Workers' Compensation

If you experience a workers’ compensation injury, you should notify your supervisor immediately (no later than 24 hours). Your supervisor will contact DOAS RISK .

Your next step is to call AmeriSys Managed Care at 678-781-2848 or 800-900-1582 to speak with a case manager who can assist you in obtaining medical care, finding a physician or getting you the appropriate follow-up care. You will be asked to choose an authorized treating physician who will supervise your medical treatment to ensure you are receiving high quality, appropriate care.

You may change your authorized treating physician, within the DOAS physician network, one time during your treatment simply by calling AmeriSys Managed Care at 678-781-2848 or 800-900-1582. Any further change of physician will require the concurrence of DOAS RISK and the Nurse Case Manager. 

As part of the contract between the Department of Administrative Services and a Third Party Administrator (TPA) , there is a minimum $150 charge by the TPA for every claim that is reported through the Telephonic Claims Reporting Center. Additionally there is a $15 per claim charge by the call center for any claim reported for a total administrative cost of $165 per claim.

Accordingly, due to these charges, certain claims need to be reported differently. Accidents or “near misses” that DO NOT RESULT in any lost work days or require medical attention, outside of first aid by the department, SHOULD NOT BE REPORTED TO DOAS THROUGH THE TELEPHONIC CLAIMS REPORTING CENTER. Instead, the supervisor should complete the “Incident Notice Form” that can be found on our Human Resources web site under Workers’ Compensation. As directed on the Incident Notice Form, the report should sent to Human Resources for future reporting if the employee requires medical treatment later.

For additional information click on Role of Supervisor

A Supervisor should always take a proactive role when an employee advises he/she has been injured on the job. The supervisor is the most effective person in the initial handling of the claim, as he/she is normally the only person with whom the injured employee communicates.

Supervisors need to do the following:

• Take time to handle the injury. Listen to the employee.
• Investigate the accident and make notes of any pertinent information:

a. How did it happen?
b. Who saw it happen? (Obtain witnesses names.)
c. How could it have been avoided? (Ensure the area is free of any hazards that could contribute to additional injuries.)

• As part of the contract between the Department of Administrative Services and a Third Party Administrator, there is a minimum $150 charge by the TPA for every claim that is reported through the Telephonic Claims Reporting Center. Additionally there is a $15 per claim charge by the call center for any claim reported for a total administrative cost of $165 per claim.

Accordingly, due to these charges, certain claims need to be reported differently.

• Accidents or “near misses” that DO NOT RESULT in any lost work days or require medical attention, outside of first aid by the department, SHOULD NOT BE REPORTED TO DOAS THROUGH THE TELEPHONIC CLAIMS REPORTING CENTER. Instead, the supervisor should complete the “Incident Notice Form” that can be found on our Human Resources web site under Workers’ Compensation. As directed on the Incident Notice form, the report should be sent to Human Resources for future reporting if the employee requires medical treatment later.
• For incidents that require medical care call the AmeriSys Case Manager at 678-781-2848 or 800-900-1582 and this person will assist you with selecting a follow-up physician, scheduling a follow-up appointment and obtaining follow-up care.
• If the employee needs emergency care, get them to the nearest emergency room immediately; then follow-up with AmeriSys Case Manager by calling 678-781-2848 or 800-900-1582. Supervisors or a designated employee should accompany employee's to the treatment facility. Once there the supervisor will only assist with insuring that the facility is aware that this is a workers compensation case. The supervisor does not play any other role at this point. Once the employee's status is known (are they returning to work or home?), then the supervisor or designee can return to work. 
• If the employee feels treatment is not needed, have him/her acknowledge in writing that treatment was offered but was declined. Keep the acknowledgement with a copy of the incident notice form. Report the injury to Human Resources (912-260-4376) as soon as possible but at least within 24 hours following the incident and send a copy of the form with the attached document.
• Make sure the following forms are completed:

Medical attention needed: Complete the WC-1 form
Medical attention NOT needed: Incident Notice form

