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What should I know about workers' compensation healthcare?


A common concern among Ohio workers who are injured on the job and are seeking benefits through workers' compensation is how the Bureau of Workers' Compensation provides healthcare. There are certain rules that mandate which doctors the injured worker can see, how it will be paid for, under what circumstances, and the way in which prescription medication is handled. If there is a problem with these issues, it is important to have legal assistance to get the workers' compensation benefits the person is entitled to.

When the worker is first injured, they have the right to see any doctor for the initial visit. However, the BWC will then request that the worker see medical professionals who are certified by the agency. An emergency is a different matter and the worker can see any doctor under those circumstances. If the worker sees a medical professional who is non-certified, they will be responsible for paying for the visit. It is possible for the non-certified provider to be certified by the BWC so the worker does not need to pay for the treatment.

The injury must qualify for coverage. If a medical professional who is certified provides the treatment, the worker will not need to pay for it. It is important to remember that there are limits to the treatment the worker can get. The Managed Care Organization manages the following: the medical claim involving treatment, approvals for surgery, paying the medical expenses, referring the worker for rehabilitative care, and return-to-work assistance. The worker and the employer can file an appeal if they disagree with an MCO decision.

With workplace injuries, there will often be a need for prescription medication. The worker will give necessary information to the pharmacist, such as the date of the injury, the BWC claim number, and the Social Security number. It is imperative to remember that if the claim has not been approved at the time the worker is getting the medication, they will have to pay for it out of pocket and will be reimbursed once the claim has been approved.

Given the rules that accompany receiving treatment after a work injury, it is unavoidable that some workers will have a problem receiving compensation. A legal firm with experience in all areas of workers' compensation can assist with a claim and help the injured worker with their workers' compensation benefits.

Source: bwc.ohio.gov, "BWC Basics for Injured Workers -- Better Health Care, page 8," accessed on April 22, 2018

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