The Ohio Bureau of Workers’ Compensation has recently adopted a new rule which makes it easier for injured workers to receive ongoing treatment in their workers’ compensation claims. This Code section, 4123-6-31.1, became effective February 1, 2025 and will apply to all treatment issues going forward.
Prior to its adoption, the Bureau and MCO’s would routinely deny ongoing conservative treatment such as chiropractic care and physical therapy. The premise for the denial often times was that if the treatment was no longer providing a definitive functional improvement for the injured worker, it would be deemed medically unnecessary and therefore not payable. The new Ohio Administrative Code section now acknowledges that sometimes treatment may be needed just to prevent an injured worker’s condition from getting worse.
Rather than requiring a showing of improvement, the Code now permits supportive care. This is any treatment which is needed to maintain the injured worker’s functioning or the therapeutic benefit of prior treatment. It also may be used in order to prevent exacerbations of one’s condition. In other words, the goal is to at least keep the injured worker stable and thereby prevent regression which may then require more invasive and expensive treatments.
One of the most frustrating areas of Ohio Workers’ Compensation claims is going through the arduous process of getting medical treatment approved and paid. If you have a claim and are running into roadblocks, the law firm of Green Haines Sgambati can help. We can work with your doctors on trying to get the treatment approved that you need, and in the meantime may also identify valuable benefits which you are owed.