriate. In the event written objection has been timely filed, the Board shall make a determination regarding appointment of a supplier and notify all parties.
(i) A rehabilitation supplier is not a party to the case. The registered rehabilitation supplier shall have sole responsibility for the rehabilitation aspects of each individual case. The registered rehabilitation supplier shall communicate with the injured employee and others to assess, plan, implement and coordinate, monitor and evaluate options and services to meet an injured employee’s health care needs through communication and available resources to promote cost effective outcomes with a goal of return to work.
(ii) The registered rehabilitation supplier shall meet with the injured employee within thirty (30) days of appointment and complete an initial rehabilitation evaluation and an appropriate plan for medical and vocational services. The initial rehabilitation plan must be filed with the Board on Form WC-R2A within ninety (90) days of the supplier’s appointment to the claim, unless excused by the Board. A current Rehabilitation Plan must be filed with the Board during all phases of service delivery.
(iii) In the event that a Board approved Rehabilitation Plan proposes that services be provided to the employee that are outside the scope of the qualifications or expertise of the appointed registered supplier, the registered rehabilitation supplier may obtain those specific services from another qualified individual, facility, or agency.
(iv) For catastrophic claims, the registered catastrophic rehabilitation supplier shall file a WC-R2 and all accompanying rehabilitation reports every ninety days.
(v) For non-catastrophic claims with dates of injury prior to July 1, 1992, the registered rehabilitation supplier shall file a WC-R2 with all rehabilitation reports and available medical information not previously submitted, every twenty-six weeks.
(vi) All rehabilitation plans shall be submitted with a current narrative report justifying the proposed action, which may include all pertinent medical documentation, evaluation reports, progress reports made since the last rehabilitation plan, labor market surveys, and other documentation. If the Board rejects the proposed rehabilitation plan, the registered rehabilitation supplier shall have 30 days to submit a revised plan. The registered rehabilitation supplier shall develop and submit an amended rehabilitation plan on a WC-R2A at any time that the circumstances change significantly such that the goals, activities, and timeliness of the current approved rehabilitation plan are no longer applicable or realistic. Amended or extended rehabilitation plans shall be submitted thirty days prior to the expiration of the current approved plan.
(i) A Medical Care Coordination Plan assists catastrophically injured employees in attaining maximum medical improvement and independence in activities of daily living. Each individual medical care coordination plan shall be in place for no longer than one year.
(iii) An Extended Evaluation Plan provides evaluation to establish vocational feasibility and appropriate vocational goals. The extended evaluation plan may include medical care coordination services to meet medical care goals. The extended evaluation plan shall be in place for no longer than one year.
The return-to-work plan shall be in place for no longer than a one-year period. Following an actual return to work, the plan may be extended for no longer than sixty days for the purpose of monitoring the return to work.
(v) A Training Plan documents the feasibility and necessity of vocational training. Each individual training plan shall be in place for no longer than one year.
(vi) A Self-Employment Plan is considered only when return-to-work plans or training plans are not feasible and when a reasonable probability of success in self-employment can be documented.
(vii) Any party objecting to a proposed rehabilitation plan shall file a written objection with the Board within fifteen days of the date of the certificate of service. The Rehabilitation Division may hold a rehabilitation conference and/or issue an administrative decision.
(i) A rehabilitation supplier shall recognize the employee’s attorney as the employee’s representative and shall encourage communication among all parties and their attorneys.
(ii) A rehabilitation supplier shall simultaneously provide copies of all correspondence to all parties and their attorneys.
(iii) The rehabilitation supplier shall provide professional identification and shall explain his or her role to any physician at the initial contact with the physician.
(iv) The employee has the right to a private physical examination and/or consultations with the medical provider. The rehabilitation supplier shall not attend such examination, except by the revocable written consent of the employee, or his or her attorney, if represented by counsel, after the employee has been advised of the right to a private examination and/or consultation.
