How do I get the Bureau of Workers’ Compensation to Cover Treatment Related to My Work Place Accident?

by The Bainbridge Firm, LLC | Feb 07, 2020 | Workers' Compensation

This first step in getting treatment covered by the Ohio Bureau of Workers’ Compensation (BWC) is, of course, requesting that the treatment costs be paid. This is done by submitting what’s known as a C9 Request for Medical Service Reimbursement. The C9 form is to be completed by the doctor prescribing the care that one would be seeking to have covered by the BWC. In this form the prescribing doctor is required to delineate the care being requested, the specific condition for which the treatment is needed, and when said treatment is needed. Once the C9 form is completed and submitted to the BWC they commence a review process to determine if they will cover the treatment at issue.

In their review the BWC will have an independent medical practitioner review the treatment being requested. In this review the BWC determines whether the treatment requested is medically necessary for one of the allowed conditions in the claim. The BWC has developed a specific test for the medical practitioner to apply in making their determination. This test is known as the Miller test.  The Miller test is a three pronged test that calls for the reviewing medical practitioner to determine 1) if the medical services are reasonably related to the given injury that occurred; 2) whether the services are reasonable necessary for treatment of the industrial injury; and 3) are the cost of the services medically reasonable. If the reviewing practitioner finds that each of the three prongs of the Miller test are met the BWC will cover the treatment at issue. Should one of the prongs note be met the BWC will deny coverage for the requested treatment.

If the BWC denies the treatment request the injured worker then has the ability to appeal that decision thereby entitling them to a hearing before the Industrial Commission of Ohio to argue that the treatment should be covered. At these hearings the injured worker is given the opportunity to show that the treatment at issue is medically necessary for an allowed condition in their claim. It is important to note that the most crucial point of analysis in determining whether treatment should be covered is whether that treatment is needed for conditions that have been recognized to be the result of an individual’s work place accident. If the treatment is directed towards some non-allowed condition it will likely remain denied.

If you are having trouble getting treatment related to allowed conditions in your claim approved don’t hesitate to contact the Bainbridge Firm. We will take all the necessary steps to get treatment covered by the Ohio Bureau of Workers’ Compensation.