2012 Annual Report – Page 2

STATE OF GEORGIA SUBSEQUENT INJURY TRUST FUND July 2013 SITF 2012 Annual Report – Page 2 State of Georgia Subsequent Injury Trust Fund Marriott Marquis Tower Two Suite 1250 285 Peachtree Center Avenue Atlanta, GA 30303-1229 Telephone: (404) 656-7000 Fax: (404) 656-7100 Website: http://sitf.georgia.gov Board of Trustees John T. Fervier, II – Chairman E. Pauline Hale John L. Quinn Barbara Tempel Steve Heinen Administrator Michael T. Coan Deputy Administrator Allan Payne SITF 2012 Annual Report – Page 3 Fund Administration .................................................................................................. 4 Introduction _____________________________________________________________________ 4 How the Fund Works ______________________________________________________________ 4 Reimbursement from the Fund _______________________________________________________ 4 Legislation ______________________________________________________________________ 4 Claims Administration _____________________________________________________________ 7 Claims Activity – 2012 _____________________________________________________________ 7 Settlement Reimbursement Limits ____________________________________________________ 8 Financial Activity _________________________________________________________________ 9 Reimbursements Paid in 2012 .................................................................................10 Reimbursements to Insurance Companies _____________________________________________ 10 Reimbursements to Self-Insurers ____________________________________________________ 15 Reimbursements to Group Self-Insurers ______________________________________________ 21 Individual Employers Benefitting from SITF Reimbursements ...............................22 Assessment by the Fund ...........................................................................................46 Legal Requirements ______________________________________________________________ 46 Assessment Calculation ___________________________________________________________ 47 Assessment Adjustment for 2011 ____________________________________________________ 47 Assessment Rate for 2012 _________________________________________________________ 47 Assessments Due for 2012 .......................................................................................48 Assessments Due from Insurance Companies __________________________________________ 48 Assessments Due from Self-Insurers _________________________________________________ 55 Assessments Due from Group Self-Insurers ___________________________________________ 63 SITF 2012 Annual Report – Page 4 Fund Administration employment provided the employer could Introduction demonstrate prior knowledge. Reimbursement from the Fund On July 1, 1977, the Georgia General Assembly enacted legislation establishing All licensed workers' compensation the Subsequent Injury Trust Fund. It is insurance carriers and self-insured designed to reduce the impact of singularly employers authorized by the State Board of large workers' compensation claims in the Workers’ Compensation in the state of event a worker with a disability, injured on Georgia may access the fund. the job, aggravates a pre-existing permanent impairment. Employers/insurers must notify the fund of a possible claim by filing a Notice of Claim no The Subsequent Injury Trust Fund is later than 78 weeks following the date of governed by a five-member Board of injury. Trustees appointed by the Governor for six- year terms. The Administrator and staff In addition to the mandatory Notice of conduct the day-to-day administration of the Claim, the employer must submit a fund. notarized Employer’s Knowledge Affidavit, certifying prior knowledge of the worker’s How the Fund Works pre-existing permanent impairment. The fund helps workers with disabilities by providing employers, who are not subject to Employers/insurers may be reimbursed for the Americans with Disabilities Act, with all weekly income benefits payable after 104 incentives to hire or retain qualified workers weeks; for 50% of all medical and with disabilities. The fund supports insured rehabilitation expenses between $5,000 and employers by keeping workers' $10,000; and for 100% of all medical and compensation premiums under control, and rehabilitation expenses in excess of if an employer is self-insured, keeps the $10,000. workers' compensation exposure at the deductible levels. If the subsequent injury was not caused by or related to a prior impairment, the In order for an employer/insurer to be reimbursement for medical expenses may eligible for reimbursement from the fund, the be reduced or denied completely. on-the-job injury of the employee must be Legislation directly caused by or combined with a prior impairment to create a greater liability for In 2005, House Bill 200 amended the lost-time benefits and medical expenses. In Official Code of Georgia by adding addition, the employee must have a pre- Chapter 34-9-368 setting the date to existing impairment that the employer dissolve the agency and establishing June considered to be permanent and likely to be 30, 2006 as the last date of injury eligible for a hindrance to employment, and the reimbursement by the Fund. employer must have knowledge of the prior impairment before the subsequent injury 34-9-368. Reimbursement of self-insured occurs. employers or insurers; actuarial study required; dissolution of Subsequent Injury Trust Fund O.C.G.A.