(v) The rehabilitation supplier shall not obtain medical information regarding an injured employee in a private meeting with any treating physician unless the rehabilitation supplier has reserved with the physician sufficient appointment time for the conference and the injured employee and his or her attorney were given ten days advance notice of their option to attend the conference. If the employee is represented by counsel, all efforts shall be made to coordinate the meeting with the employee’s attorney. All legal excuses for the injured employee’s attorney’s inability to attend the conference will be recognized. If the injured employee or the physician does not consent to a joint conference, or if, in the physician’s opinion, it is medically contraindicated for the injured employee to participate in the conference, the rehabilitation supplier shall note this in his or her report and may in those specific instances communicate directly with the physician. The rehabilitation supplier shall report to all parties and the employee’s attorney the substance of the communication between him or her and the physician. Exceptions to the above notice requirements may be made in cases of medical necessity or with the consent of the injured employee or his or her attorney.
(vi) The rehabilitation supplier shall simultaneously provide copies of all written communications and shall report the substance of all oral communications between him or her and the treating physicians to all parties and their attorneys.
(vii) The rehabilitation supplier may assist the physician in scheduling second opinions and specialized treatment and shall give the injured employee and his or her attorney at least ten days notice of the time and place of any requested examination, unless waived by the Board or by agreement of the parties.
(viii) The rehabilitation supplier may assist in obtaining a permanent partial disability rating from the authorized treating physician.
(4) when the Board directs rehabilitation closure.
(ii) At any time, upon review of the file, the Board may determine that rehabilitation closure is appropriate and may issue an order or an administrative decision to close rehabilitation.
(iii) A party may request that the Board close rehabilitation services by filing a written request setting forth the specific reasons in support of their request for closure with copies to all parties and the supplier.
(1) A change in registered rehabilitation supplier shall be requested only by parties to the claim and must be approved by the Board. The WC-R1 requesting a change in supplier shall include the names and addresses of the involved suppliers and the specific reasons the change is requested. The requesting party shall send copies of the WC-R1 to all parties and their attorneys and to involved rehabilitation suppliers and complete the certificate of service on the WC-R1.
(2) When a WC-R1 is filed to request a change of registered rehabilitation supplier, the current Board appointed rehabilitation supplier shall maintain responsibility for providing necessary rehabilitation services until all appeals have been exhausted, unless excused by the Board.
(3) Any party objecting to a change of rehabilitation supplier shall file a written objection with the Board within fifteen days of the date of the certificate of service. The Rehabilitation Division may hold a rehabilitation conference and/or issue an administrative decision.
Any party to the claim dissatisfied with an administrative decision must file a WC-14, Request for Hearing, served on all parties and their attorneys and involved rehabilitation supplier within twenty days of the date of the administrative decision. The Board, in its discretion, may order the parties to participate in a mediation conference before the scheduling of the de novo hearing. The administrative decision shall be admissible in evidence.
Peer review shall be the procedure by which disputes concerning the necessity of services and the reasonableness of fees are resolved.
(1) Benefits may be suspended for failure or refusal to accept or cooperate with authorized rehabilitation services only by order of the Board.
(v) Failure to attend a rehabilitation conference without good cause.
(3) At the request of a party, a rehabilitation supplier, an Administrative Law Judge, or the Board’s rehabilitation coordinator, the Board may schedule a mediation or an administrative rehabilitation conference to resolve problems relating to the rehabilitation process. The parties should make all efforts to resolve the problems before requesting a mediation or conference. At Board scheduled rehabilitation conferences or mediations, all parties, attorneys of record, and the rehabilitation supplier may be required to attend or to be represented by a person with full authority to resolve the pending disputes. Only the parties, attorneys of record, and rehabilitation supplier may attend a scheduled mediation or rehabilitation conference. Exceptions to attendance may be granted if agreed or consented to by the parties and attorneys of record and approved by a mediator, rehabilitation coordinator, or administrative law judge. Agreements reached at mediations or rehabilitation conferences will be reduced to writing. Agreements reached at mediation shall be governed by Rule 100.
