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Showdown at the Ohio Industrial Commission: Part One


Diagnostics V. Treatment

The Ohio workers compensation attorneys at Malek & Malek often find ourselves down at the Ohio Industrial Commission in regard to treatment issues. At its most basic form, treatment is “something done”, like surgery/epidural steroid injections/physical therapy/etc , and diagnostics are “searching for something.” Diagnostics come in the form of x-rays/ct scans/mri’s/emg’s/discograms/etc.

The medical provider requests treatment and diagnostics through the C9 form. One is below for your reference:

Medical reimbursement page 1

Medical reimbursement page 2

C9 Overview

In this C9 you can see that the doctor has requested an mri, emg, and x-ray of the lumbar spine. This would be considered a diagnostic because these are essentially tests that look to find where pain is being generated or a specific condition or dysfunction that is impairing the injured worker. An x-ray and mri are imaging studies that allow the doctor to see into the workers’ body. An emg tests the nerve pathways to see if there is any signal dysfunction.

You can also see that the doctor requested a pain management consultation and ,on the second page, physical medicine. Physical medicine is treatment, something is being done to the injured worker. Consultations, in general, are deemed treatment in the Bureau of Workers’ Comp world.

The final thing you will notice is that the treatment has been denied by the MCO or self-insured employer. This requires Malek & Malek to submit a C-86 motion. The C86 motion we submitted in response to this particular C9 denial is pasted below for your reference:

Medical reimbursement page 3

The Ohio Bureau of Workers’ Compensation (BWC) in turn will then refer this matter to the Industrial Commission for a hearing. In the second part of this article I will discuss the possible arguments for and against treatment and diagnostics that you may hear at your own Ohio Industrial Commission hearing. Stay tuned!