§ 45-25-3 — Limitations and restrictions of benefits

Georgia § 45-25-3

• Jurisdiction: Georgia
• Title: 45

Text

(a) A public entity shall provide and maintain sufficient insurance coverage on each of its first responders to pay the benefits described in subsection (b) of this Code section to eligible first responders with covered conditions arising from a traumatic event which the first responder experienced or was exposed to while performing first responder services for such public entity. Such coverage shall also pay such benefits for covered conditions arising from an employed first responder's services as a volunteer first responder for the same or another public entity. In the event a volunteer first responder of one public entity is simultaneously employed as a first responder by another public entity, the public entity for which such person is a volunteer shall not be required to maintain the coverage on such volunteer otherwise required under this Code section during the period of such employment with the other public entity. In no circumstance shall a first responder be entitled, as a result of this chapter, to more than the lifetime benefits described under this chapter. (b) An eligible first responder with a covered condition shall be entitled to the following benefits: (1) One lump sum benefit per lifetime of $3,000.00 payable to the eligible first responder upon submission to the insurer of acceptable proof of a clinical diagnosis of a covered condition by a qualified diagnostician as provided for in subsection (f) of this Code section; and (2) An income replacement disability benefit payable as a result of a clinical diagnosis of a covered condition, which disability benefit is payable as described below: (A) If the first responder's qualified diagnostician determines that the covered condition precludes continuation of the first responder's regular occupational or volunteer duties as a first responder and provides proof acceptable to the insurer, including evidence of appropriate care and treatment, then the disability benefit shall begin 90 days after the date the covered condition first precludes continuation of such duties; (B) The disability benefit shall continue, subject to standard requirements of disability insurances and subject to the cumulative lifetime disability benefit limit described in subparagraph (E) of this paragraph, during the period of continuous disability arising from the covered condition; (C) The disability benefit shall cease when the first responder's qualified diagnostician determines that the eligible first responder has regained the ability to perform the duties previously performed as a first responder; (D) Subject to the cumulative lifetime disability benefit limit provided for in subparagraph (E) of this paragraph, the disability benefit shall recommence if the first responder's qualified diagnostician determines that the eligible first responder has again become unable to perform his or her regular occupational or volunteer duties as a first responder due to a covered condition and provides proof acceptable to the insurer; and (E) The disability benefit shall end after a total of 36 monthly payments in the amount set forth below have been made to the eligible first responder: (i) If the eligible first responder is employed by a public entity, a monthly benefit equal to 60 percent of the eligible first responder's combined monthly salary for all public entities for which the first responder is employed as a first responder or a monthly benefit of $5,000.00, whichever is less; or (ii) If the eligible first responder is a volunteer first responder and not employed as a first responder by any public entity, a monthly benefit of $1,500.00. (c) Any first responder who receives income replacement disability benefits under paragraph (2) of subsection (b) of this Code section may be required by the insurer providing such benefits to have his or her condition reevaluated by a qualified diagnostician selected by the insurer. In the event any such reevaluation reveals that such first responder has regained the ability to perform the duties previously performed as a first responder, then such benefits shall cease. (d) The benefits under paragraph (1) of subsection (b) of this Code section, as applicable, shall be subordinate to any other insurance benefit payable to the first responder for medical expenses incurred as a result of the covered condition. (e) The benefits under paragraph (2) of subsection (b) of this Code section, as applicable, shall be subordinate to any other income replacement disability benefit payable to the first responder for such disability from any employer funded group long-term disability plan or workers' compensation benefit, not including any disability insurance purchased in whole or in part by the first responder, and shall be limited to the difference between the amount of such other paid benefit and the amount specified under subparagraph (b)(2)(E) of this Code section, as applicable. (f) Proof of a first responder's covered condition requires both of the following: (1) A clinical diagnosis of post-traumatic stress disorder made by a qualified diagnostician which substantiates that the clinical diagnosis is the direct result of experiencing or being exposed to a traumatic event, or repeated experiences or exposures to traumatic events, during his or her regular occupational or volunteer duties on behalf of a public entity. Such clinical diagnosis shall be made within two years following the date of the traumatic event, and such clinical diagnosis shall include documentation indicating the date and nature of the traumatic event or the most recent traumatic event related to the symptoms of post-traumatic stress disorder if due to repeated experiences or exposures; and (2) Written documentation of criteria required for the diagnosis of post-traumatic stress disorder under the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders , in effect on January 1, 2024. (g) Information that could reasonably be used to identify individuals making claims or who have made claims or who have received benefits under this Code section shall be treated as sensitive mental health information and, absent express authorization by the individual, shall only be used and shared for administration of benefits, underwriting, and for purposes of aggregation and de-identification or for purposes of compliance with Article 4 of Chapter 18 of Title 50 or other applicable laws. Communications, in any form, between such individuals and the administrator or insurer of the benefits shall be confidential and privileged. (h) The benefits shall be administered in a manner designed to ensure that first responders are able to obtain the lump sum benefit provided for in paragraph (1) of subsection (b) of this Code section in a confidential manner similar to receiving mental health benefits under an employer sponsored major medical health plan or employee assistance program, or, for the disability benefit provided for in paragraph (2) of subsection (b) of this Code section, in a confidential manner similar to receiving other employer sponsored disability benefits involving mental health issues. In no event shall information solely about an individual's diagnosis, claims, or benefits be used for any employment action. (i) The benefits shall be administered in a manner designed to enforce lifetime limits and to coordinate benefits. Any insurer or self-insurer of the benefits shall disclose the amount of benefits already paid to an individual upon written request by another insurer or self-insurer that is evaluating a claim by such individual as provided under subsection (b) of this Code section.

Legislative History

Added by 2024 Ga. Laws 511,§ 2, eff. 1/1/2025.