RP032-22 Ad1

August 16, 2022

Addendum #1

RP032-22

Provision of Workers’ Compensation Claims Administration Services on an Annual Contract

Please see the below summation of revisions, questions and answers for the above solicitation.

Revision Page 1 – Change From Questions regarding proposals should be directed to Dana Garland at dana.garland@gwinnettcounty.com or by calling 770-822-8723, no later than 3:00 P.M. on June 14, 2022.

Page 1 – Change To:

Questions regarding proposals should be directed to Dana Garland at dana.garland@gwinnettcounty.com or by calling 770-822-8723, no later than 3:00 P.M. on August 10, 2022.

Questions Q1. Is the County interested in proposals for Managed Care and Utilization Review services outside of a third-party administrator (TPA) or is the County looking for a single service provider?

A1. The County is looking for a single service provider.

Q2. Is the Excess Workers' Compensation placement a part of this request for proposal?

A2. No.

Q3. Please provide a detailed Loss Run of all open claims, separated by Indemnity/ Lost Time and Medical Only.

A3. See attached Open Claims Report.

Q4. Who does ASC/Davies utilize as their medical bill review vendor?

A4. GenEx

Q5. Who is the County's current Pharmacy Benefit Manager (PBM)?

A5. Mitchell Script Advisor

Q6. Who does the County use as their defense attorney firm(s)?

A6. Ryan Prescott, Sutton Law Group LLC and Brown Dennis, Chambless Higdon Richardson Katz Giggs LLP

Q7. Please provide detailed loss runs for the past five (5) years, which including elements such as, claim status

(open/close); claim type (LT / MO), expense incurred, paid medical, paid indemnity, total experience, open date, close date, brief description of the loss.

A7. For detained loss runs for the past (5) years see attached report (Gwinnett County Claims 2017 – 2022).

For open claims see attached report Gwinnett County Open Claims_081222

Q8. Please identify the total number of open files, including claim type (LT/MO).

A8. See A3.

Q9. What is the County’s definition of a Medical Only Claim?

A9. Claims with medical treatment but no loss time.

Q10. Please provide loss runs dating back to policy years necessary to include all open claim files.

A10. See A7.

Q11. Please provide a complete copy of the in-force contract between Davies Claims Solutions and Gwinnett

County Board of Commissioners, including all pricing exhibits.

A11. To obtain a copy of the current contract, please submit an open records request through the County website at www.gwinnettcounty.com.

http://www.gwinnettcounty.com/

Addendum 1

Q12. Does the County intend to continue using the claims administration system through Riskonnect Clearsight, LLC, should the County elect to award this contract to another TPA?

A12. The County would expect the TPA to provide their own claims administration system. The County would need access to the system in order to run reports.

Q13. What activities does the County undertake through Riskonnect Clearsight, LLC?

A13. The County runs reports and checks on specific data on claims.

Q14. How many users of the TPA’s Risk Management Information System does the County require? Of those, how many are “Full Access” (i.e., read and write) users? How many are “Read Only” users?

A14. The County would need 5 “Read Only” users.

Q15. Does the County administer the full salary payments to injured employees during the first 360 days post injury?

A15. Yes, if the employee elects to participate in the program the County makes the payment during the 360 days.

Q16. Does the TPA issue any loss time benefits to injured employees during the first 360 days post injury?

A16. The employee has the ability to opt out of the 360-day enhanced program. If the employee opts out of the program, the TPA would administer any lost time payments.

Q17. Does the TPA make statistical entry of lost time benefits, and in what amounts, into the claim file during the first 360 days post injury? In other words, does the claim file reflect the statutory requirements for lost time benefits or the full salary levels approved by the County?

A17. Yes, the TPA makes the statistical entry, and the claim file shows all time missed.

Q18. On Page 4 of the request for proposal, there is reference to an attached Safety Policy and Procedures manual. Please provide a copy of this document.

A18. Please see attached claims manual.

Q19. Is the County open to discussing a hybrid schedule for the on-site claims examiner?

A19. Yes

Q20. Will the County provide office space for the on-site claims examiner to use when she is on premises?

A20. Yes

Q21. Will the County provide internet access for the on-site claims examiner to log onto the TPA’s claims system during days she is working at the County office location?

A21. Yes

Q22. Will the County provide computer monitors for our on-site claims examiner to use when she is on the

County’s premises?

A22. Yes

Q23. Will the County permit the service provider’s loss control team to visit the County office location to review the designed office space where the claims examiner would be stationed for ergonomics and other human factors related analyses?

A23. Yes

Q24. What is the current settlement authority level established for the County’s incumbent TPA?

A24. All settlements must be preapproved by the County.

Q25. What quantity of Telephonic Nurse Case Management was used in the past policy year?

A25. The County does not currently utilize this service.

Q26. What quantity of Field Nurse Case Management was used in the past policy year?

A26. The County does not have information.

Q27. How many medical bills were reviewed in the past policy year?

A27. We need clarification on requested information.

Q28. In Section V, Proposed Pricing, there is a reference to “Consultant Medical Exams (per exam cost).” There can be great variability in consulting medical examination fees depending on the nature of the injury. Please explain this fee/charge in greater detail. Does this relate to the administrative fees associated with securing the Consulting Physician’s professional medical fee?

