Work it Out Blog

Another Reason to Be Proactive: New BWC Pilot Program Authorizes Treatment for Non-Allowed Conditions

May 20, 2015

We always advise our clients that it is best to get involved in a workers’ compensation claim early. Early claim investigation, including obtaining incident reports, witness statements, and prior medical records, can help defray future claims costs. A new Bureau of Workers’ Compensation program that goes into effect this summer provides us with a great example of why getting involved in a claim early is crucial.

The Enhanced Care Program begins this summer in sixteen Northeast Ohio counties, including Cuyahoga, Summit, Stark, Trumbull, and Mahoning. The BWC created this program to give medical providers a greater ability to treat injured workers in the early stages of a workers’ compensation claim. The program allows any BWC certified provider who participates in the program to provide treatment for conditions not currently allowed in the claim if the provider reasonably believes it to be causally related to the injury. The physician must submit the request for treatment to the Managed Care Organization within five days, but may begin treatment if it is consistent with the Official Disability Guidelines. For the time being, participation in the program will be limited to claims allowed only for a knee sprain.

So, what does this mean? In claims allowed for a knee sprain, the physician of record can begin physical therapy without waiting for the MCO’s approval. Surgery could be approved without a more serious condition being officially allowed in the claim. Essentially, the program has the possibility to skyrocket the amount of money paid out for medical treatment in claims. It is unclear what will happen if the treatment or additional conditions are ultimately denied. One possibility is that the money paid out will be charged off of the surplus fund. This program could expand to the rest of the state and become permanent if it is successful.

Moving forward, we suggest getting involved in your workers’ compensation claims as early as possible in order to save money down the line. This includes obtaining statements from the injured worker and any witnesses, getting medical records that predate the incident, and being proactive in obtaining independent medical examinations or record reviews. The more you do now, the more money you could save in the future.  For any BWC claims questions, please contact your Day Ketterer Workers’ Compensation attorney.

The content of this blog is for informational purposes only and is not intended as legal advice for any purpose. This blog is not intended to present an exhaustive summary of all applicable laws, or to take the place of legal advice.  If you have any questions regarding the law, please contact us for assistance.