As an injured worker filing a workers’ compensation case, is your medical information actually private? Under Georgia law, possibly not.
If you were recently hurt on the job and filed a workers’ compensation case, the last thing you would want is for third-party players to gain access to your medical information and consult your doctor behind your back relating to information about you. Under the Georgia State Board of Workers’ Compensation, Board Rule 200.2 allows for such an invasion of privacy. So what can we do in response to the potential and actual abuses of this rule that take place in private meetings between “qualified medical case managers” and an employee’s treating physician?
First, let’s start with what Board Rule 200.2 says. You can view the full rule here, but we’ll sum it up here: Board Rule 200.2 sets forth specific guidelines for both the qualifications of third party medical case managers and the manner in which they can assist with a claim. Board Rule 200.2 is inapplicable to catastrophic claims and does not apply to direct employees of the Employer, Insurer, or Servicing Agent.
What is a medical case manager? Medical case managers (MCMs) are individuals outside of your doctor, employer, or insurance agency and related staff who serve as a mediator between those groups. MCMs might sit in on your medical appointment, serving as an additional care coordinator for your case—or, as stipulated under Board Rule 200.2, they might meet with your physician without you present. While MCMs are required to have qualified certifications, they are NOT required to be registered with the Board (as is the case with rehab suppliers in catastrophic claims).
With instances involving medical case managers, consent is everything. Board Rule 200.2 requires written or verbal consent from the employee or employee’s attorney for any MCM to work with the injured worker. Written consent is necessary if a MCM wishes to attend a medical appointment. Any time consent can be granted by the worker, it can be revoked by the worker—this must be made known to the employee in writing.
There are, however, instances where consent is not required. Consent is NOT required in allowing the MCM to contact the treating physician for purposes of assessing, planning, implementing and evaluating the options and services required to effect a cure or provide relief. Also of note, the injured worker/claimant attorney cannot prevent the MCM from conducting private meetings (meetings without the injured worker), but 10 days’ notice is required as a condition for a private meeting. This is meant to allow the claimant attorney and the injured worker the option to attend, but even with the required notice, a meeting between a Board Rule 200.2 MCM and an employee’s treating physician may take place without the employee’s consent. There is currently no guidance in the instance that the injured worker wishes to change the appointed medical case manager.
As outlined above, Board Rule 200.2 limits workers’ rights to privacy—a violation of the very rights us workers’ compensation attorneys work to defend. I, along with Todd K. Maziar, Attorney at Law and Jennifer Jarvis, Sartain Law Offices, propositioned the State Board to amend this rule. Check back for more updates on this issue.
Sources:
https://sbwc.georgia.gov/sites/sbwc.georgia.gov/files/Rule200_2_Revised01012016.pdf
https://sbwc.georgia.gov/frequently-asked-questions/medical-case-management-faqs