Information received indicates that, effective 1-1-2010, the Ohio BWC will impose NEW rules regarding BWC settlement offers: Read the rest of this entry »
Posts Tagged worker
The current atmosphere at the OhioBWC is anti-injured worker. The MCO’s continue to deny requested medical treatment, the BWC is actively making settlements of claims more onerous.
It’s bad enough to get hurt on the job, but fighting the system that is supposed to protect injured workers is downright demoralizing.
The BWC is now forcing settlement allocations between compensation, future medical expense, and protection of Medicare interests. That would not be bad but when the BWC forces allocation in a settlement for an injured worker who will not be eligible for Medicare benefits until age 65 or 66, it becomes absurd.
As a result of an internal audit performed late in 2008, the BWC decided that, in order to clean house, it would reduce settlement offers to injured workers, utilize co-morbidity tables (taking a persons whole medical history into account in the settlement of a broken leg, for example), and use the current economic situation to ’squeeze’ low settlement amounts for workers’ in economic distress (terminated due to economy, etc.)
So much for a system that makes a ‘Plegde’ of Service to injured workers.
Now, the Ohio Senate is considering bringing privatization to workers’ compensation in Ohio. Anyone who is injured in the service of a self-insured employer knows the extra nightmare of claim battles. Bringing privatization into the BWC arena will increase the battle between the injured worker and the benefits to which he/she is entitled.
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.
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.
“should any part of . . . my settlement or this agreement be challenged and found to be unconstitutional, unlawful, or invalid by a court of competent jurisdiction, the settlement and this acknowledgement and waiver shall remain in full force and effect.”
My fingers are buring as I type this entry. I am outraged by the current actions of the Ohio Bureau of Workers’ Compensation – not only in the recent low-balling of lump sum settlement top offers, but , insult on injury, requiring Ohio Injured Workers to sign the attached document.
Today, I was blown away by the latest Bizarre BWC position with regard to ACS, the Ohio Bureau of Workers’ Compensation Pharmacy Vendor. The Governor of Ohio needs to take action and appoint a responsive person as Administrator of The Ohio Bureau of Workers’ Compensation.
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!
Ohio Bureau of Workers’ Compensation Claim Processing Deadlines
No matter what the injury, each claim at the Ohio Bureau of Workers’ Compensation (OhioBWC) goes through certain steps to determine compensibility.
Temporary Total Disability
My injury hasn’t healed and I can’t go back to work yet – How do I get paid – How do I feed my family?
An injured worker who misses more than seven days of work as a result of their injury, may request payment of temporary total disability compensation. This is the compensation an injured worker receives during the period of inablity to return to work.
An injured worker who misses less than 7 days of work does not receive any temporary total disability compensation for the work days missed. The computation of days does not include the day you are injured or the day you return. The days counted include weekends, whether you work weekends or not.