(i) Any person notified by the Board who fails to attend a Board scheduled mediation or rehabilitation conference without reasonable grounds may be subject to sanction pursuant to O.C.G.A. § 34-9-18. Any party requesting cancellation or rescheduling of a rehabilitation conference or mediation shall notify the Board and other parties with adequate notice to all parties.
(ii) Following the rehabilitation conference, the Board may issue an administrative decision.
(viii) Certified Occupational Health Nurse Specialist (COHN-S).
(i) To register as a rehabilitation supplier or rehabilitation resident, an applicant shall submit a completed, notarized application and a registration fee of one hundred dollars ($100.00). The registration shall be renewed annually. Not later than November 30th each year, an applicant shall submit a completed, notarized renewal application, a renewal fee of fifty dollars ($50.00), and documentation of current certification. Rehabilitation suppliers registered prior to July 1, 1985, who are not certified by CRC, CDMS, WAVES, LPC, CCM, CRRN, COHN, or COHN-S shall continue to renew registration annually. The renewal application for uncertified rehabilitation suppliers shall be accompanied by proof of completion of at least thirty contact hours of approved continuing education units. Any person who fails to renew on or before November 30th, shall be penalized an additional twenty-five dollars ($25.00). Any person who is delinquent on or after January 1st of each year shall be penalized an additional amount up to one hundred dollars ($100.00). A rehabilitation supplier who has not renewed his or her rehabilitation supplier registration by November 30th of the year following his or her supplier registration expiration date, shall not be eligible for renewal. If that individual wishes to provide rehabilitation services to injured employees, he or she will be required to submit a new application to become a rehabilitation supplier in accordance with the first paragraph of this section. In addition, if that supplier was registered as a catastrophic rehabilitation supplier, and wishes to provide catastrophic rehabilitation services, he or she will also be required to re-apply for catastrophic registration pursuant to (4) of this section.
(ii) Notice of a rehabilitation supplier’s registration approval will contain a supplier registration number with the November 30th expiration date, which shall be included on all reports submitted to the Board by the rehabilitation supplier.
(iii) An appeal of a denial of an application for registration, renewal, or reinstatement may be made within twenty days of notification of the denial by letter to the Board requesting a hearing. The applicant will be advised by the Board of the date, time, and place of the appeal hearing.
(iv) The Director of Managed Care and Rehabilitation may require a rehabilitation supplier to submit corrective action plans and/or may recommend the assessment of penalties for the violation of Board Rules, consistent submission of inappropriate rehabilitation or medical care plans, consistent failure to timely revise denied rehabilitation plans, and/or unethical behavior during rehabilitation services.
(v) Rehabilitation supplier registration may be revoked or suspended for violation of Board Rules. A complaint against a registered rehabilitation supplier shall be filed in writing, with copies to all case parties and the supplier, with the Director of the Managed Care and Rehabilitation Division of the Board. Upon receipt of a complaint, or upon the Board’s knowledge of a violation, the Director of Managed Care and Rehabilitation shall notify the rehabilitation supplier in writing of the nature of the complaint. Within fifteen days of the date of the notice, the rehabilitation supplier shall file with the Director of Managed Care and Rehabilitation a written response to the complaint. If the Director of Managed Care and Rehabilitation determines that justification exists for penalties and/or revocation or suspension of the rehabilitation supplier’s registration, the issue will be referred to the Enforcement Division and the Legal Division for a hearing to be held before an Administrative Law Judge. The Administrative Law Judge shall issue an order either dismissing the complaint, assessing penalties and/or revoking or suspending the rehabilitation supplier’s registration, or placing the rehabilitation supplier on probation. The rehabilitation supplier may appeal the order of the Administrative Law Judge in accordance with O.C.G.A. § 34-9-103 and § 34-9-105.