A28. The physician’s professional medical fee is normally included in the cost of the claim. However, if the service provider does not include or offer these services, identify that this is not applicable.

Q29. In Section V, Proposed Pricing, there is an option called, “a.1 Workers’ Compensation Administration

Services (per claim),” which calls for pricing for New Lost Time Claims and New Medical Only Claims. In Section I of the request for proposal, the County advises that the selected TPA will “assume and manage” all existing claims. If the proposing TPA recommends a price to assume and manage all existing claims, where should that price be indicated within Section V?

A29. If price per claim is different for existing claims, indicate that information in the Full Installation Charges.

Q30. In Section V, Proposed Pricing, in the Miscellaneous Fees and Charges, at subparagraph h., there is a reference to “Full Installation Charges (flat fee).” Please provide further details about this Fee and Charge.

A30. This is any fees associated with assuming the existing claims including the transfer of data.

Q31. Does the Full Installation Charge (flat fee) reflect the proposing TPA’s fee/charge to assume and manage the existing claims, inclusive of any recommended costs to move claim data from the Incumbent’s data source?

A31. Yes

Q32. Has the incumbent TPA executed a Business Associate Agreement (BAA) with the County, like the one included at Page 31 of the request for proposal?

A32. Yes

Q33. If the incumbent TPA and the County have entered into a Business Associate’s Agreement, have the County and the incumbent TPA agreed to exceptions or exemptions related to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) regarding workers’ compensation claims?

A33. There were no exceptions or exemptions to the BAA.

Q34. What is the anticipated award date for this contract?

A34. Contract to begin January 1, 2023.

Q35. Does the contract contemplated in the request for proposal need to be approved by the Gwinnett County

Board of Commissioners? If so, on approximately what date will the County present this contract for approval to the Board of County Commissioners?

A35. Yes. An exact date it unknown at this time.

Q36. If proposing on this opportunity, does the service provider need to fill out the form on Page 37 with N/A and include it with the submission or should it be excluded from the submission package?

A36. It can be excluded.

Q37. Does the Cost Containment question set on Page 10 need to be included in the sealed envelope with pricing or just the pricing proposal on Pages 13-15?

A37. Yes, it should be included in the sealed envelope.

Q38. Please share the medical bill volume for the past three years.

A38. 2018-4,532, 2019-4,490, 2020-3,074, 2021-3,470, 2022-2,490 YTD

Q39. Would it disqualify us in not signing a business associate agreement?

A39. Please provide redlines to this agreement as part of the proposal response.

Q40. How frequently does the County need data feeds?

A40. Currently we do not send or receive any data feeds.

Q41. Can the County clarify the "on site" adjuster job responsibilities? What are the adjuster roles/responsibilities/interaction/training/consultation/staff engagement?

A41. Manage all claims, answer questions from injured employees, County Department Liaisons, and managers. Provide training on Workers’ Compensation. Assist with getting appointments set up. Provide advice and recommendations to the County on claims. Work with attorneys to provide information and submit settlement recommendations to the County. Attend meetings as required.

Q42. Does the dedicated claims representative work in the Gwinnett risk/claims systems or the TPA's claims system?

A42. The dedicated claims representative will work in the TPA’s claims system. Gwinnett County does not have its own system.

Preproposal Conference Attendees

• Brentwood

• Gallagher Bassett

• Georgia Administrative Services

• PMA Management Corporation

• TriStar Claims Management

• Underwriters Safety and Claims

Attachments

• Workers Compensation Handbook

• Open Claims Report

• Gwinnett County Claims 2017 – 2022

• Gwinnett County Open Claims_081222

Acknowledge receipt of this addendum on Page 9 of the proposal document.

Sincerely, Dana Garland, CPPB, NIGP-CPP Purchasing

Workers’ Compensation

Employee Handbook

Revisions thru June 2022

Gwinnett County Workers’ Compensation Employee Handbook | 2

Table of Contents Introduction

Our Pledge to Gwinnett County Employees

State Board of Workers' Compensation Bill of Rights for the Injured Worker

General Questions & Answers

Medical Benefit Questions

Disability Benefit Questions

Questions About Specific Injuries

Questions Regarding Time Limits & Filing Claims

Gwinnett County Workers’ Compensation Employee Handbook | 3

Introduction

The Gwinnett County Board of Commissioners provides workers’ compensation coverage for all active employees at no cost to the employee. Workers’ compensation benefits are designed to help compensate an employee who is injured on the job. Workers’ compensation benefits are approved by the County’s workers’ compensation administrator, Alternative Services Concepts.

The Department of Human Resources and Alternative Services Concepts want to assist you by providing accurate, timely service and answer any questions you may have regarding your workers’ compensation claim.

This booklet is not a contract or policy of insurance, and possession of this booklet is designed to assist employees and management in the effective and expeditious handling of work-related injuries.

If you are injured on the job, you have certain rights, benefits, and responsibilities. The Gwinnett County Board of Commissioners, as your employer, also has obligations and responsibilities regarding your workers’ compensation claim.

The Department of Human Resources and Alternative Services Concepts want to assist employees who are injured on the job in assuring immediate and quality medical care, to administer Workers’ Compensation claim from the initial injury until the closure of the claim, and to safely return employees to productive employment.

