Fox & Fox Co. L.P.A.
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What is presumptive approval with workers' compensation?

For Ohio workers who suffer an injury or condition on the job, their priority should be to get treatment and improve their health, so they can get back to work. Workers' compensation benefits are meant to provide that treatment and cover the wages of an injured worker. Certain issues, however, might be confusing to a worker. These should be understood to know what treatment they can get, and the circumstances under which it is received. One specific issue to understand is presumptive approval.

In some cases, if the worker is receiving treatment from a physician within 60 days of the injury, there will be presumed approval for the worker to be treated and get services for that injury. The most frequent kind of injuries that workers suffer from are musculoskeletal and soft tissue.

There are certain criteria that must be met for there to be presumptive approval. With presumptive approval, there will be no wait time for the treatment to be authorized. The worker can get treatment as soon as possible. This is beneficial to everyone as the worker will not need to wait to be treated and the cost will be less.

Treatments for soft tissue or musculoskeletal injury can be given presumptively: there can be as many as 12 visits to be treated for chiropractic manipulation, physical therapy, rehabilitation and osteopathic treatment; the worker can get X-rays, CAT scans; MRI, EMG/NCB to diagnose the problems -- this does not cover surgical or arthroscopic procedures to determine the issue except in cases of an emergency; care for fractures and to recast or place a splint; as many as three injections for soft tissue or joints in the extremities and trigger points; and to consult.

If the worker is not aware of what they can get with presumptive approval, or there is an attempt on the part of the employer to prevent the worker from using the services provided under presumptive approval, having legal help is a must. A lawyer who has experience in helping clients with all areas of workers' compensation can be of assistance in a case.

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