NEWS & RESOURCES

Appealing Denied Medical Treatment Through the Ohio BWC

08.09.19
Ohio BWC Denied Treatment

A common task that Malek & Malek performs on behalf of our clients is appealing denied medical treatment through the Ohio BWC. I’ve created a youtube video which walks through this process in a step-by-step manner which you can find by click here . But the bottomline is that anytime that your doctor requests treatment is that they must do so through a document called a C9.

Whereas if you had personal insurance, your doctor would refer you to a surgical referral. First you would check, “is this surgeon in my network.” If he is, go to him, if not have your doctor refer you to another surgeon within your network. You show up for the appointment, hand them your insurance card, pay whatever co-pay you may have, then get seen by the surgeon. The time between the referral and seeing the doctor most likely is constrained by the availability of the surgeon to see you.

Contrast this with the BWC claims process. Your BWC POR (physician of record), first has to submit a request for a surgical consult through the C9. The MCO (managed care organization) reviews that request and either authorizes, denies, or pends the treatment. If the treatment is denied, there’s multiple steps you must take before the denied treatment ultimately is heard by a hearing office at the Ohio Industrial Commission.

The time delay between when the treatment is denied and when you have had your IC Hearing can be anywhere from a month to eight months. That is the BWC process. Its frustrating, and if you do something wrong, that time delay can be even greater.

For these reasons we highly recommend you contact a workers comp attorney to handle the process of appealing denied medical treatment on your behalf. It likes I mention constantly, to a mechanic fixing an engine is easy, for everybody else might as well be rocket science. Likewise to a workers comp attorney we appeal denied treatment nearly everyday, but to a lay person it can be very complex, full of pitfalls.

 

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