Please be aware that the Workers’ Compensation Law, Rules and Regulations are subject to change on July 1 of each year. If you have any questions about the information contained in this handbook, please contact the Department of Human Resources, Alternative Services Concepts adjuster, or the State Board of Workers’ Compensation.

Gwinnett County Workers’ Compensation Employee Handbook | 4

Our Pledge to Gwinnett County Employees

The Department of Human Resources staff and Alternative Services Concepts understand the concerns of an injured employee and their family when a wage earner is injured on the job and cannot work. They are available and ready to assist an injured worker through this difficult time.

The Department of Human Resources and Alternative Services Concepts pledges to:

• Give each injured employee individual attention

• Handle your claim in a prompt and courteous manner

• Fully inform you of all workers’ compensation income benefits you are entitled to receive and to pay these benefits to you in a timely manner

• Pay all authorized medical expenses in a prompt and accurate manner

• Make every effort to work with you in returning you to your regular job should your injury require you to lose time from work

Gwinnett County Workers’ Compensation Employee Handbook | 5

State Board of Workers’ Compensation Bill of Rights for the Injured Worker

As required by law, O.C.G.A. (34-9-81.1), this is a summary of your rights and responsibilities. The Workers’ Compensation Law provides you, as a worker in the State of Georgia, with certain rights and responsibilities should you be injured on the job. The Workers’ Compensation Law provides you coverage for a work-related injury even if an injury occurs on the first day on the job. In addition to rights, you also have certain responsibilities. Your rights and responsibilities are described below.

Employee’s Rights

1. If you are injured on the job, you may receive medical, rehabilitation, and income benefits. These benefits are provided to help you return to work. Your dependents may also receive benefits if you die as a result of a job-related injury.

2. Your employer is required to post a list of at least six doctors or the name of the certified WC/MCO which provides medical care. You may choose a doctor from the list and make one change to another doctor on the list without the permission of your employer. However, in an emergency, you may get temporary medical care from any doctor until the emergency is over; then, you must get treatment from a doctor on the posted list.

3. Your authorized doctor bills, hospital bills, rehabilitation in some cases, physical therapy, pres-criptions, and necessary travel expenses will be paid if injury was caused by an accident on the job.

4. You are entitled to weekly income benefits if you have more than seven days of lost time due to an injury. Your first check should be mailed to you within 21 days after the first day you missed work. If you are out more than 21 consecutive days due to your injury, you will be paid for the first week.

5. Accidents are classified as being either catastrophic or non-catastrophic. Catastrophic injuries are those involving amputations, severe paralysis, severe head injuries, severe burns, blindness, or of a nature and severity that prevents the employee from being able to perform his or her prior work and any work available in substantial numbers within the national economy. In catastrophic cases, you are entitled to receive two-thirds of your average weekly wage up to the maximum allowed under the law for a job-related injury for as long as you are unable to return to work. You are also entitled to receive medical and vocational rehabilitation benefits to help in recovering from your injury. If you need help in this area, call the State Board of Workers’ Compensation at

404.656.3875 or toll-free number 800.533.0682. Your employer will advise you of the amount of your weekly benefit.

6. In all other cases (non-catastrophic), you are entitled to receive two-thirds of your average weekly wage, but not more than the maximum allowed under the law for a job- related injury. You will receive these weekly benefits as long as you are totally disabled, but no longer than 400 weeks. If you are not working and it is determined that you have been capable of performing work with restrictions for 52 consecutive weeks or 78 aggregate weeks, your weekly income benefits will be reduced to two-thirds of your average weekly wage, but no more than the maximum allowed under the law, not to exceed 350 weeks.

Gwinnett County Workers’ Compensation Employee Handbook | 6

7. When you are able to return to work but can only get a lower paying job as a result of your injury, you are entitled to a weekly benefit of not more than the maximum allowed under the law for no longer than 350 weeks.

8. Your dependent(s), in the event you die as a result of an on-the-job accident, will receive burial expenses up to the maximum allowed under the law and two-thirds of your average weekly wage, but not more than the maximum allowed under the law. A widowed spouse with no children will be paid a maximum allowed by law at the time of injury. Benefits continue until he/she remarries or openly cohabits with a person of the opposite sex.

9. If you do not receive benefits when due, the insurance carrier/employer must pay a penalty which will be added to your payments.

Employee’s Responsibilities

1. You should follow written rules of safety and other reasonable policies and procedures of the employer.

2. You must report any accident immediately, but not later than 30 days after the accident, to your employer, your employer’s representative, your foreman, or immediate supervisor. Failure to do so may result in the loss of the benefits.

3. You must accept reasonable medical treatment and rehabilitation services when ordered by the State Board of Workers’ Compensation, or the Board may suspend your benefits.

4. No compensation shall be allowed for an injury or death due to the employee’s willful misconduct.

5. You must notify the insurance carrier/employer of your address when you move to a new location.

You should notify the insurance carrier/employer when you are able to return to full-time or part-time work and report the amount of your weekly earnings because you may be entitled to some income benefits even though you have returned to work.

6. A dependent spouse of a deceased employee shall notify the insurance carrier/employer upon change of address or remarriage.

7. You must attempt a job approved by the authorized treating physician even if the pay is lower than the job you had when you were injured. If you do not attempt the job, your benefits may be suspended.

