Georgia’s New “Limited Medical” Law Shifts Costs to Medicare


The Georgia Governor and Legislature amended the Workers’ Compensation Act to limit the medical benefits afforded to injured workers.  Currently, if you are injured on the job, you are entitled to “lifetime” medical benefits related to that injury so long as your claim remains open and unsettled.  Also, the desired medical treatment must continue to relate or be caused by the original accident.  Georgia workers injured on or after July 1, 2013 will be entitled to treatment for about 7.5 years after the date of injury unless the case is deemed to be “catastrophic.”

The current policy of the Centers for Medicare and Medicaid state that “[a]ll parties in a workers’ compensation case . . . [must] protect Medicare’s interest when resolving workers’ compensation cases that include medical expenses.  The recommended method to protect Medicare’s interest is a Workers’ Compensation Set-aside Arrangement (WCMSA), which allocates a portion of the workers’ compensation settlement for future medical expenses.  The amount of the set aside is determined on a case-by-case basis and should be reviewed by CMS, when appropriate. Once the CMS determined set aside amount is exhausted and accurately accounted for to CMS, Medicare will agree to pay primary for future Medicare covered expenses related to the workers’ compensation injury.”

After July 1, 2013, the amended Georgia Workers’ Compensation Act reducing the Employer/Insurer’s overall medical exposure insidiously shifts the responsibility (after 400 weeks) to Medicare in certain cases.   Prior to July 1, 2013, the WCMSA would be forced to contemplate future medical expenses for the life of the injured workers.  Now, the WCMSA analysis simply stops after 7.5 years of treatment from the date of accident in non-catastrophically designated claims.  Consequently, if the injured worker is a Medicare beneficiary, or there is a reasonable expectation he or she will be within 30 months, Medicare will likely bear the cost of the bulk of the injured workers’ future medical treatment.  For example, if an injured worker required a replacement of an artificial knee, this cost would likely be thrust upon Medicare.  This would also include diagnostic scans, films, and medication related to the Georgia work injury.

This new law is a drastic departure and it will likely impact the settlement value of many claims as well.  If you would like to have a free consultation about your workers’ compensation claim, please contact our office.