Once a workers’ compensation claim is approved, people frequently think they will get all the treatment they need. Unfortunately, many cases arise from a dispute over how much treatment is needed. Workers should know how to appeal a treatment decision.
Key points about appealing medical treatment determinations
Many injuries and conditions are difficult to fully diagnose and accurately assess their severity. The Bureau of Workers’ Compensation (BWC) gives the injured worker options when there is a disagreement about a case. With medical treatment, the determinations are made by the Managed Care Organization (MCO). Anyone involved in the case can appeal. That includes the worker, the employer and the medical provider.
Appeals are made through Alternative Dispute Resolution (ADR). When treatment is provided, the medical professionals overseeing it will write reports as to whether the treatment being given is connected to the injury; if it is medically needed; and if the expense is reasonable.
In some cases, the MCO might decide to send the worker for an independent evaluation. That doctor will assess the worker and send a report to the BWC as to what they think is necessary. If the worker still disagrees with the decision, an appeal can be filed with the Ohio Industrial Commission (IC).
Workers may want to seek legal help
Medical decisions can invite dispute. If, for example, a warehouse worker suffers a back injury that they say is not improving with the treatment they are getting and they want to receive diagnosis and treatment from a specialist, it is not guaranteed. The employer or MCO might even say that the worker is able to get back on the job. This is when it will be necessary to file an appeal.
Workers are frequently unaware of their rights regarding workers’ compensation claims. They might be concerned that they will lose their job, their income and the medical treatment they have been getting if they complain. It is imperative to understand the law and how these cases are handled. From the outset, it is important to have experienced guidance with a workers’ compensation claim at every stage of the case.