8. If you believe you are due benefits and your insurance carrier/employer denies these benefits, you must file a claim within one year after the date of last authorized medical treatment or within two years of your last payment of weekly benefits or you will lose your right to these benefits.

9. If your dependent(s) do not receive allowable benefit payments, the dependent(s) must file a claim with the State Board of Workers’ Compensation within one year after your death or lose the right to these benefits.

Gwinnett County Workers’ Compensation Employee Handbook | 7

10. Any request for reimbursement to you for mileage or other expenses related to medical care must be submitted to the insurance carrier/employer within one year of the date the expense was incurred.

11. If an employee unjustifiably refuses to submit to a drug test following an on-the-job injury, there shall be a presumption that the accident and injury were caused by alcohol or drugs. If the presumption is not overcome by other evidence, any claim for workers’ compensation benefits would be denied.

12. You shall be guilty of a misdemeanor and, upon conviction, shall be punished by a fine of not more than $10,000 or imprisonment up to 12 months, or both for making false or misleading statements when claiming benefits. Also, any false statements or false evidence given under oath during the course of any administrative or appellate division hearing is perjury.

The State Board of Workers’ Compensation will provide you with information regarding how to file a claim and will answer any other questions regarding your rights under the law. If you are calling in the Atlanta area, the telephone number is 404.656.3875.

Outside the metro Atlanta area, call 1.800.533.0682 or write the State Board of Workers’ Compensation at: 270 Peachtree Street, NW, Atlanta, Georgia 30303-1299. A lawyer is not needed to file a claim with the Board. However, if you think you need a lawyer and do not have your own personal lawyer, you may contact the Lawyer Referral Service at 404.521.0777 or 1.800.334.6865.

Willfully making a false statement for the purpose of obtaining or denying benefits is a crime subject to penalties of up to $10,000 per violation (O.C.G.A. 34-9-18 and 34-9-19).

Gwinnett County Workers’ Compensation Employee Handbook | 8

General Questions & Answers

What is workers’ compensation?

Workers’ compensation is a benefits program created by state law that provides medical, rehabilitation, income, death, and other benefits to employees and dependents due to injury, illness, and death resulting from a compensable work-related claim covered by the law.

When does coverage begin?

Workers’ compensation coverage begins the first day of employment. Employers with three or more employees are required by law to provide coverage.

What is considered an on-the-job injury, illness, and death claim?

Any injury, illness, or death arising out of and in the course of employment is by definition a compensable work-related claim. This means if employees are injured while performing assigned job duties during assigned work hours, they are covered under the workers’ compensation program.

Injuries sustained while engaging in unassigned duties, during lunch, and breaks are not covered. In addition, injuries that occur during an employee’s normal commute to and from work are not covered.

If I am injured on the job, what should I do?

You should immediately report your injury to your supervisor. Obtain and fill out the required paperwork and forward to the appropriate organization — Alternative Services Concepts — for processing. Be as specific as possible when reporting your injury. If anyone witnessed your accident, inform your supervisor of such a witness. Prompt notification will enable Alternative Services Concepts to begin your benefits in a timely manner.

Your supervisor may report your injury by one of the following options:

• Call: 615.630.6428

• Fax: 888.316.8751

• Email: Marian.Franks@US.Davies-Group.com

The injured employee should complete the following forms:

• Employee’s Report of On-The-Job Injury

• Workers’ Compensation Employee Statement

• Employee Election Certificate

Your supervisor should complete:

• WC-1

• Supervisor’s Report of On-The-Job Injury Form

Failure to report an injury could jeopardize your workers’ compensation benefits.

Gwinnett County Workers’ Compensation Employee Handbook | 9

Who should receive the completed forms?

Alternative Services Concepts administers the Gwinnett County’s Workers’ Compensation Program.

Completed forms should be faxed to 888.316.8751 or emailed — Marian.Franks@US.Davies-Group.com — immediately to the Alternative Services Concepts adjuster and the Department of Human Resources.

Alternative Services Concepts’ normal office hours are Monday through Friday, 8:00am to 5:00pm. If you call outside these hours, you may leave a detailed voicemail message to 615.630.6428, including your name and phone number. A staff member will return your call.

What happens if I cannot make a report of my injury?

If your injury is such that you are unable to make a report, you will be provided immediate medical assistance, and a report will be made for you. Others reporting the injury should also be as specific as possible when reporting the accident, and the report should be turned over to Alternative Services Concepts as soon as possible.

Who should I contact if I have questions about my claim?

For general questions about your claim, call 615.630.6428. A staff member will be happy to assist you. You may also contact the Department of Human Resources at 770.822.7932 if you need additional assistance.

How long does it normally take for a claim decision from Alternative Services Concepts?

It should only take one to two days to make a decision once Alternative Services Concepts is notified. Although, in some instances, additional time may be necessary

Are employee misconduct claims resulting from on-the-job injuries covered?

No. Workers’ compensation does not provide benefits for an injury or accident resulting from an employee’s willful misconduct (i.e. fighting, horseplay, willful act of third party for personal reasons, injuries related to alcohol or drug abuse).

Are injuries resulting from haste and inattentiveness covered?

Yes. These types of injuries would be covered under the workers’ compensation program. However, employees are encouraged to follow the County’s policies and safety rules and may subject themselves to discipline if these rules are not adhered to.