• Forward all forms to SGSC Human Resources.
• If you suspect fraud – don’t publicize it; immediately notify the SGSC Human Resources Office in writing and they will request an investigation by the Department of Administrative Services.
• Demonstrate your concern by communicating frequently with your injured employee during the recovery process (calls, cards, visits).
• If after the first seven days of lost time the employee elects to go on leave without pay status, notify the SGSC Human Resources office immediately so the workers’ compensation weekly benefits can begin. Have the employee complete the “Leave Election Form” notifying the agency whether they choose to receive full pay by utilizing sick or annual leave in lieu of Workers’ Compensation Benefit or to freeze all leave and receive the Workers’ Compensation Benefits for lost time in excess of seven (7) days.
• Upon the employee’s return to work notify Human Resources at 912-260-4376 so that appropriate action can be taken on the Injured Employee’s Workers’ Compensation Claim.

Return to Work Program (803.02e)

Please see 803.02 for additional information.

Your authorized treating physician is responsible for determining the medical necessity for referrals to specialists if needed. Your authorized treating physician is required to contact AmeriSys Managed Care at 678-781-2848 or 800-900-1582 for referral approval within the network. Authorization for non-participating physicians will be considered only in special circumstances when required for specialized care not available within network.

• Matrix Healthcare Services (1-877-804-4900)
• Injured employees should identify themselves at the pharmacy by stating that the Processor is:
• Premier Pharmacy Plan – Group ID 2105

You are required to receive all medical care through a participating network provider. The only exception will be under special circumstances as approved by the Nurse Case Manager and DOAS RISK jointly and in compliance with the State Board of Worker’s Compensation Rule 208.

If you experienced a workers’ compensation injury or illness prior to the effective date of this managed care plan, you may continue treatment already in effect. An AmeriSys Nurse Case Manager will be assigned for continued coordination of care when needed, in accordance with the State Board of Worker’s Compensation Rule 208.

The AmeriSys Case Manager will be in contact with you from the time of your injury ensuring that you are receiving the best medical care to enable you to return to work as quickly as possible. The nature and severity of your injury will determine the extent of the case management services provided. Your medical case manager is a licensed, registered health care professional whose responsibilities include helping you make informed decisions regarding your care. Your case manager will also work with your employer in developing a return to work plan that is approved by your authorized treating physician.

If, as a result of a work related injury or illness, you require immediate medical attention, you should proceed to the nearest emergency medical care facility or call 911 for assistance.

Following your emergency admission, service or procedure, you or your designated representative must notify AmeriSys Managed Care of your injury by calling 678-781-2848 or 800-900-1582.

If you require additional care contact AmeriSys Managed Care at 678-781-2848 or 800-900-1582 and speak to a Case Manager who will assist you in selecting an authorized treating physician. Your authorized treating physician will then evaluate your treatment plan and make further recommendations

AmeriSys Managed Care will respond to any dissatisfaction regarding a network provider or managed care service under your employer’s plan. If you have a complaint, please contact AmeriSys Managed Care at 678-781-2848 or 800-900-1582. The Dispute Resolution Coordinator will discuss your complaint with the appropriate party.

The Dispute Resolution Coordinator will respond to you within 24 hours, or the next working day.

A written complaint regarding claims practices or provision of services concerning the Managed Care Plan or its network providers may be sent in writing to:

AmeriSys Dispute Resolution Coordinator c/ o Integrated Care Management
5 Dunwoody Park
Suite 118
Atlanta, Georgia 30338

If the dispute cannot be resolved within 30 days of a written notice, by the Managed Care Dispute Resolution Procedure, any party may request intervention by the State Board of Worker’s Compensation.  DOAS Risk Management may become involved at anytime during the dispute process upon the request of the injured party.

Please Note: If your dispute involves the payment of benefits or aspects of your claims not directly related to the provision of medical care, contact Risk Management for assistance by calling 404-656-6245 or 877-656-RISK (7475) and selection Option #3.

Effective February 1, 2012, DOAS, Risk Management Services will move to “pre- paid” Visa cards for payment of Workers’ Compensation Weekly benefits.   DOAS will roll out the new card with new payments going forward from February 1st and will move existing payments to recipients. The card will be the default payment for WC benefits as opposed to a paper check.