My Claim Was Allowed. Will My Medical Bills Be Covered?

Posted on: September 26th, 2013 by admin No Comments

Generally speaking, medical bills are payable in an allowed workers compensation claim. Prior authorization for treatment must, however, be obtained.

Some Ohio employers are self-insured. In claims involving a self-insured employer, a request for benefits must be filed first with the employer. If the employer disputes payment of medical bills or the necessity of the treatment requested, it is required to refer the matter to the Bureau and the Industrial Commission.

If the employer participates in the Bureau’s state insurance fund, requests for treatment must be submitted to the employer’s managed care organization (MCO). The MCO is responsible for determining whether the requested treatment will initially be approved or denied. Appeals from the MCO’s initial decision are eventually referred to the Bureau for further evaluation. Appeals from Bureau denials are then referred to the Industrial Commission for hearing.