Gwinnett County Workers’ Compensation Employee Handbook | 10

Will I receive compensation for my personal items if damaged in the accident resulting in my injury?

No. Personal items are not covered by the Workers’ Compensation Act for the State of Georgia.

Can I receive other monetary compensation for damages from the County in addition to workers’ compensation benefits if I am injured on the job?

No. Workers’ compensation is the “exclusive remedy” a worker has against his/her employer for damages resulting from an on-the-job injury.

Can I sue anyone for a work-related injury?

If your injury was caused by the negligence of a third party other than another person who is also an employee of the company for which you work, you may have a right to sue that party. If you sue and receive a dollar award, Gwinnett County may have a right to recover some or all of the cost expended in your workers’ compensation claim. This is known as a subrogation lien. The lien would only be recoverable after you had been fully compensated for your loss resulting from your on-the-job injury.

How much will an attorney charge to handle a workers’ compensation claim?

Most workers’ compensation claims can be handled without having to hire an attorney. However, if you feel that an attorney is needed, the Workers’ Compensation Statute limits the attorney’s fee to a maximum of 25 percent of income benefits received, not to exceed 400 weeks of benefits. In addition, you would also be responsible for paying any expenses associated with the pursuit of your claim. Employees have rights and responsibilities under the Workers’ Compensation Act established by the State Board of Workers’ Compensation.

You may contact the State Board of Workers’ Compensation for additional information and assistance at:

State Board of Workers’ Compensation 270 Peachtree Street NW Atlanta, GA 30303-1299 1.800.533.0682 404.656.3818

How can I jeopardize my benefits?

Yes. You may jeopardize your benefits if you:

• Fail to report injuries promptly

• Fail to cooperate with employer and authorized treating physician regarding medical evaluations, treatment, rehabilitation services and claim investigation

Gwinnett County Workers’ Compensation Employee Handbook | 11

• Refuse to return to suitable employment

• Work elsewhere while receiving temporary total disability benefits

• Submit fraudulent information

• Refuse to take a drug test

• Refuse to submit to a medical examination by the authorized treating physician at reasonable times

Are there circumstances where I would not receive workers’ compensation benefits as a result of an on-the-job injury?

Yes. For instance, benefits are not payable if you are injured while engaged in willful misconduct or if your injury is due to the use of alcohol or drugs or the misuse of controlled substances. At the time of an on-the-job injury, a drug screen may be required. A refusal to have the drug screen may jeopardize your workers’ compensation benefits. A positive drug screen may result in your workers’ compensation benefits being denied.

How does my workers’ compensation claim affect my accrued leave?

The authorized treating physician must approve any time you miss from work due to your on-the-job injury. The approved hours should be coded as WCMP leave on your time sheet. Otherwise, you must use accrued sick leave. If no sick leave is available, annual leave will be used. In the event there is no annual leave available, the missed time will be coded as leave without pay.

Are on-the-job accidents or injuries investigated?

Yes. Alternative Services Concepts investigates on-the-job injuries or accidents to determine why and how the injury occurred and to implement policies and procedures to make the work place a safe environment.

Can my employment be terminated for reporting an on-the-job injury or unsafe condition?

No. Injuries should be reported immediately so that medical assistance may be provided. Any unsafe work condition/hazard should be reported and corrected expeditiously to provide a safe work environment for all employees.

Does the State Board of Workers’ Compensation investigate fraud?

Yes. The Board has an Enforcement Division that investigates allegations of fraud. The Board also has authority to assess civil penalties of up to $10,000 for violations involving fraud.

Gwinnett County Workers’ Compensation Employee Handbook | 12

Medical Benefit Questions

How will I identify the Panel of Physicians?

The list of physicians will be printed on paper titled “OFFICIAL NOTICE. This business operates under the Georgia Workers’ Compensation Law.” It will contain the name, specialty, address, and phone number of the authorized physicians approved by the Gwinnett County Board of Commissioners to treat employees who are injured on the job. The notice should be posted in a prominent area at your work location. The law requires that you are informed of this list and understand its function. One of the following referral methods may be used:

Panel of Physicians — This must contain at least six qualified physicians. The makeup of the panel must include one orthopedic surgeon, a minority physician, and four other properly qualified physicians.

Conformed Panel — This must include at least 10 qualified physicians.

Workers’ Compensation Managed Care Organization (WC/MCO) — A WC/MCO offers a much larger choice of treating physicians from many disciplines. The WC/MCO must be approved by the State Board of Workers’ Compensation.

The physicians/facilities listed on the Official Notice do not work for Gwinnett County Board of Commissioners or Alternative Services Concepts. Gwinnett County makes every effort to list physicians who are well qualified in treating occupational injuries.

May I go to my personal physician for treatment for my on-the-job injury?

No, unless your physician is listed on the Official Notice. The law requires that you select a physician from a posted Official Notice. If you elect to seek medical treatment by a physician that is not listed on the approved panel, it would be considered unauthorized treatment, and Gwinnett County will not be responsible for the cost associated with the medical care. In addition, most personal health insurance carriers will not pay for medical treatment associated with an on-the-job injury.

What if I am dissatisfied with the treatment I receive from the panel physician?

