About Workers’ Comp

The Workers’ Compensation System

The Ohio Workers’ Compensation system is made up of two branches – the Bureau of Workers’ Compensation (BWC), the administrative branch; and the Industrial Commission of Ohio (IC), the claims adjudicative branch. The BWC handles the daily processing of claims, and makes payments as appropriate. It monitors medical treatment, disability and return to work issues, and “medically manages” the claims with the help of outside companies called Managed Care Organizations (or “MCO’s” for short)

The BWC’s health-care system

Managed Care Organizations, (or “MCO’s” for short) medically manage claims. This includes treatment and surgery approvals, payment of medical bills and rehabilitation referrals. These MCO's are private companies like insurance companies who are contracted by the BWC to pay bills and medically manage a claim. This used to be a function of the BWC itself, with state employees doing this. But, like so many other things in a big organization, this has now been "outsourced" to these companies. Critics have noted that the BWC did a better job at medically managing the claim. this is mainly because they appeared to be more "liberal" in their appklication of the claims and medical management principles. Defenders cite cost-savings, and profit motives as reasons for the need to have outside private companies perform this function. It saves money. Either way, the system in place involves a private company making the initial decision on whether payment for medical services is approved, and then the government steps in afterwards in the event of an appeal.

When an employee is hurt on the job, the injured worker can see any doctor for his or her first visit. After that the employee must visit a BWC-certified provider. The employer may suggest a doctor for the injured worker to visit, but the employee has the right to visit any BWC-certified provider that they choose. This is independent of the employer’s wishes. BWC-certified providers have agreed to provide injured workers with the quality care they need to get back to work. They are also skilled at completing the paperwork and forms needed to process the claim, and can work with the MCO and BWC on billing and other issues. To locate a BWC-certified provider, call your local customer service office of the BWC, or get assistance at 1-800-OHIOBWC. You can also log on to the BWC’s website and click on the Medical Community (provider) section at www.ohiobwc.com as this also contains at list of BWC-certified providers.

If the injured workers’ doctor prescribes medicine for their work-related injury, the employee should inform the pharmacist that the prescription is for a Workers’ Compensation claim. If the claim is allowed, they will receive prescriptions for the work-related injury at no up-front cost. If, however, the injured worker’s pharmacist fills their prescription before BWC allows the claim, the injured worker may have to pay for the prescription. When the Bureau allows the claim, the employee will be reimbursed.