Your Rights with an Ohio Workers' Compensation Medical Review
As an injured worker, it can be confusing to understand your rights after the Ohio Bureau of Workers' Compensation (BWC) medical review disputes your need for treatment and testing. While your healthcare providers have specific reasons to ask for more treatment, testing, or other procedures, what can you do if the BWC disagrees?
At Monast Law Office, we have considerable experience dealing with claims stuck in this loop. We’re ready to help you understand the BWC's medical review process and what to do if your workers’ compensation benefits claim is denied.
How the BWC Medical Review Process Works
When your doctor submits a request for medical treatment, testing, or recognition of additional conditions related to your workplace injury, the BWC doesn’t automatically approve it. It holds a medical review conducted by healthcare professionals working for or contracting with the BWC. They examine your doctor's request, your medical records, and the specifics of your claim to determine if they believe the requested treatment or testing is medically necessary and related to your allowed conditions.
Often, the reviewers haven’t examined you personally. They make decisions based on paperwork, not a face-to-face evaluation of your condition. This is why disagreements occur, and you have the right to challenge their decisions.
Know Your Rights if Your Ohio Workers' Comp Claim Was Denied
When the BWC disagrees with your doctor’s recommendations, you might feel like you have no options. However, Ohio law gives you significant rights, such as appealing the BWC’s decision.
You also have the right to:
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- Receive a clear, written explanation of why your request was denied.
- Access all medical records and reports used in making the decision.
- Have your doctor provide more information or clarification.
- Ask for an independent medical examination.
Remember, the BWC's decision isn't final until you've exhausted your appeal options.
Appealing a Denial from the BWC
Appealing a BWC decision isn't just about saying you disagree with the outcome. You must build a compelling case for why the requested medical treatment or testing is necessary. Start by gathering all relevant medical documentation, such as:
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- Your doctor's original request and justification
- Any test results or imaging studies that support your need for medical treatment
- Records of earlier medical treatments and their outcomes
Next, work with your doctor to develop a detailed statement explaining why the requested treatment is medically necessary and directly related to your workplace injury. You might obtain a second medical opinion to support your case. An independent expert provides a fresh perspective and lends additional credibility to your appeal.
At Monast Law Office, we've helped countless Ohio workers through this appeal process. We know that a well-crafted appeal makes all the difference in getting you the care you need to recover and return to work.
Navigating the Ohio Workers' Comp Hearing Process
If your initial appeal is denied, you still have options. The next step is typically a hearing before the Ohio Industrial Commission, which is your opportunity to present your case personally.
You have the right to legal representation at this hearing. Having us on your side significantly improves your chances of success. We’ll help you prepare to present medical evidence, including written testimony from your doctor. Additionally, you may need to explain how the denied treatment or testing impacts your ability to recover and return to work.
Remember, the hearing officer's job is to make an impartial decision based on the evidence. At Monast Law Office, we've stood beside many injured workers during these hearings, helping them present their cases persuasively. As noted by our client, Don Holliday, “Monast law office has been totally awesome … I had to do nothing but show up for my hearings. They handled everything flawlessly.” Another client, Margaret Hiles, is also pleased with how Monast Law Office handles her BWC hearing process, stating, “Mr. Monast has been at every hearing I’ve had with BWC … I really appreciate him understanding the difficulties I have and how important it is for me to receive my treatments so that I can function better on a daily basis.”
We choose our workers' compensation cases carefully and dedicate ourselves to our clients.
Read our case results to learn more about the successful outcomes we’ve secured for Ohio’s hardworking employees.