If you are dissatisfied with the treatment you received from your authorized treating physician, you may elect to make a one-time change to another physician by submitting your written request to your assigned adjuster and selecting another physician listed on the Official Notice. Should you choose to go to a doctor not on the approved list, this is considered unauthorized treatment, and your employer will not be responsible for the cost associated with this medical care. In addition, most health insurance policies will not pay for medical treatment associated with an on-the-job injury.

Gwinnett County Workers’ Compensation Employee Handbook | 13

What must I do if I need emergency treatment?

In a true emergency situation, you may get temporary medical care from the nearest emergency location available. Once the emergency is over, however, you must continue your care by selecting a doctor from the list of physicians on the approved Official Notice.

What happens if I need surgery?

Prior to scheduling any major surgical procedures for an on-the-job injury, except in the case of an emergency, your doctor will notify Alternative Services Concepts. The Alternative Services Concepts adjuster will work with your physician and/or his/her medical staff to ensure that all the necessary arrangements are made.

What if the doctor says that I need an MRI or CT scan?

To ensure that you are provided with quality, prompt, and convenient MRI/CT scan service, Alternative Services Concepts has established a network to provide these services to you if your physician cannot perform this service at the treatment facility.

What if I need physical therapy?

Your authorized treating physician will prescribe your needed physical therapy. You will be contacted by the physical therapy network to set up your physical therapy sessions within a location near your work or home.

Am I required to pay a portion of the cost of the medical care I receive resulting from my on-the-job injury?

No. Your physician’s bills and reasonable medical bills are covered if an authorized physician provides your medical care. All medical charges are paid according to the Georgia Workers’ Compensation Medical Fee Schedule. If your medical provider charges above the fee schedule, the charges will be reduced to the fee schedule, and that amount will be paid. Occasionally, the provider will bill the injured employee directly for the balance. You are not responsible for charges above the fee schedule. If you receive a medical bill, simply notify the Alternative Services Concepts adjuster at 615.630.6428.

If the physician prescribes medicines for me, what do I do?

Prescription drugs are covered under workers’ compensation and can be billed directly to Alternative Services Concepts. This process will prevent you from having any out-of- pocket expenses. In the event it is necessary for you to pay for a prescription, simply forward your receipt to the Alternative Services Concepts adjuster, and the costs will be refunded to you. Temporary prescription cards are available on the County intranet under the Employment and Benefits, Risk Management section.

Gwinnett County Workers’ Compensation Employee Handbook | 14

Are there any expenses that I incur to be reimbursed to me?

The Workers’ Compensation Statute provides for reimbursement of certain reasonable personal expenses incurred to obtain medical treatment. This includes mileage, meals, lodging, and other expenses, in limited instances, which are deemed necessary and appropriate in order to ensure you receive quality medical care. You should check with the Alternative Services Concepts adjuster before incurring expenses.

How long do reimbursements take?

Approved expenses will be reimbursed within 30 days of submission as required by the Workers’ Compensation Statute. However, most carriers process reimbursements in less time. If reimbursements are not paid within 30 days of receipt of documentation requesting reimbursement, penalties shall be added in addition to the reimbursement amount. It is important to submit your approved expenses within a year’s time of the date of service, otherwise you will have waived your right to collect such charges.

Does my workers’ compensation claim qualify me for Family Medical Leave Act (FMLA) protection?

You are eligible for FMLA if you have been employed by Gwinnett County Board of Commissioners for at least 12 months, worked 1,250 hours during the 12 months preceding commencement of the requested leave, and unable to work as a result of a serious health condition. Decisions regarding FMLA and disability have separate regulations and guidelines. For more details and/or FMLA paperwork, please contact your Human Resources team at 770.822.7915.

Gwinnett County Workers’ Compensation Employee Handbook | 15

Disability Benefit Questions

What if I cannot perform my regular job and another job is not available?

You would be eligible to receive temporary total disability benefits if you are unable to work due to your on-the-job injury. It is recommended that you contact the Department of Human Resources to seek other employment opportunities within Gwinnett County.

What happens if my disability becomes permanent?

If your authorized treating physician determines you have suffered a permanent disability, you would be entitled to receive temporary total disability benefits for as long as you remain disabled. If you are able to work, you would begin receiving a weekly income benefit based on the permanent disability rating given you by your authorized treating physician (see Permanent Partial Disability Benefits below). The benefit would be paid to you regardless of your wage rate or total income.

What income benefits are available under the Workers’ Compensation Program?

Under current policy, full-time employees of Gwinnett County Board of Commissioners who are injured on the job may elect to receive an enhanced benefit of full salary in lieu of workers’ compensation state-mandated benefits. In order to be eligible to receive the enhanced benefit, injured employees must participate fully in an alternative work assignment. Additionally, there is no waiting period for commencement of benefits as mandated by the State.

The Workers’ Compensation Statue provides four basic income benefits. The maximum amount of weekly workers’ compensation benefits an employee can receive from an on- the-job injury, illness, or death depends on the workers’ compensation rate at the time of the injury and the employee’s average weekly wage.

Temporary Total Disability Benefits — This benefit is payable to an employee who is injured on the job and unable to work as determined by the authorized treating physician. The amount is two-thirds of the employee’s average weekly wage at the time of the injury, not to exceed the maximum amount allowed under the law. For non- catastrophic injuries, there is a limit of 400 weeks of benefits from date of injury if the injury occurred on or after July 1, 1992. For catastrophic injuries, benefits are unlimited.

