TITLE 34 LABOR AND INDUSTRIAL RELATIONS

Section 15. Reserved [Repealed].

ARTICLE 2 VENDING FACILITIES ON STATE PROPERTY

15. Stipulated Settlements.

The party submitting the stipulation shall:

A stipulation which provides for liability of the employer or insurer shall:

state the legal and/or factual matters about which the parties disagree;

state that all incurred medical expenses which were reasonable and necessary have been or will be paid by the employer/insurer. If the parties have agreed for medical treatment to be provided for a specific period in the future, then the stipulation must so state, and must further specify whether the agreement is limited to certain specific providers, and whether those providers may refer to others if needed. Furthermore, the stipulation shall provide that the parties will petition the Board for a change of physician in the event that a specifically named physician is unable to render services, and the parties cannot agree. If the stipulation does not contain a provision that medical expenses may be incurred for a specific period in the future after the approval of the stipulation, then the stipulation must contain a statement which explains why that provision is not necessary; and,

attach the most recent medical report or summary which describes the medical condition of the employee, including a very brief statement of the surgical history, if any, if that history is not already specified within the stipulation. The entire medical record should NOT be attached.

The insurer shall certify that it has complied with O.C.G.A. §34-9-15 by having sent a copy of the proposed settlement to the employer prior to any party having signed it.

The revision effective July 1, 2007, in paragraph (a)(2), substituted "ICMS Board claim number(s)" for "claim number" near the beginning, inserted "where a Board file has been created by a Form WC-1 or Form WC-14" near the middle, and added "For dates of accident where a Board file has not been created but covered by the stipulation, such dates of accident shall only be listed in the body of the agreement" at the end; in paragraph (a)(4), deleted "and WC-4" following "Form WC-1"; in subsection (d), added the last sentence; in subsection (e), added "and the attorney shall certify that the expenses comply with Rule 1.8(e) of the Georgia Rules of Professional Responsibility and Board Rule 108" at the end of the last sentence; and in subsection (f), substituted "Form WC-1 shall be filed" for "Form WC-1 and final completed Form WC-4 must be filed" in the first sentence, and made a punctuation change in the second sentence.

The revision effective July 1, 2008, added paragraphs (a)(9) and (a)(10).

The revision effective July 1, 2009, in subsection (e), inserted the third sentence and added subsection (i).

The revision effective July 1, 2010, deleted paragraph (a)(3) and redesignated former paragraphs (a)(4) through (a)(10) as present paragraphs (a)(3) through (a)(9), respectively; in subsection (d), rewrote the first sentence, and inserted "or projected" in the last sentence; substituted "non-liability" for "no-liability" in the first sentence of subsection (f); and added subsections (j) through (l).

The revision effective July 1, 2011, added the last sentence in paragraph (a)(2); substituted the present provisions of paragraph (a)(3), for the former provisions, which read: "attach a copy of the Form WC-1 for each date of accident covered by the settlement"; added "if an attorney fee contract has not previously been filed with the Board," at the beginning of paragraph (a)(4); redesignated former paragraph (a)(5) as present paragraph (b)(3); redesignated former paragraphs (a)(6) through (a)(9) as present paragraphs (a)(5) through (a)(8), respectively; and deleted the former first sentence of paragraph (f), which read: "A Form WC-1 shall be filed with every non-liability stipulation for each date of accident covered in that stipulation."

The revision effective July 1, 2012, added the last sentence to subsection (e); inserted "confidential" in subsection (h); substituted "shall stipulate" for "stipulates" in subsection (l); and added subsection (m).

The revision effective July 1, 2013, substituted "the Board may require the attachment of" for "attach" in paragraph (a)(3); deleted "including supporting documents," preceding "unless prior approval" in paragraph (a)(8); and added subsections (n) and (o).