(i) An individual who meets the academic and experience criteria and who has applied for and been registered to sit for the examination to be certified or licensed as CRC, CDMS, WAVES, CRRN, LPC, CCM, COHN, or COHN-S may register to be a rehabilitation resident. A resident may provide rehabilitation services under the direct supervision of a registered rehabilitation supplier. However it is the registered rehabilitation supplier who shall perform the initial evaluation and prepare any rehabilitation plans, job analyses, progress reports, or closure report and who has any personal contact with the injured employee.
(ii) In the event a rehabilitation resident does not become certified or licensed by the appropriate licensing board within a two-year period from the date of initial application, the rehabilitation resident shall be disqualified from providing services to injured employees. A rehabilitation resident shall register with the Board on forms supplied by the Board.
(iii) Nothing contained in this subsection shall be construed to permit a rehabilitation resident to act independently as a registered rehabilitation supplier or to relieve the registered rehabilitation supplier from his or her responsibilities in any claim where a rehabilitation resident is utilized.
(iv) Any individual participating in a Council on Rehabilitation Education (CORE) approved master’s level program of study practicum/internship shall not be required to register with the Board while completing that short term internship. The registered rehabilitation supplier supervising an educational intern shall be responsible for all activities on the claims.
In order to provide services to catastrophically injured employees, the rehabilitation supplier must be registered with the Board as a catastrophic supplier.
(i) A catastrophic applicant shall have been registered as a rehabilitation supplier for a minimum of two years immediately prior to beginning the catastrophic application process. The applicant for catastrophic supplier registration shall document experience and/or training in at least three of the types of catastrophic injury listed in O.C.G.A. § 34-9-200.1(g) 1 through 5. Other detailed requirements for becoming a catastrophic supplier, including education, experience and renewal are set forth in the current edition of the Board’s Procedure Manual.
(ii) Within thirty days of the date of a denial of an application for registration as a catastrophic supplier, an appeal may be initiated by filing a written request with the Board for a conference with the Catastrophic Certification Committee. The applicant will be notified in writing of the date, time, and place of the conference within thirty days of the appeal.
(1) When there is no dispute, the employer/insurer shall file a Form WC-R1 requesting a catastrophic designation and an appointment of a registered catastrophic rehabilitation supplier. The claim is automatically accepted as a catastrophic claim.
(2) When a catastrophic designation is disputed, an employee or employee’s attorney shall file a WC-R1CATEE, with certificate of service with the Managed Care and Rehabilitation Division to request a catastrophic designation and an appointment of a registered catastrophic rehabilitation supplier. The WC-R1CATEE must be accompanied by documentation as specified in the current edition of the Board’s Procedure Manual, or as requested by the Board.
(3) Any objections must be filed with the Board in writing within twenty days of the certificate of service on the WC-R1CATEE. In the alternative, either party may file a Form WC-14 requesting an evidentiary hearing within 20 days of the certificate of service on the WC-R1CATEE. In the event a Form WC-14 is filed, the file shall be transferred to an administrative law judge for an evidentiary hearing without an administrative decision being rendered by the Rehabilitation Coordinator. The timeliness of the objection or hearing request will be processed in accordance with provisions of O.C.G.A. § 9-11-6(e).
(4) The Board’s Rehabilitation Coordinator will review the file and render an administrative decision, in writing as soon as possible. Prior to issuing a decision, the Rehabilitation Coordinator may schedule a rehabilitation conference. The administrative decision will be issued, in writing promptly following the conference.
(5) Any party to the claim dissatisfied with the administrative decision must, within twenty days of the date of the administrative decision, file a WC-14, Request for Hearing. The WC-14 must be served on all parties, their attorneys and involved rehabilitation suppliers. The Board, in its discretion, may order the parties to participate in a mediation conference before the scheduling of the de novo hearing.