§34-9-361 contains a list of (a) The Subsequent Injury Trust Fund shall not conditions that are presumed to be reimburse a self-insured employer or an insurer permanent and likely to be a hindrance to for a subsequent injury for which a claim is made for an injury occurring after June 30, SITF 2012 Annual Report – Page 5 2006. The Subsequent Injury Trust Fund shall continue to reimburse self-insured employers or 34-9-362. Notice by employer or insurer of insurers for claims for injuries occurring on and claim against fund prior to June 30, 2006, which qualify for (a) An employer or insurer shall notify the reimbursement. administrator of the fund of any possible claim (b) Self-insured employers and insurers shall against the fund as soon as practicable, but in continue to pay assessments pursuant to Code no event later than 78 calendar weeks following Section 34-9-358 to the extent necessary to fund the injury or the payment of an amount claims for injuries occurring on and prior to equivalent to 78 weeks of income or death June 30, 2006. benefits, whichever occurs last. (c) Upon or in contemplation of the final (b) The claim must be filed in accordance with payment of all claims filed for subsequent the requirements of subsection (a) of this Code injuries for which claims are filed for injuries section prior to the final settlement of the claim. occurring on and prior to June 30, 2006, the (c) Failure to comply with the provisions of board of trustees shall adopt and implement subsections (a) and (b) of this Code section will resolutions providing for the final dissolution of constitute a bar to recovery from the Subsequent the Subsequent Injury Trust Fund. Such Injury Trust Fund. resolutions shall become effective when all (d) For those notices of claim filed with the claims made for injuries occurring on and prior fund on or before July 1, 2006, the employer or to June 30, 2006, have been fully paid or insurer shall have until June 30, 2009, to obtain otherwise resolved and shall include provisions a reimbursement agreement issued by the fund for: or the claim for reimbursement shall be deemed (1) The termination of assessments against automatically denied. insurers or self-insurers; (e) For those notices of claim filed with the (2) The pro rata refund of assessments fund after July 1, 2006, the employer or insurer previously collected and unexpended; shall have three years from the date the notice (3) The termination of employment of the was received by the fund to obtain a employees of the fund or the transfer of reimbursement agreement issued by the fund or employment of any employees to any other state the claim for reimbursement shall be deemed agency desiring to accept them; automatically denied. (4) A final accounting of the financial affairs (f) Notwithstanding subsections (d) and (e) of of the fund; and this Code section, if compensability of the (5) The transfer of the books, records, and underlying workers' compensation claim is at property of the fund to the custody of the State issue before the State Board of Workers' Board of Workers' Compensation. Compensation, then the employer or insurer Upon the completion of all matters provided for shall have three years from the date of final in such resolutions, but not later than December adjudication of compensability by the State 31, 2020, the Subsequent Injury Trust Fund and Board of Workers' Compensation or any the members of its board of trustees shall be appellate court to obtain a reimbursement discharged from their duties except for such agreement issued by the fund or the claim for personnel necessary to administer any reimbursement shall be deemed automatically remaining claims. denied. (g) Upon actual or statutory automatic denial In 2006, an amendment to OCGA 34-9-362 pursuant to subsection (d), (e), or (f) of this was passed to establish time limits for Code section, the employer or insurer shall have employers or insurers to satisfactorily prove 20 days from the date of denial to request a a claim once filed with the Subsequent hearing with the

Load more