Who, What, and How will the Georgia SITF reimburse me?

medical money

Any insurance company licensed in Georgia to issue workers’ compensation policies or self-insured employer authorized by the State Board of Workers’ Compensation is eligible to file a claim for potential reimbursement from the Subsequent Injury Trust Fund. The employer/insurer should forward a letter to the fund stating a desire to actively pursue the claim. The fund requires medical documentation of the prior and subsequent injuries and, where indicated, investigative reports supporting compensability. In addition, the fund requires the statement of merger.

The employer/insurer files a claim for reimbursement directly with the fund. The Fund investigates the claim to determine eligibility for reimbursement. When a reimbursement agreement is reached between the Fund and the employer or insurer, it must be approved by the Sate Board of Workers’ Compensation. If an agreement cannot be reached, either party may request a mediation conference or a hearing with the State Board of Workers’ Compensation.

Employers/insurers may be reimbursed for all weekly income benefits payable after 104 weeks, for 50% of all medical and rehabilitation expenses between $5,000 and $10,000, and for 100% of all medical and rehabilitation expenses in excess of $10,000. If the subsequent injury was not caused by or related to a prior impairment, the reimbursement for medical expenses may be reduced or denied completely.