(6) When no hearing is requested following an administrative decision by a Board Rehabilitation Coordinator or when an administrative law judge determines that an injury is catastrophic, the employer/insurer have 20 days from the date of such administrative decision or administrative law judge’s award to select a Board-registered rehabilitation supplier. If the employer/insurer fails to select a supplier, or requests a hearing without reasonable grounds following an administrative decision, or files an appeal of the administrative law judge’s decision granting catastrophic designation and the catastrophic designation is upheld on appeal, the Board will select the supplier, and may, in the exercise of its discretion, appoint the supplier requested by the employee.
Any party may request the appointment of a registered rehabilitation supplier on a voluntary basis upon agreement of the parties. The registered rehabilitation supplier shall be responsible for obtaining the written agreement from the employee.
If one party does not consent to voluntary rehabilitation services or subsequently withdraws consent for rehabilitation services, the rehabilitation supplier shall have no further contact, written, oral or otherwise, with the employee, the employee’s attorney, or the employee’s authorized treating physicians.
(1) A rehabilitation supplier may contract as a consultant with an employer/insurer or attorney, to review files, give recommendations regarding case management, safety and rehabilitation issues, and to perform job analyses of employment positions. All recommendations and reviews must be submitted directly to the employer/insurer or its agent requesting rehabilitation services.
(2) The rehabilitation supplier utilized by the parties must hold one of the certifications, or licenses specified in subsection (f) of this Rule and the supplier must be registered with the Board.
(3) A rehabilitation supplier will inform all parties of the legal limitations of their services or the benefits offered to the injured employee. The rehabilitation supplier shall function within the limitations of his or her role, training, and technical competency and will accept only those positions for which he or she is professionally qualified. A rehabilitation supplier will not misrepresent his or her role or competence to an injured employee and will refer the injured employee to a specialist as the needs of the injured employee dictate.
(4) The rehabilitation supplier shall disclose at the outset of a case to health care providers, the parties, and their attorneys any possible conflicts of interest. The rehabilitation supplier shall inform any health care providers, the parties, and their attorneys of his or her assignment and proposed role in the case.
(5) The rehabilitation supplier shall exercise independent professional judgment in making and documenting recommendations for medical and vocational services, including any alternatives for medical treatment and cost-effective return-to-work options including retraining or retirement. The rehabilitation supplier shall acknowledge that the authorized treating physician directs the medical care of an injured employee.
(6) Subject to the qualifications of the rehabilitation supplier, he or she may explain medical information to the injured employee, and shall discuss with the injured employee all treatment options appropriate to the injured employee’s conditions.
(7) The rehabilitation supplier shall insure the confidentiality of the injured employee’s medical records and shall not disclose the medical records to non-parties without the written consent of the injured employee or unless otherwise legally required to do so.
(8) As an expert witness or consultant, the rehabilitation supplier shall provide unbiased, objective opinions. The limits of his or her relationship shall be clearly defined in writing to all parties.
(9) A rehabilitation supplier shall not conduct or assist any party in claims negotiation, investigative activities, or perform any other non-rehabilitation.
(10) A rehabilitation supplier shall not advise the injured employee as to any legal matter, including but not limited to claims settlement options or procedures, monetary evaluation of claims, or the applicability of benefits of any kind under the Workers’ Compensation Act. Rehabilitation suppliers shall advise a non-represented injured employee to direct such questions to the State Board of Workers’ Compensation and a represented injured employee to direct such questions to his or her counsel.
(11) A rehabilitation supplier shall not accept any additional compensation or reward from any source as a result of settlement of a case.
(12) The assigned rehabilitation supplier shall not perform any additional services for either party for compensation not contemplated by the approved plan, unless all parties agree.
(13) A rehabilitation supplier who possesses information concerning an alleged violation of this rule shall reveal such information to the Managed Care & Rehabilitation Division of the State Board of Workers’ Compensation, unless the information is protected by law.

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