What are the Official Disability Guidelines, and how do they affect my workers’ comp?

how national guidelines approve workers' comp treatmentIf you're collecting workers’ compensation in Ohio for an ongoing work injury or illness and seeking continued care or new treatment options, you must get approval from your managed care organization (MCO).

The Ohio Bureau of Workers’ Compensation (BWC) requires MCOs to use approved treatment and return-to-work guidelines to evaluate the necessity and effectiveness of the requested medical care.

Since 2004, the BWC follows the Work Loss Data Institute’s (WLDI) Official Disability Guidelines (ODG) to "assist" in decision making.

What Is the ODG?

It's an online database created by the WLDI on behalf of the insurance industry. When reviewing a claimant’s request, BWC or MCO staff members enter the particular illness or injury into the database, then receive the ODG’s treatment recommendations.

While the WLDI claims it provides evidence-based and data-driven treatment guidelines, the organization's ultimate goal is to “reduce excessive utilization of medical services and corresponding medical cost” and get workers back on the job "as efficiently as possible".

In other words, it's on the side of the insurance company—in our case, the BWC—and the employer. Far too often, the ODG is used merely to deny requests rather than as just another piece of information to consider. If you're requesting treatment that isn't explicitly listed in the ODG, you're likely to be denied, first by the MCO and then by the rubber-stamp of the BWC. Because, hey, medical treatment costs money and the MCOs and BWC are all about saving money!

What Can You Do About it?

Appeal the MCO’s decisions and the BWC’s order to the Industrial Commission to get a hearing. The Industrial Commission is not bound to follow the ODG guidelines. The ODG should be used as it was intended—as a guideline for decision-making, not as the sole piece of evidence being considered. Make sure you get a letter from your doctor supporting her request for treatment: i.e., why it's reasonable, beneficial and necessary in your case. This needs to be submitted to your claim file before or at the hearing.

Your treating physician’s opinion, diagnostic testing, results of past treatment attempts, and many other factors should be considered when making a treatment decision. Also, I suggest you never go into a treatment request hearing alone. A qualified Ohio workers’ comp attorney will make sure all evidence is reviewed and that your request is given fair consideration.

When You Need Help in Ohio, Call Monast Law Office

Don't go through this process alone. I've helped hundreds of injured workers get the respect they deserve as they go through the workers’ comp process. Contact my office to discover if I can help you.

For more information meanwhile, request a free copy of our book, The Worker’s Guide to Injury Compensation in Ohio.     

 

 

James Monast
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Fighting for Ohio’s Injured Workers and their Families