The Ohio Revised Code provides that every employee who is injured or who contracts an occupational disease is entitled to receive such medical, nursing, and hospital services as are authorized under Chapter 423 of the Revised Code. Section 4123.66 authorizes the Administrator of the BWC to pay such amounts from the State Insurance Fund for such medical services, nursing services, hospital services, and medicine as the Administrator “deems proper.”
In terms of medical supplies and services, payment is made only for those medical supplies and services that are medically necessary in the diagnosis and treatment of any allowed conditions. Ohio Administrative Code § 4123-16-16.2(B) requires MCOs to evaluate medical treatment reimbursement requests by applying a three-part test:
(1) The requested services are reasonably related to the allowed conditions;
(2) The requested services are reasonably necessary for treatment of the allowed conditions; and
(3) The cost of the services are medically reasonable.
If you have medical costs that should be covered because they are the result of a workplace injury, please contact the Bainbridge Firm.