Ohio workers who are injured on the job and need medical treatment will use their workers’ compensation benefits to receive it. Medical expenses and lost wages are covered under workers’ compensation. If there are no disputes regarding the injuries and the employer or insurer approves the workers’ compensation benefits, there should be no problem. The proper treatment is imperative to the worker getting back to full health and, if possible, getting back on the job.
Still, not every case is the same and there can be disagreements regarding various aspects of a workers’ compensation claim in relation to the injuries. If there is a dispute between the worker and the insurer or employer about a decision on the workers’ compensation claim, knowing how to appeal is key. Treatment decisions are made by the managed care organization (MCO). When there is a disagreement, the worker can use the Alternative Dispute Resolution (ADR) process.
ADR is an appeal to decide on a dispute. The MCO will have the case reviewed by medical professionals. They will: decide if the medical services are necessary for the worker injury; assess if the treatment is required; and determine if the amount it costs is reasonable. The MCO might decide to have the worker take part in an independent medical examination (IME). If the decision does not return in the worker’s favor, there is still recourse. Both the worker and the employer are granted 14 days to lodge an appeal to the Ohio Industrial Commission (IC). There will be a hearing and if either side is dissatisfied with the decision, there are other levels of appeal that can be used.
For workers who do not believe they are getting the medical care they need to treat their work-related injuries, they could be worried that their workers’ compensation benefits will end, that they will not be able to return to work and that they could face an uncertain future. For disputes related to medical care, treatment decisions, appeals and any other part of a workers’ compensation claim, a law firm that handles workers’ compensation cases may be a useful resource.