Time & Attendance
By Sheena Harrison
Oct. 6, 2011
Georgia’s Supreme Court upheld a state rule this week giving insurers and self-insured employers five days to respond on whether they will pay for workers’ compensation-related medical claims in the state. However, the court said the rule only applies to compensable injuries.
Georgia’s State Board of Workers’ Compensation says insurers and self-insurers must notify medical providers of whether they will pay for a procedure within five days of receiving a pre-approval request. If the deadline is missed, payment is considered to be approved automatically by the insurer.
In a decision issued Oct. 3, the Supreme Court said the rule can’t be used to make insurers pay for claims unrelated to workers’ comp cases.
“The fact that an insurer or self-insurer does not timely respond to a request for treatment or tests, and thereby, becomes obligated for pre-approval of that which is requested does not abrogate the threshold mandate that the medical care be for a compensable injury,” the decision reads.
The case, Mulligan vs. Selective HR Solutions Inc., centered on a woman who underwent two back surgeries for injuries sustained in 2005 and 2007. While she sustained the first back injury at work, the second surgery may have resulted from an accident in her home, according to court records.
Selective paid for Maria Mulligan’s first surgery under a workers comp claim, but argued it shouldn’t have to pay for the second surgery without a second opinion. The court’s decision says Selective took more than a month to respond to a surgery pre-authorization request submitted by Mulligan’s doctor.
Georgia’s appeals court ruled that Selective was not required to pay for Mulligan’s second surgery, arguing the state workers comp board put an unfair burden on insurers to prove whether an injury is compensable.
The state Supreme Court upheld the appeals court ruling, but it disagreed with the reasoning, saying the rule only applies to injuries already deemed to be workers’ comp-related.
Come see what we’re building in the world of predictive employee scheduling, superior labor insights and next-gen employee apps. We’re on a mission to automate workforce management for hourly employees and bring productivity, optimization and engagement to the frontline.
ComplianceMinimum Wage by State in 2023 – All You Need to Know
Summary Twenty-three states and D.C. raised their minimum wage rates in 2023, effective January 1. Thr...
federal law, minimum wage, pay rates, state law, wage law compliance
ComplianceExempt vs. non-exempt employees: knowing the difference
Summary Employees are exempt from FLSA requirements when they meet specific exemption criteria based on...
Department of Labor, exempt employees, Misclassification, non-exempt employees
ComplianceCalifornia fast food workers bill: why it’s more than meets the eye and how to prepare
Summary: California signs bill establishing a “fast food council” that has the power to raise the indus...