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Ocga A 349203 Employers Pecuniary Liability For Medical Charges

Ocga A 349203 Employers Pecuniary Liability For Medical Charges Liability For Medical Malpractice Payment Of Reasonable Charges Inclusion Of Reports And Documentation With Charges Defense For Failure To Make Payments Penalties

(a)  The pecuniary liability of the employer for medical, surgical, hospital service, or other treatment required, when ordered by the board, shall be limited to such charges as prevail in the State of Georgia for similar treatment of injured persons of a like standard of living when such treatment is paid for by the injured persons.

(b)  The employer shall not be liable in damages for malpractice by a physician or surgeon furnished pursuant to this chapter, but the consequences of any malpractice shall be deemed part of the injury resulting from the accident and shall be compensated for as such.

(c)

(1)  All reasonable charges for medical, surgical, hospital, and pharmacy goods and services shall be payable by the employer or its workers’ compensation insurer within 30 days from the date that the employer or the insurer receives the charges and reports required by the board.  The employer or insurer shall, within 30 days after receipt of charges for health care goods or services, mail to the provider of such health care goods or services payment of such charges or a letter or other written notice that states the reasons the employer or insurer has for not paying the claim, either in whole or in part, and which also gives the person so notified a written itemization of any documents or other information needed to process the claim or any portion thereof.(2)  The failure by the employee or the health care goods or services provider to include with its submission of charges any reports or other documents required by the board shall constitute a defense for the employer’s or insurer’s failure to pay the submitted charges within 30 days of receipt of the charges.  However, if the employer or insurer fails to send the employee or the health care goods or services provider the requisite notice indicating a need for further documentation within 30 days of receipt of the charges, the employer and insurer will be deemed to have waived the right to defend a claim for failure to pay such charges in a timely fashion on the grounds that the charges were not appropriately accompanied by required reports.  Such waiver shall not extend to any other defense the employer and insurer may have with respect to a claim of untimely payment.

(3)  If any charges for health care goods or services are not paid when due, or any reimbursement for health care goods or services paid by the employee or any charges for mileage incurred by the employee are not paid when due, penalties shall be added to such charges and paid at the same time as and in addition to the charges claimed for the health care goods or services.  For any payment of charges paid more than 30 days after their due date, but paid within 60 days of such date, there shall be added to such charges an amount equal to 10 percent of the charges. For any payment of charges paid more than 60 days after their due date, but paid within 90 days of such date, there shall be added to such charges an amount equal to 20 percent of the charges.  For any charges not paid within 90 days of their due date, in addition to the 20 percent add-on penalty, the employer or insurer shall pay interest on that combined sum in an amount equal to 12 percent per annum from the ninety-first day after the date the charges were due until full payment is made.  All such penalties and interest shall be paid to the provider of the health care goods or services.

(4)  Notwithstanding any other provision of this subsection, if the employee or the provider of health care goods or services fails to submit its charges to the employer or its workers’ compensation insurer within one year of the date of service or the issuance of such goods or services or, in the case of an employee, within one year of the date of incurring of mileage expenses, then the provider is deemed to have waived its right to collect such charges from the employer, its workers’ compensation insurer, and the employee; and, in regard to mileage expenses, the employee is deemed to have waived his or her right to collect such charges from the employer or its workers’ compensation insurer.

See also:

  • Board Rule 203. Payment of Medical Expenses; Procedure When Amount of Expenses are Disputed
  • Mileage Reimbursement Form
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