Your claim may have been denied because you are missing a small piece of required information or medical support for your request. Or your claim may be denied because a legal question exists as to whether or not you are entitled to participate in the Ohio Workers' Compensation Fund for your injury. Either way, you may find yourself needing help to navigate the Ohio BWC system, hearings, and any potential appeals.
The BWC's MCO standardized prior authorization table
A tight, burning and stabbing sensation. Muscles spasms and tingling. The feeling of being electrocuted in the same spot repeatedly. Back pain comes in many forms. Millions of people experience the agony of back pain and while the pain is often bearable at first, bearable doesn't cut it forever. For some people, surgery might feel like the only option.
A Court of Appeals has held that injuries sustained by the claimant while traveling to or from a Bureau medical examination are compensable "as being directly and proximately caused by circumstances that arose out of employment as the original injuries and obligations necessitated by those injuries in order to participate in the Workers' compensation fund, directly resulted in the new injuries."
On October 15, 2018, the BWC will be launching a pilot program to support employers willing to hire workers struggling to overcome an addiction to opioids and other dangerous substances1. With the opioid crisis currently being a big issue in Ohio, many employers are having a difficult time finding qualified applicants who do not have a history of substance abuse or addiction. In Montgomery County alone, 521 accidental overdose deaths accrued in 20172. This is why the BWC has made this program available for Montgomery, Ross and Scioto counties. The BWC will be partnering with the counties Alcohol, Drug Addiction and Mental Health board (ADAMH). The job of the ADAMH board will be to identify eligible employers and employees, disperse funding among employers as needed and measure the results of the program3. The BWC then, will be in charge of the training of supervisors and managers along with reimbursement for drug testing and providing a venue for employer's to share "second chance" stories. In Ohio, opioid addiction, abuse and overdose deaths cost the state $6.6 billion-$8.8 billion each year4. The state instead hopes to put more money into helping Employers hire, manage and retain workers by providing $5 million over two years as needed by employers. Small businesses sometimes feel a burden when it comes to drug testing employees because of the amount of time and money it costs5. This means that some businesses tend not to hire applicants who have a history of substance abuse or addiction. With this pilot program, the BWC reimburse employers for drug testing allowing the employer not to feel burdened. Penny Dehner, Executive Director of the Pain Valley ADAMH board says, "If someone tests positive, we want them to give people a second chance... but we have to make sure there are treatment options available for them, and there's someone to track that" 6. Studies show that people on a pathway to recovery show more success when they are employed7. The opioid crisis is lowering the labor force participation rate in Ohio. The BWC is trying to put a stop to it and get people on the right path to recovery8!
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.
According to the book, Ohio Workers' Compensation Law, written by Phillip Fulton, under R.C. § 4123.651 injured workers are entitled to freely choose a physician to treat a covered injury. This includes both the initial choice of physician and any decision by the injured worker to change physicians. The Bureau of Workers Compensation may require the injured worker to give notice of change in treating physician and the reason for change. Once a claimant goes to a private physician for treatment other than on an emergency basis, the claimant is generally regarded as having chosen that physician. Before 1959 employees didn't have a choice of physician. Choosing a treating physician and notifying the Bureau of your choice is important because authorized payment for treatment is only allowed by one physician. According to O.A.C. § 4123-7-05, the Bureau will not approve payment of medical fees for treatment rendered by more than one physician for the same condition over the same period of time. There is however one exception. If the BWC or self-insurer has authorized treatment where a consultant, anesthetist or assistant is required, or it is necessary for treatment to be seen by a specialist, then the BWC can authorize payment for medical fees. Not all licensed practitioners are qualified as treating physicians. Revised code § 1737.01 (A) defines "licensed physicians and surgeons" as persons certified under R.C. § 4731.14, which certification is limited to medical doctors and doctors of osteopathy. A medical doctor or osteopath may therefore be the treating physician. A chiropractor may also be the treating physician, because R.C. § 4734.09 specifically provides that the chiropractor is a physician for the purpose of chapter 4123.
It has been about six weeks since we discussed how heat illness can put people who work outdoors in the summer at serious risk. Many workers are not vulnerable to heat illness, due to the nature of their jobs, but may still develop an occupational illness that makes them seriously ill, and may even cause their death.
The settlement of a workers' compensation claim can be a way for an injured worker to receive a final monetary payment under the claim. Once a claim is settled, no further costs (medical or monetary benefits) are payable under the claim.
According to the BWC, In 2011, more than 80,000 injured workers took the equivalent of at least 60mg a day of morphine for 60 days or more, becoming "clinically dependent" on Opioids.1 With an increasing number of opioids routinely being prescribed after injuries or surgeries, people are runing into more and more issues with these drugs. Surgeries often include long recovery times, resulting in prolonged use of opioids which then causes poeple to become dependent on these drugs.