Temporary Partial Disability Benefits — This benefit is payable to an employee when he/she returns to work in a job paying less as a result of an on-the-job accident. These benefits are payable for up to 350 weeks from the date of injury. This lost wage amount is two-thirds of the difference between the employee’s average weekly wage before and after the injury. The maximum amount payable cannot exceed the maximum allowed under the law.

Gwinnett County Workers’ Compensation Employee Handbook | 16

Permanent Partial Disability Benefits — This benefit is payable to the employee for a permanent disability resulting from an on-the-job injury. It is payable based upon a percentage given by your authorized treating physician in accordance with current AMA Guidelines. The percentage is calculated by a formula that contains number of weeks assigned by the State Board X the percentage rating X the temporary total disability rate. Not all injuries result in ratings assigned by a physician.

Death Benefits — This benefit is payable to eligible dependents (i.e., dependent spouse, minor children) of an employee whose on-the-job injuries result in death. This benefit is payable at the rate of two-thirds of the deceased employee’s average weekly wage at the time of the accident not to exceed the maximum allowed under the law for all eligible dependents. Funeral expenses are payable up to the maximum allowed under the law at the time of injury.

Benefits cannot be combined. Only one type of benefit is payable at a time.

What happens to my workers’ compensation benefits if I receive a light-duty release from my physician while I am out of work?

You must present the light duty release to your supervisor. If no work is available in your department within your listed limitations or restrictions, your supervisor should contact the Department of Human Resources for instructions on where you should report to be placed in a temporary alternative position. However, if a light-duty job is not available and you remain out of work in a light-duty status for 52 consecutive weeks or, if periods of disability are interrupted, a maximum of 78 total calendar weeks, your income benefits will be reduced automatically by law from the temporary total disability benefit to the maximum eligible temporary partial disability benefit.

If you are given a light-duty release and a light-duty job is available, Gwinnett County will expect you to return to work. A refusal to return to work in this situation could result in termination of your workers’ compensation benefits. The Workers’ Compensation Statute provides for unilateral suspension of the employee’s disability benefits for failure of the employee to attempt a suitable job for eight cumulative hours or one scheduled workday, whichever is greater.

Gwinnett County Workers’ Compensation Employee Handbook | 17

Questions About Specific Injuries

Can I be compensated for occupational-related diseases?

Yes. If your disease meets certain tests imposed by law, you can be compensated. There must be a causal relationship between your employment and the disease. It cannot be a disease that is an ordinary disease of life to which others are exposed.

What happens if I re-injure a preexisting condition or injury?

The Workers’ Compensation Act limits the extent to which an aggravation of a preexisting condition or injury is compensable. An aggravation of an on-the-job injury is compensable while the aggravation is the cause of the disability. Once the aggravation resolves and you return to the pre-injury condition, the claim will no longer be compensable.

Can I be compensated for a repetitive motion injury?

Yes. Repetitive motion injuries are compensable if they arise out of and in the course of employment.

What is a catastrophic injury?

Catastrophic injuries are extremely severe injuries, i.e., loss of limbs, severe burns, etc. A rehabilitation supplier who has expertise in handling catastrophic cases will be assigned to your claim. This expert would assist you in managing your medical care as well as any other assistance you might need in the recovery period following the accident. You will be entitled to temporary total disability benefits for as long as you remain unable to work. Once you have returned to work, the temporary total disability benefits will cease. If you are placed in a lower paying job, you will begin receiving temporary partial disability benefits. After those benefits have been paid, you will begin receiving permanent partial disability benefits.

Are heart attacks and strokes covered under workers’ compensation?

Heart attacks and strokes are not considered injuries under workers’ compensation unless it is shown by a preponderance of competent and credible evidence, which shall include medical evidence, that the condition was attributable to the performance of the usual work of employment.

Will my dependents receive benefits if my death occurs as the result of an on-the-job injury?

Yes. Qualified dependents, generally the surviving spouse and dependent children, will receive two-thirds of the injured employee’s average week wage not to exceed the maximum amount provided by the Workers’ Compensation Act at the time of injury. A widowed spouse with no children is limited to a maximum amount as provided by the Workers’ Compensation Act. When minor children are involved, benefits will continue until the youngest child is age 18, or 22 if a full-time college student.

Gwinnett County Workers’ Compensation Employee Handbook | 18

Questions Regarding Time Limits & Filing Claims

What if my workers’ compensation claim is denied?

If your claim is denied, you will be notified of the reason for the denial. If you feel your claim was improperly denied, you should contact Alternative Services Concepts to discuss your claim situation with the claim supervisor. You have the right to request a hearing from the State Board of Workers’ Compensation if you disagree with the denial of your claim. A claim with the State Board must be filed within one year of the date of injury. The procedure for filing a claim with the State Board of Workers’ Compensation is outlined on the back of the workers’ compensation form titled, “Employer’s First Report of Injury” (WC-1).

Is there a time limit or statute of limitation on filing a workers’ compensation claim, and, if so, what is it?

After properly reporting an injury, you have one year from the date of the injury to file a claim. If you received remedial treatment from your employer for the injury, you have one year from the date of treatment to file a claim for workers’ compensation benefits. If you received weekly income benefits as a result of the on-the-job injury, you have two years from the date of your last payment of weekly income benefits to file a claim.

