QUESTION
Workers Comp isn't approving my surgery. What can I do?
Asked on Apr 07th, 2015 on Workers Compensation - Ohio
More details to this question:
From my husband: Injured in January 2015. Tear in my rotator cuff, cyst in right front shoulder, tear in elbow as well. My employer is paying me 100% of my wages and has agreed to the surgery I need. The surgeon has sent the required paperwork. Workers comp has not "allowed" my surgery. They say they're working on it. It's April. I'm in serious pain and in fear of losing mobility. They have denied any more physical therapy. How can I get this expedited? Is there a state agency that will help me? Thanks!
1 ANSWER
I am operating on the premise that your employer is State Funded and pays WC premiums to the Bureau of Workers' Compensation (BWC).
In 1995, the law was changed to allow the BWC to delegate medical management of claims to independent 3rd parties called Managed Care Organizations (MCO). MCOs are for-profit companies and operate under BWC rules. Some MCOs are better than others. By BWC rule, MCOs have 10 days to make a decision on a treatment request. Also by BWC, the request is deemed approved if the MCO does not meet the 10 days or "pends" the request to obtain a medical examination.
Your best bet is to push your doctor to hound the MCO. You could also call 1-800-OHIO BWC and make a complaint about the MCO to the Ombudsman's Office.
I do not recommend calling the MCO yourself -- that is better done by your doctor.
If you have an attorney, then your attorney can also call the MCO.
Answered on Apr 07th, 2015 at 12:25 PM
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