by Jennifer M. Smith, Esq.

Questions sometimes arise when an out of state healthcare provider provides services for an injured employee and requests to reimbursed at the fee schedule rate for the other state instead of Georgia’s rates. Does Georgia’s fee schedule apply in these instances or does the fee schedule for the other state apply?

As indicated under the “General Reimbursement Requirements” of the Georgia Workers’ Compensation Medical Fee Schedule, the answer depends on whether the injury falls under the jurisdiction of the Georgia Workers’ Compensation Act or another state.

If the injury or disease occurred within Georgia, then typically the Georgia Board of Workers’ Compensation has jurisdiction over the claim and the Georgia fee schedule would apply. Most situations will fall under this category and the answer will be quite simple: apply the Georgia fee schedule even if the out of state provider contends otherwise (which the provider will likely argue when the out of state fee schedule is higher than Georgia’s).

If the injury occurred outside of Georgia, then jurisdiction may not be as clear, but the Georgia Board of Workers’ Compensation may have jurisdiction if at least one of the following circumstances exist:

  1. the prerequisites for jurisdiction of O.C.G.A § 34-9-242 are met, which are:
      1. if the contract of employment was made in Georgia AND
      2. if the employer’s place of business is in Georgia OR the employee’s
        residence is in Georgia (unless the contract of employment was expressly for service exclusively outside of Georgia);
  2. the contract provisions of O.C.G.A § 34-9-7 apply, which cover any contract of service between an employer and an employee, whether written, oral or implied as indicated in O.C.G.A § 34-9-2; OR
  3. the principal locality of the employment is in Georgia.

Occasionally, one or more states, in addition to Georgia, will have jurisdiction in regard to a workers’ compensation claim and then choice of law issues arise. There are four possibilities to determine which State will adjudicate the claim (and therefore which fee schedule would ultimately be applicable): the state in which the employee resided; the state in which the employer is located; the state in which the individual was hired; or the state in which the accident occurred. The state in which the injury occurred is generally the clearest, but problems can arise for transient employees where the state the accident occurred may have little or no real connection to the employee, the employer or even the work performed.

Regardless, Georgia presumes workers’ compensation jurisdiction in Georgia for an injury which occurred in Georgia even if the employee was not a Georgia resident and even if the contract of employment was not made in Georgia, so long as nothing prohibits jurisdiction, such as a contract in another state or because of residence in another state.