In the case of an occupational disease claim, you have one year from the date you become aware of your disease or, in the exercise of reasonable diligence, should have known of the relationship between your disability and its relationship to your employment. No claim for an occupational disease may be filed after seven years from the last date you were exposed to the employment hazards related to your disease. However, for the diseases asbestosis or mesothelioma related to exposure to asbestos, you have one year from the date of first disablement after diagnosis to file a claim.

Once I’m treated for my injury and have reached maximum medical improvement and begin having problems in the future due to my injury, may I receive additional treatment for this injury?

Yes. You can go back to your authorized treating physician and receive treatment in accordance with the established guidelines set by the State Board of Workers’ Compensation as outlined above.

When will my claim be officially closed?

When appropriate benefits have been paid, or once a settlement agreement is reached by all parties and approved by the State Board of Workers’ Compensation and a monetary amount is paid to you or your dependents, your claim is closed. Note that not all claims are closed. Some claims, due to the nature of the injury, remain open until the statute of limitations runs, or until the injured worker’s death, whichever occurs first.

Gwinnett County Workers’ Compensation Employee Handbook | 19

If this information has not answered your questions regarding your workers’ compensation benefits, please feel free to contact Alternative Services Concepts at 615.630.6428, and a staff member will be happy to assist you. You may also contact the Department of Human Resources at 770.822.7932 if you need additional assistance.

If for any reason you are uncomfortable with Alternative Services Concepts or the Department of Human Resources’ explanation of workers’ compensation, the State Board of Workers’ Compensation is available to answer your questions. You may contact the State Board of Workers’ Compensation at:

State Board of Workers’ Compensation 270 Peachtree Street NW Atlanta, GA 30303-1299

1.800.533.0682 or 404.656.3818

Open Claims - Indemnity

Claim Type (m/i)

Date Of Loss

Osha Reporta ble

Osha Severity Code

Occ Illness

Lost Hours

Lost Days

Restricte d Days

Location Body Part Nature Of Injury Cause Paid Med/bi/loss

Paid Expense

Paid Ind/pd

Paid Legal

Paid Voc Rehab

Paid Total Paid Recovery

Incurred Total

O/S Reserve Total

Statu s

Accident Description

I 7/18/2022 Y 0 5 17040001 Ankle Sprain Strain/Inj Miscellaneous 0.00 0.00 0.00 0.00 0.00 0.00 0.00 5,751.00 5,751.00 O EMPLOYEE WAS WALKING BUILDING AT THE END OF THE DAY AND

ROLLED LEFT ANKLE

I 7/5/2022 Y 0 15 22010001 Shoulders Strain Strain/Inj Miscellaneous 3,292.30 77.63 0.00 0.00 0.00 3,369.93 0.00 7,000.00 3,630.07 O EMPLOYEE WAS BREAKING UP A FIGHT BETWEEN TWO OFFENDERS AND

INJURED RIGHT SHOULDER

I 8/4/2020 Y 0 0 24020007 Great Toe Multiple Physical Injuries

Struck/Inj Falling/Flying Object 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,500.00 2,500.00 O PERSON MAKING THE CLAIM IS UNABLE TO PROVIDE DETAILS OF WHAT

EMPLOYEE WAS DOING AT THE TIME OF THE INJURY WHEN PLEXIGLASS

WAS DROPPED ON EMPLOYEE'S LEFT GREAT TOE

I 6/3/2019 0 0 24100006 Hand Puncture Animal or Insect 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,500.00 2,500.00 O EMPLOYEE WAS PUTTING A DOG BACK IN THE PEN WHEN DOG BIT

EMPLOYEE'S LEFT HAND

I 11/30/2020 0 133 24100006 Knee Strain Strain/Inj Twisting 3,181.40 285.16 0.00 0.00 0.00 3,466.56 0.00 10,425.41 6,958.85 O EMPLOYEE WAS IMPOUNDING A ROOSTER DUE TO A COMPLAINT AND

SHE TWISTED HER LEFT KNEE DUE TO THE RAIN

I 1/14/2022 Y 0 0 27050001 Knee All Other Strike/Step Miscellaneous 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,500.00 2,500.00 O EMPLOYEE WAS IN TRAINING AND WAS RUNNING ON A HARD SURFACE

AND EMPLOYEE BEGAN EXPERIENCING PAIN AND SWELLING IN

EMPLOYEE'S LEFT KNEE

I 3/29/2022 Y 0 23 21200015 Multiple Body Parts Strain Veh/Air Collision w/ Another Vehicle

1,068.70 33.68 0.00 0.00 0.00 1,102.38 0.00 19,875.00 18,772.62 O EMPLOYEE WAS WAITING IN RIGHT TURN LANE TO TURN AND WAS REAR

ENDED BY ANOTHER VEHICLE

I 5/17/2021 7 63 21200017 Finger(s) Sprain Strain/Inj Holding or Carrying 16,883.28 775.48 6,075.00 0.00 0.00 23,733.76 0.00 42,844.86 19,111.10 O HE WAS CARRYING A RIFLE SHIELD WITH HIS LEFT ARM AND AN AED

WITH HIS RIGHT ARM TO HIS PATROL CAR, EMPLOYEE'S LEFT ELBOW

POPPED AND THE RIFLE SHIELD PRESSED HIS LEFT…