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Is Workers’ Comp Dragging Out Medical Treatment or Denying You in Ohio?

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You Can Fight a Medical Treatment Denial and Get What’s Fair

When disaster strikes at work—an accident leaves you injured, or exposure to hazardous conditions causes an occupational disease —workers’ compensation benefits are meant to cover the costs of your medical care.

In Ohio, a job-related illness or injury is covered from Day 1 under workers’ compensation. That includes your first emergency visit, no matter which doctor or hospital you visit.

But medical treatment under the Ohio workers’ compensation system can quickly get tricky. There are complicated rules you must follow to stay in compliance.

And employers, the Ohio Bureau of Workers’ Compensation (BWC), or the managed care organization (MCO) in charge of your care may not prioritize what’s best for you. Often, they’re driven to save money by getting you back to work—fast—and minimizing medical treatment costs.

At Horenstein, Nicholson & Blumenthal (HNB), our experienced Ohio workers’ compensation lawyers know how to counter delays or outright denials of your medical treatment. We can help you get access to effective care that’s fully covered by the workers’ compensation benefits you’re entitled to.

If you live in Cincinnati, Cleveland, Columbus, Dayton or anywhere in Ohio and have suffered any type of work injury in any occupation, give us a call for help taking care of yourself and regaining control of your life.

We want our clients to say, “Helping me, that’s HNB.”

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    How Workers’ Compensation Medical Treatment Works

    Here’s what to do first when you’re hurt on the job:

    STEP 1: Report the injury to your employer immediately. Your report should not only be verbal, but in a written First Report of Injury and sent electronically via-mail or text message to your employer. (The written and electronic reports provide proof that you reported your injury, which you may need later if your employer or the BWC contests your claim.)

    STEP 2: Get medical treatment as fast as possible. Preferably the day you get injured, but definitely within 24 hours. Any delays in getting treated will be used against you by the Ohio BWC, your employer, and the Ohio Industrial Commission.

    For your first medical treatment after a work injury, it’s best not to see your family doctor, since they usually don’t take workers’ compensation insurance.

    Instead, go to an urgent care clinic or occupational health center to document your work injury. These types of providers know the Ohio workers’ compensation system and accept workers’ compensation insurance, so you’re less likely to get stuck with a medical bill.

    Tell them you had a job injury and plan to seek medical care through the Ohio workers’ compensation system.

    Don’t worry about coverage for that first visit, since the urgent care or occupational health facility knows how to get their services paid for by the Ohio BWC.

    STEP 3: Later you can seek additional treatment from a specialist, like an orthopedist, chiropractor or surgeon.

    If you didn’t get the chance at first, report your injury to your employer after your injury stabilizes.

    You can also get the work injury attorneys at Horenstein, Nicholson & Blumenthal to file your Ohio BWC claim electronically and get a claim number assigned, so there are no delays in your medical care or financial compensation.

    To get further treatment after the initial visit, you have more rules to follow. If you don’t, you could be on the hook for your medical bills.

    • If your employer has workers’ compensation benefits through the Ohio BWC, you must go to a BWC-certified medical provider. Your employer’s managed care organization (MCO) will have a list of providers, but the work injury attorneys at HNB can also help you find an eligible provider.
    • If your employer is self-insured, they will have a list of doctors approved by a third-party administrator (TPA). But keep in mind that self-insured employers typically refer you to medical providers who are sympathetic to the employer’s wishes, not your needs. Contact HNB to help find the best providers for your injury.

    As you heal, the MCO or TPA decides whether to approve or deny your treatment options, which gives them a lot of control over your medical care.

    They have an incentive to minimize medical treatment and get you back to work as soon as possible, which can lead to disagreements about the status of your recovery. They may also refuse to let you see the health care provider of your choosing if they’re not on the certified list.

    At HNB, our work injury lawyers can look at your claim and help you choose the best course of action for your health and your future working life. Give us a call. We’ll evaluate your case at no charge.

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    What to Do if Your Workers’ Compensation Medical Treatment Gets Denied or Slowed

    Once you’ve started medical care, you have to navigate the MCO’s or TPA’s approval process for treatment. This creates pinch points when they can slow or deny your medical benefits.

    These points arise when your medical provider files a request for certain treatment. Your provider needs to use an Ohio BWC C-9 form. They submit it to the MCO if you have a state-fund claim, or to the TPA for an employer self-insured claim.

    The treatment could be a diagnostic test, such as an x-ray, MRI or CT scan. It could be a request for physical therapy, a consultation with a specialist, or prescribing a medical device to help you heal.

    The MCO or TPA has the power to approve or deny these requests. If the C-9 form is denied by an MCO, you need to appeal it. If the C-9 is denied by a TPA, you need to file a C-86 motion to get a hearing before the Ohio Industrial Commission. There, you’ll try to get a hearing officer to approve treatment.

    Whichever path you need, the work injury attorneys at Horenstein, Nicholson & Blumenthal can file the forms and request the hearings for you.

    When your claim goes before the Industrial Commission for a legally binding hearing, your HNB workers’ compensation lawyer will represent you at every level, from a district hearing officer to a staff hearing officer and beyond.

    MCOs or TPAs also look for mistakes or missing information to use in denying your claim. Common mistakes include:

    • Not reporting an injury immediately—or at all. Remember, HNB can file your work injury claim for you.
    • Not seeking medical care right away. Also keep detailed notes on your symptoms, diagnoses, and the steps you took in your claim.
    • Not keeping thorough and accurate records throughout your case. Keep a written record of everything that happens, track your expenses, and save all your paperwork.

    Always keep in mind that an MCO or TPA works to protect the BWC and/or your employer.

    To protect yourself, a skilled Ohio workers’ compensation attorney is invaluable to ensure you are treated fairly so you get access to the best medical treatment you need to get better.

    If you have questions about your case, the attorneys at HNB have the experience to look out for your best interests and stand up to MCOs, TPAs, the Ohio BWC, and employers who don’t look out for their employees.

    Give us a call and let’s secure for you the peace of mind you deserve so you can get back on your feet.

    Contact Us Today!