What to do before, during and after
a workplace injury occurs:
Know your employer’s coverage
Ohio’s employers are either state fund or self-insured. If you do not know whether your employer is state fund or self-insured, ask your employer. State-fund employers pay an insurance premium to BWC. The bureau then pays compensation benefits directly to the injured worker. Self-insuring employers pay workers’ compensation benefits directly to their employees.
Know your MCO
Under BWC’s health-care system, managed care organizations (MCOs) manage the medical services in your claim. This includes treatment and surgery approvals, payment of medical bills and rehabilitation referrals. Each state-fund employer has an MCO, while self-insuring employers may have their own managed care systems.
If your employer is state fund, your MCO will work with your doctor to make sure you receive appropriate medical care geared toward return to work. Remember, BWC cannot pay any benefits until your claim is allowed. BWC will decide if the claim is allowed or denied. If your claim is allowed, your MCO will pay your medical bills. If you lose eight or more days from work due to your injury, BWC will pay your compensation for lost-time wages.
Choose a doctor
If you are hurt on the job, you can see any doctor for your first visit. After that, you have the right to choose any BWC-certified provider to treat your injury. If you choose to be treated by a noncertified provider, except in emergency situations, you may be responsible for payment of medical bills. You can select a BWC-certified provider in your area by logging on to www.ohiobwc.com and clicking on:
Medical providers;
Look-ups;
BWC-certified Provider look-up.
If you sustain an injury
I understand what a difficult time it can be after sustaining a workplace injury. I want to make sure the workers’ compensation process is as simple and smooth for you as possible. Immediately after a work-place injury, you should:
1. Seek medical attention;
2. Tell your employer you have been injured. Ask your
employer if you need to fill out an internal accident report;
3. Tell your doctor or emergency room that you have a work related injury at the time of service. This is very important.
4. Inform the pharmacist that your prescriptions are for the treatment of an Ohio workers’ compensation claim and provide the pharmacist with your date of injury. Provide your BWC claim number if one has been assigned, but it is not required to have your medication bill submitted to BWC.
5. Contact the Law Offices of Thomas Tootle
After you file a claim
You will receive an informational packet, including a BWC identification card. The identification card contains your claim number, the name of your claims services specialist (CSS), his or her phone number, and your MCO’s name and phone number. You will be asked for your claim number any time you work with BWC, your MCO or your doctor. If you have not received your notification letter and brochure from BWC within two weeks of your injury, call the Law Offices of Thomas Tootle Co., L.P.A.
If you fill a prescription
Inform your pharmacist your prescription is for treatment of an Ohio workers’ compensation claim. Provide the pharmacist with your Social Security number, date of injury and your BWC claim number, if you have received it. BWC has contracted with a pharmacy benefit manager (PBM) to process outpatient medication bills at the point-of-service. There are pharmacies that will not ask you to pay for outpatient medications prior to your claim allowance. However, since your claim will not be in an allowed status immediately after your injury, it is likely the pharmacy will ask you to pay for the medication initially. For this reason, ask your physician to prescribe generic drugs and small quantities of drugs to lessen the amount that you may be asked to pay. Also, do not use a group health insurance plan to pay for your outpatient medications prior to your claim allowance as BWC cannot reimburse you for any co-payments that you pay for out-of-pocket. Note: Once your claim is allowed, the PBM will send you a check at the BWC fee schedule amount. You do not need to do anything further to be reimbursed. Future prescriptions for the treatment of the conditions allowed in your claim will be approved for payment directly to the pharmacy, so you will not have to pay up front again.
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