Pursuant to Ohio Law, if an injured worker does not apply for and receive his/her permanent partial disability award, the claim is considered medical only. This can be trouble because medical only claims close sooner than a claim that paid injury money.
Posts Tagged medical treatment
You’ve moved and you didn’t inform Ohio Workers’ Compensation that you have a new address. Your benefits are at risk when the BWC has your incorrect address!
If orders are issued regarding your claim and you don’t appeal in a timely fashion, your benefits could end. There is a mechanism to correct the situation, but that might take months. If orders are issued that you do not receive, you will have to file a motion with the BWC requesting Ohio Revised Code § 4123.522 relief. This motion will be forwarded to the Ohio Industrial Commission for adjudication. This is a scenario that takes time, during which your benefits – temporary total disability – medical treatment – might be suspended. Don’t let that happen.
You can easily notify the OhioBWC that you have a new address by filing a C-77 Form, Notification of Change of Address.
Once you download the form from this link, you can Fax the form to the OhioBWC using their Toll Free Fax Number 1-877-520-OHIO (6446) or you can mail the form to BWC 30 W. Spring St. Columbus, OH 43215-2256.
Just remember to keep the BWC and your lawyer up to date with your new address and any new phone number you have.
I was called by a prospective client about her BWC claim and the fact that she could not get authorized for treatment. After talking to her for a few minutes it became obvious that I needed to speak with her doctor. So, I call the doctor and ask about the treatment that he requested on the C9 authorization form. I was dumbfounded by his comments during the conversation! Here is the skinny on our discussion.
First I ask him what he filled out on the form. He told me that he asked for permission to provide therapy modalities over a multi week period. It was apparent to me, during the conversation with the prospective client and the doctor, that the claim was medically inactive. The request should have asked for claim reactivation.
If you are an injured worker, you must be informed and know that if you have an allowed BWC claim and you do not obtain medical treatment for a period of 14 months, your claim becomes inactive. Once that happens, you may have to prove – all over again - that your needed treatment is related to the original work injury. The doctor’s mistake was not requesting reactivation of the claim.
But now for the clincher to the conversation . . . . Then I ask the doctor when he sent the C9 Form to the MCO (Medical Care Organization). His reply, on the 5th (today is the 13th). I ask if he has a fax transmittal sheet to prove that he sent it on the 5th and that the MCO received the C9 on the 5th. He seemed surprised by the question. Well, if he was surprised by the question, I was dumbfounded that a medical provider – an OhioBWC Certified Medical Provider at that – would not be aware of the simple rules governing the time limits pertaining to authorization of treatment requested via the C9 Form.
I explain that there are rules and that the rules are printed right on the form. A state funded employer’s MCO has 3 days to respond to a C9. If there is no response, guess what – the requested treatment is authorized. For a self insured employer, there is a 10 day response time. I can’t tell y0u how many times MCO’s blow the response time. A C9 Form is attached to this article via hyperlink below so you can see it for yourselves.
In this instance, the doctor could not prove that he sent the C9 form to the MCO over 7 days before, without response.
Who suffers? The injured worker because here she is waiting for necessary treatment that could have started days before.
I then explained to the doctor that there is a rule regarding the submission of medical bills. A medical bill must be submitted to the MCO or OhioBWC within 2 years of the date of service. If the bill isn’t filed within the 2 year period, the BWC doesn’t have to pay the bill, even if the treatment was rendered for allowed claim conditions, because the bill is time barred. Who suffers in such situation? Both the doctor and the injured worker. But then I suppose the doctor eventually would sue the injured worker for payment of the bill even though the doctor failed to file his bill in a timely fashion.
Bottom Line – The Importance of a Fax Transmittal Sheet - I explained that the doctor needed to set his fax machine to spit out a transmittal sheet so he can prove when and to whom he sent the C9 for treatment approval and also to prove when and to whom he submitted his medical bills for payment.
Hopefully, the doctor learned what needs to be done.
Please check with your doctor to make sure that he/she can prove when documents, office notes, C9 authorization requests, and bills were filed with the BWC.
To make sure your claim is being handled correctly, call a Board Certified Ohio Workers’ Compensation Specialist. Get the protection you need and all of the compensation benefits and money you deserve.
With everything I see as a Workers’ Compensation Specialist, all I can say is this – any injured worker going it alone on a workers’ comp claim may as well bare his/her throat and tell them to cut your jugular vein!
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The OhioBWC has its’ lawyers and your Employer has its’ lawyers, so if a workers’ comp claim was really something you could do yourself, why does “the other side” have lawyers?
That fact alone should give you the “heads-up” that you need a lawyer representing you and protecting your right to medical treatment and money awards!
And if you are going to pay the same 1/3 contingency fee, why wouldn’t you want a lawyer who is a Board Certified Workers’ Compensation Specialist representing you?