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BWC New Rule on Behavioral Assessment Payment

Until recently, medical treatment in workers compensation claims have been limited to treatment of conditions that are "allowed" in the claim.1  Allowed conditions are medical conditions that are proven to have resulted from a compensable work-related injury or occupational disease.2  The BWC has now taken steps to address cognitive, emotional, behavioral, social and psychological issues in a claim that are not directly related to the allowed conditions.3 Instead, these issues are believed to have arisen after the allowed condition, and these issues are believed to prolong pain and disability of the allowed condition. This does not include mental illness and psychological disorders, but instead, normal emotional responses that many people experience following a serious injury.4  The idea of this new rule is to allow injured workers to get the guidance they need, before these issues turn into something more serious such as depression or opioid addiction, hindering the ability for the injured worker to heal.

Now, as of July 1, 2018, if the injured workers physician of record determines that the injured worker is not progressing with their injury after the initial course of treatment and that the injured worker's healing appears to be delayed due to behavioral barriers, the BWC will cover one health and behavioral assessment and up to six hours of intervention sessions per 12 month period.5  This includes licensed professionals such as physicians, chiropractors, psychologists, social workers and counselors.6  The injured worker must show initiative and understanding during the face-to-face encounters between the injured worker and the physician. The purpose for this issue is to speed up the recovery of the injured worker, reducing the clam cost and reduce the amount of time off work due to the injury.

1.Joan M. Verchot and J. Andrew Recker, Dinsmore, The Ohio OWC's New Rule on Health and Behavioral Assessment Intervention (August 16, 2018), https://www.dinsmore.com/publications/the-ohio-bwcs-new-rule-on-health-and-behavioral-assessment-intervention/ (accessed August 20, 2018).

2.Ohio BWC-Basics: Claim Allowance, Claims, https://www.bwc.ohio.gov/basics/guidedtour/generalinfo/provglossclaimall.asp (accessed August 21,2018).

3.Joan M. Verchot and J. Andrew Recker, Dinsmore, The Ohio OWC's New Rule on Health and Behavioral Assessment Intervention (August 16, 2018), https://www.dinsmore.com/publications/the-ohio-bwcs-new-rule-on-health-and-behavioral-assessment-intervention/ (accessed August 20, 2018).

4.Louis Esola, Business Insurance, Ohio comp could pay for behavioral tests for injured workers (May 11, 2018), https://www.businessinsurance.com/article/00010101/NEW08/912321229/ohio-comp-could-pay-for-injured-workers (accessed August 20, 2018).

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