Your workers' comp claim finally went through. The Ohio Bureau of Workers' Compensation (BWC) allowed your condition. Then you asked for an MRI—or physical therapy, or a specialist referral—but your physician’s request for treatment hasn’t been approved yet, and you’re trying to be patient while your symptoms persist.
Delayed medical treatment is one of the most frustrating parts of workers' comp cases, but it's not the end of the road.
Monast Law Office helps people understand what's causing these delays and take action to access the care they need under BWC guidelines. When treatment approval drags on too long, knowing your options and having someone advocate for your rights can make all the difference.
Key Takeaways:
- Why delays happen. BWC treatment approval can stall due to documentation issues, allowed-condition questions, or extra review.
- Non-emergency care. This requires a C-9 from your physician and may proceed with retro-review if the MCO doesn’t respond in three days.
- How to respond. Contact the MCO, document everything, and seek help from the BWC’s Ombuds Office or Monast Law Office if delays persist.
Why Does Medical Treatment Get Delayed in Workers’ Comp Cases?
The BWC has specific procedures for approval, which sometimes creates bottlenecks. Managed care organizations (MCO) review treatment requests to ensure they're necessary and related to your workplace injury. That review can stretch on if:
- Documentation is incomplete.
- The treatment seems outside your certified conditions.
- The insurer questions whether the care is reasonable.
- Your self-insured employer is denying the request.
Sometimes delays happen because your employer's third-party administrator hasn't forwarded records properly. Other times, a request gets flagged for additional review simply because it's expensive or involves surgery. Injured workers often pay the price in lost time and worsening symptoms while they wait for approval.
Can You Get Emergency or Urgent Care While Waiting for Approval?
Usually. For true emergency services arising from your allowed work-injury, you may seek certain forms of treatment without prior authorization, also known as presumptive approval. The services must be for the allowed conditions and rendered by a BWC-certified medical provider.
For non-emergency care—and here’s where it sometimes gets confusing—your treating physician must submit to the MCO the appropriate authorization request, which is Form C-9: “Request for Medical Service or Recommendation for Additional Conditions”. The MCO must also have your First Report of Injury form on file, and your claim must be in payable status. Then, it reviews the request and, hopefully, approves your treatment in a reasonable amount of time. The BWC states that “in instances where the MCO does not respond to the C-9 within three days and the provider initiates treatment, the MCO will provide a concurrent and retro review.”
So, if you’re experiencing new symptoms and now need an MRI, additional diagnostic tests, or a specialist referral—and your doctor agrees to more care but hasn’t followed these guidelines—there might be a delay in approved medical treatment.
What Steps Can You Take Regarding Delayed Medical Treatment?
If your approved or allowed workers’ comp claim experiences delays in treatment approval, here’s what you can do:
- Contact the MCO. You or your treating physician can call the MCO assigned to your claim and ask for the status of the C-9 request for treatment. Ask what documentation or information is missing and what else is required.
- Document everything. Keep records of submission dates, calls to the MCO—who you spoke with, when, and what was said—treatment requests submitted, your symptoms or worsening condition, and any refusals or delays. Having clear documentation helps if you need to contest a decision or escalate.
- Call the BWC Ombuds Office. If you have tried working through the MCO and your provider but the issue remains unresolved, you may contact the BWC’s independent Ombuds Office. It helps clarify your rights, direct you to the appropriate contact, and assist you in understanding your next steps — although it doesn’t represent you in formal hearings.
By staying informed, engaged, and keeping good records, you improve your chances of breaking through delays and securing needed care.
When Should You Contact Monast Law Office?
Some delays resolve quickly once you make the right calls or submit missing paperwork. But if days turn into weeks, or if your condition deteriorates while you wait, bringing in a workers' comp attorney can change the dynamic.
Jim Monast was one of the first attorneys certified as a workers' compensation specialist in Ohio. Now, after 40 years, he and his team know how to push managed care organizations for faster decisions, file motions that reopen stalled claims, and appeal denials that shouldn't have happened in the first place. Sometimes the best path forward involves filing for a hearing before an industrial commission district hearing officer—something most injured workers can't navigate effectively on their own.
You don't have to accept delayed medical treatment as inevitable. Ohio's workers' compensation system has built-in protections for injured workers, but accessing those protections often requires persistence and knowledge of how the BWC operates. Whether that means making strategic calls, filing the right motions, or bringing in legal help, taking action with our legal help puts you back in control of your recovery timeline.
