Your Ohio workers’ comp claim was approved, and you're ready to start medical treatment to overcome your workplace injury.
Unfortunately, like almost everything with the Bureau of Worker’s Compensation (BWC), it’s not that easy.
As we’ve discussed in other articles on this website, you have to go to a BWC-certified doctor who assesses your condition and decides on a course of treatment.
He or she will then have to fill out a C-9 form to request the treatment be approved by your employer’s Managed Care Organization (MCO). If the procedure is authorized, you’re all set. However, if it’s not, things become more complicated.
Next Steps After Denial of Treatment by Your MCO
If you don’t already have a workers’ comp attorney, now would be a good time to get one. Your attorney will guide you through the appeals process and make sure you're providing complete information at each step.
If the MCO denies treatment, you or your attorney has 14 days to appeal the decision to the BWC. If the BWC also issues a denial, your next step will be to request a medical treatment hearing with the Ohio Industrial Commission (IC). This hearing is your chance to explain why the treatment is necessary and demonstrate how it will help you.
Preparing for Your Medical Treatment Hearing
While not as formal as a trial, this is an official proceeding you should take seriously. Dress appropriately, be on time, and have a positive attitude. The hearing is held in a state building, so you'll need an ID and will pass through security to get in. If you have an attorney, he or she will be with you, but you're answering the questions yourself. And, for heaven's sake, make sure to be there. Clients occasionally ask me whether they need to attend treatment hearings and the answer is a resounding "yes!". It's my belief, based on experience, that hearing officers will conclude you don't care one way or another about treatment if you don't even bother to show up to argue for it.
I encourage my clients to be honest and tell the Hearing Officer about:
- Limitations you have because of the injury
- Treatments tried in the past and how they did or didn't help
- Why a doctor is recommending this treatment now
- How this treatment will help you get better and return to work more quickly
- If you’ve had this treatment before, how it helped, and how long it lasted
- Your commitment to following this treatment
The job of the Hearing Officer who's deciding your appeal is to determine if the therapy is advantageous and if it's cost-effective. The clarity you use to explain how the treatment will help improves your chances of success.
If the District Hearing Officer denies your request, you can appeal again. You'll be referred to a Staff Hearing Officer at the IC.
I Can Help You Tell Your Story
As your workers’ compensation attorney, I'll guide you in how to explain the importance of your requested treatment. You need not be a medical expert to succeed in a medical treatment hearing—just tell the story in your words.
If you're struggling with a work-related illness or injury, I invite you to download my free book, The Workers' Guide to Injury Compensation in Ohio and contact my office for a personalized assessment of your claim.