As of 07/01/07, the self-insured employers and the carriers in New York can no longer file claims for reimbursement with the Special Funds Conservation Committee under Section 15-8. In other words, for claims with dates of accident or dates of disablement of 07/01/07 or later, (more…)
SITF
Types of Second-Injury Funds
The two major types of second-injury funds are reimbursement funds and take-over funds. In both of these situations, the employer/insurer can reduce liability when the fund becomes liable. (more…)
Acronyms and Definitions
§ – Section
CAT claim – Catastrophic designation (designation through the SBWC)
CAT scan, CT or CT scan – Computed Tomography (medical procedure)
CMS – Centers for Medicare & Medicaid Services
FCE – Functional Capacity Evaluation
Depo – Deposition
IME – Independent Medical Examination
MMI – Maximum Medical Improvement
MRI – Magnetic Resonance Imaging
MSA – Medicare Set-Aside
O.C.G.A. – Official Code of Georgia Annotated
PPD – Permanent Partial Disability
PT – Physical Therapy
SITF – Subsequent Injury Trust Fund
TPD – Temporary Partial Disability
TTD – Temporary Total Disability
WC or Workers Comp – Workers’ Compensation
WCMSA – Workers’ Compensation Medicare Set-Aside
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Unprecedented growth Contributes to Closing of Georgia SITF
The unprecedented growth of the Georgia SITF over the past few years reportedly indicates growth of a substantial unfunded liability. These ever-rising liabilities, coupled with incentives to submit cases into the Fund and increasing assessments, have been a recipe for financial disaster that the Georgia Legislature has now addressed. (more…)
Are expenses incurred prior to 2003 reimbursable?
The 2003 amendment to O.C.G.A. § 34-9-203, effective July 1, 2003, added paragraph (c)(4), imposing a one year limitation period on the filing of reimbursement claims. While this amendment imposed a one year filing limitation (more…)
Benefits of Settling a Claim when the SITF is Involved…
Settlement may occur prior to OR following SITF acceptance of a claim. In the case where a claim is settled prior to SITF acceptance, SITF does not consider itself a party to the agreement and is not subject to its provisions.
When settlement negotiations are initiated during the evaluation process, SITF must be notified by the employer/insurer of any and all settlement demands. The employer/insurer must submit a Settlement Authority Request in writing. The settlement authority request must include (more…)
23 Presumptive Medical Conditions
In order for an employer/insured to be eligible for reimbursement from the Subsequent Injury Trust Fund, the employee’s subsequent injury must be directly caused by the prior impairment. The employer must show that this prior impairment was permanent and likely to be a hindrance to employment. Any pre-existing, permanent condition qualifies. The condition may be derived from an automobile accident, personal injury, or an acquired or congenital disease.
For some medical conditions, the Fund has defined them as presumptive conditions. In other words, the employer/insured need not provide documentation to prove that these medical conditions are permanent and a hindrance to employment. Pursuant to Section 34-9-361 of the Official Code of Georgia, the presumptive medical conditions are defined as permanent and a hindrance to employment.
The 23 presumptive medical conditions in O.C.G.A. § 34-9-361 are: (more…)
Who, What, and How will the Georgia SITF reimburse me?
Any insurance company licensed in Georgia to issue workers’ compensation policies or self-insured employer authorized by the State Board of Workers’ Compensation is eligible to file a claim for potential reimbursement from the Subsequent Injury Trust Fund. The employer/insurer should forward a letter to the fund stating a desire to actively pursue the claim. The fund requires medical documentation of the prior and subsequent injuries and, where indicated, investigative reports supporting compensability. In addition, the fund requires the statement of merger.
The employer/insurer files a claim for reimbursement directly with the fund. The Fund investigates the claim to determine eligibility for reimbursement. When a reimbursement agreement is reached between the Fund and the employer or insurer, it must be approved by the Sate Board of Workers’ Compensation. If an agreement cannot be reached, either party may request a mediation conference or a hearing with the State Board of Workers’ Compensation.
Employers/insurers may be reimbursed for all weekly income benefits payable after 104 weeks, for 50% of all medical and rehabilitation expenses between $5,000 and $10,000, and for 100% of all medical and rehabilitation expenses in excess of $10,000. If the subsequent injury was not caused by or related to a prior impairment, the reimbursement for medical expenses may be reduced or denied completely.
