Work injuries take place daily. Workers who experience an injury or illness due to their employment are entitled to care which is covered through workers' compensation and, therefore, paid by their employer. Some details concerning workers compensation and care due to a work-related injury or illness are outlined below. For more information concerning the Ohio BWC regulations and information, visit www.ohiobwc.com.
For Ohio workers who experience a new injury or illness due to their employment, a First Report of Injury should be filed with the Ohio BWC. This form is commonly filed through the treating physician's office or the injured worker's employer. If the worker's employer is self-insured, the First Report of Injury may be filed through the employer's human resources/workers' compensation representative. For assistance in filing a claim, the injured worker may contact the BWC at 1-800-OHIOBWC or file a claim online at www.ohiobwc.com.
Information needed in order to allow the claim varies based on each individual claim and circumstances. Generally, the following information is needed in order to make a claim determination:
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Name and address of injured worker
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Employer name and workers' compensation policy number
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Detailed accident description
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Medical diagnosis of an injury
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Medical documentation to support the relationship of the treatment to the work-related injury or occupational disease
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Information regarding disability
Responsibility for obtaining the needed information is placed on the MCO (Managed Care Organization). The MCO serves as the liason between the BWC and the healthcare provider in obtaining and sending in medical information; however, BWC will accept information directly from the injured worker, a legal representative, a healthcare provider, or the employer.
To clarify, the BWC is the State of Ohio government agency responsible for Ohio's workers' compensation system. The MCO's are private companies selected by or assigned to each state-funded Ohio employer to medically manage the employer's workers' compensation claims. BWC makes decisions regarding claim allowances and issues benefit payments. The MCO's coordinate medical care and make treatment decisions.
Once the First Report of Injury (FROI) has been filed, the injured worker will receive a notice in the mail with their claim number and the contact information for their MCO. The information may also be accessed online at the BWC website (www.ohiobwc.com).
Injured workers who have already filed a claim and have an established workers' compensation claim may find it necessary to seek treatment with a different physician after receiving initial treatment and diagnosis. When this is the case, the injured worker will need to file a Notice to Change Physician of Record with BWC. This notifies the BWC of the need and reason for further care with a new physician. If an injured worker is uncertain of their current Physician of Record, they may contact BWC or the MCO to retreive this information. This information is also available online at www.ohiobwc.com. Once received and processed, the requested physician will be assigned to the claim as the Physician of Record. The Notice to Change Physician of Record is commonly filed through the office of the new physician or may be accessed online at the BWC website (www.ohiobwc.com).
An occupational disease is a disease contracted in the course of employment to which, otherwise, the employee would not have generally been subjected or exposed, usually occurring over a period of time. For example, asbestosis may be considered an occupational disease.
Injured workers who wish to be treated under their workers' compensation claim must be treated by a BWC certified provider. At Orthopaedics & Sports Medicine Consultants, Inc., all of our surgeons are certified by the Ohio Bureau of Workers' Compensation. Injured workers may contact BWC to verify a doctor's certification or access this information online at www.ohiobwc.com. Injured workers may also contact their MCO for assistance in finding a physician.
Once the claim is allowed, the providers who have provided treatment for a work-related injury will submit their bills to the MCO. The MCO reviews and prices the bills and forwards them electronically to BWC. BWC pays the MCO who in turn disburses payment to the providers. If a bill is received by an injured worker for treatment that was for a work-related injury, the injured worker should contact the provider and give the provider the name and billing address of the MCO and request that a bill be sent to them.
Treating physicians are responsible for requesting treatment authorization from the MCO's. The MCO's review all medical treatment requests and issue approvals and denials. Injured workers may contact the MCO to obtain information about treatment requests, approvals, and denials.
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