2020 Georgia Code
Title 34 - Labor and Industrial Relations
Chapter 9 - Workers' Compensation
Article 6 - Payment of Compensation
Part 1 - Medical Attention
§ 34-9-205. Board Approval of Physician's Fees, Hospital, and Other Charges; Collection of Fees; Schedule of Charges; Filing Costs for Peer Review

1. Fees of physicians, charges of hospitals, charges for prescription drugs, and charges for other items and services under this chapter shall be subject to the approval of the State Board of Workers' Compensation. No physician, hospital, or other provider of services shall be entitled to collect any fee unless reports required by the board have been made.
2. Annually, the board shall publish in print or electronically a list by geographical location of usual, customary, and reasonable charges for all medical services provided under subsection (a) of this Code section. The board may consult with medical specialists in preparing said list. Fees within this list shall be presumed reasonable. No physician or hospital or medical supplier shall bill the employee for authorized medical treatment; provided, however, that if an employee fails to notify a physician, hospital, or medical supplier that he or she is being treated for an injury covered by workers' compensation insurance, such provider of medical services shall not be civilly liable to any person for erroneous billing for such covered treatment if the billing error is corrected by the provider upon notice of the same. The board may require recommendations from a panel of appropriate peers of the physician or hospital or other authorized medical supplier in determining whether the fees submitted and necessity of services rendered were reasonable. The recommendations of the panel of appropriate peers shall be evidence of the reasonableness of fees and necessity of service which the board shall consider in its determinations.
3. Any party requesting peer review pursuant to the provisions of this Code section shall pay to the board such filing costs for peer review as established by the board; provided, however, that the prevailing party in any peer review request shall be entitled to recover its filing costs, if any, from the party which does not prevail.

(Ga. L. 1920, p. 167, § 63; Code 1933, § 114-714; Ga. L. 1937, p. 528; Ga. L. 1978, p. 2220, § 15; Ga. L. 1985, p. 727, § 5; Ga. L. 1990, p. 1409, § 8; Ga. L. 1992, p. 6, § 34; Ga. L. 1997, p. 1367, § 7; Ga. L. 2007, p. 616, § 5/HB 424; Ga. L. 2010, p. 838, § 10/SB 388.)

- For survey article on workers' compensation law, see 59 Mercer L. Rev. 463 (2007).

JUDICIAL DECISIONS

Jurisdiction.

- Tort action by workers against health care providers who billed the workers for medical services in violation of O.C.G.A. § 34-9-205 was properly dismissed since the complaints were grounded upon an alleged violation of the Workers' Compensation Act, O.C.G.A. § 34-9-1 et seq., and redress was through the workers' compensation remedies. Mullis v. NC-CNH, Inc., 218 Ga. App. 332, 461 S.E.2d 237 (1995).

State Board of Workers' Compensation did not have exclusive jurisdiction over medical care providers' claims, under a third party beneficiary theory, against workers' compensation insurer/payors as the breach of contract claims raised a dispute related to contractual rights and did not implicate the rights of injured employees. Aetna Workers' Comp Access, LLC v. Coliseum Med. Ctr., 322 Ga. App. 641, 746 S.E.2d 148 (2013).

Fee schedule is a guideline rather than a "rule" which must be followed, and the board's approval of charges beyond those on the schedule can be challenged only on abuse-of-discretion grounds. Chatham County Dep't of Family & Children Servs. v. Williams, 221 Ga. App. 366, 471 S.E.2d 316 (1996).

- Authority to approve attorney's fees necessarily includes the authority to approve pro tanto as well as in toto any contract between the claimant and an attorney prosecuting the compensation claim. Clark v. Royal Globe Ins. Co., 116 Ga. App. 561, 158 S.E.2d 699 (1967).

Authority to approve attorney's fees is limited to the examination and approval of contracts between the claimant and claimant's attorney and does not include the authority to set the fees of attorneys, or to examine and approve contracts between attorneys as to the division of fees when associated to represent a claimant. Clark v. Royal Globe Ins. Co., 116 Ga. App. 561, 158 S.E.2d 699 (1967).

- State court did not have jurisdiction of action arising from an alleged violation of a fee schedule by a photocopy company which supplied copies of medical records to institutions for workers' compensation claimants. Claimants' redress was through workers' compensation remedies. Smart Professional Photocopy Corp. v. Dixon, 216 Ga. App. 825, 456 S.E.2d 233 (1995).

- Because the Georgia Workers' Compensation Board, and not the Health Records Act, O.C.G.A. § 31-33-3, regulated the medical photocopying charges in workers' compensation proceedings, the trial court properly dismissed a declaratory judgment complaint filed by a photocopier, which sought guidance regarding the appropriate fee structure for medical photocopying services in workers' compensation proceedings, for failure to state a claim upon which relief could be granted. Smart Document Solutions, LLC v. Hall, 290 Ga. App. 483, 659 S.E.2d 838 (2008).

- Workers' compensation insurers/payors were not entitled to dismissal of a breach of contract claim by medical care providers as the claim provided fair notice of the allegations, and the contract rights did not violate any law or public policy with respect to assertions as to promised reimbursement rates for services provided. Aetna Workers' Comp Access, LLC v. Coliseum Med. Ctr., 322 Ga. App. 641, 746 S.E.2d 148 (2013).

Cited in Cowart v. Ara Transp., Inc., 178 Ga. App. 766, 344 S.E.2d 734 (1986).

OPINIONS OF THE ATTORNEY GENERAL

Procedure for referral of rehabilitative service fees to peer review committee unauthorized.

- The State Board of Workers' Compensation lacks the statutory authority to establish a procedure when questions concerning fee charges for rehabilitation services are referred to a peer review committee. 1983 Op. Att'y Gen. No. 83-28.

- The State Board of Workers' Compensation has the authority to implement a fee schedule for vocational rehabilitation suppliers. 1991 Op. Att'y Gen. No. 91-31.