and Procedure Name:
to Dentures, Eyeglasses and Hearing Aids
4123.66; O.A.C. 4123-6-31
Percy, Chief of Operational Policy, Analytics & Compliance
policies and procedures, directives or memos regarding damage to dentures, eyeglasses
and hearing aids that predate the effective date of this policy.
purpose of this policy is to ensure that requests for the repair or replacement
of dentures, eyeglasses and hearing aids damaged in the course of an allowed industrial
injury are processed appropriately.
policy applies to BWC Field Operations and MCO staff.
replacement of a tooth or teeth.
Eyeglasses: For the
purpose of this policy, refers to any removable prescriptive corrective lenses
(i.e., glasses and contacts).
Aid: A removable electronic device used to amplify sound that is worn in or
behind the ear of a person with a hearing impairment.
A. General Policy
Statements for both repair or replacement
1. It is the policy
of BWC to ensure that the repair or replacement of dentures, eyeglasses and
hearing aids damaged in the course of an injury or industrial accident resulting
in an allowed claim is covered regardless of:
a. The allowed
condition(s) in the claim; and,
b. Whether or not
the items were in use at the time of the injury. For example, an injured worker
(IW) has a hearing aid in a pocket and not his/her ear at the time of the
injury, but the device is damaged in the course of the industrial accident.
2. BWC pays for repair
or replacement of an item one time for each industrial accident resulting in injury.
B. Repair - The
MCO shall approve only a repair when:
1. The denture,
eyeglasses or hearing aid is repairable; and,
2. The cost of the
repair would be less than the replacement cost.
1. BWC shall only
pay for replacement dentures, eyeglasses or hearing aids when the IW submits documentation
from the original supplier or a servicing provider (e.g., a bill or an itemized
statement of the original item).
2. The MCO shall only
approve a deluxe feature (e.g., anti-reflective or scratch-resistant coating
for glasses, bluetooth-capable hearing aids) on a replacement of dentures,
eyeglasses or hearing aids when the IW submits documentation from the service
provider attesting that a deluxe feature was on the damaged item.
3. The MCO shall
only approve a replacement of dentures, eyeglasses and hearing aids based on
the BWC fee schedule.
4. It is the
responsibility of the IW to pay for any exams necessary to obtain replacement
dentures, eyeglasses and hearing aids.
D. BWC shall not
pay for any other personal use items damaged in an industrial accident (e.g., shoes,
jewelry, clothes, wheelchairs).
E. Requests to
reimburse an IW directly for services the IW paid out-of-pocket must be
submitted within the later of:
1. One year of the
date of service; or,
2. One year after
the earlier of:
a. The Staff
Hearing Officer order; or,
b. The final
administrative or judicial order allowing payment.
A. The MCO shall
process requests submitted via the Physician's Request for Medical Service
or Recommendation for Additional Conditions for Industrial Injury or
in accordance with the C-9 procedures.
B. Field Staff
shall refer all requests for repair or replacement submitted via a Motion
(C-86) to the MCO on an “MCO Referral” letter, in accordance with the Motions
policy and procedure.
C. When the MCO
receives a reimbursement request for repair or replacement of denture,
eyeglasses or hearing aid that the IW, employer or other third party has
already paid, the MCO shall request:
1. A receipt; and
2. Proof of
D. The MCO shall review
the documentation provided to determine if it is payable.
1. If it is
determined that the service is payable, the MCO shall:
a. Submit to BWC a Service
Invoice (C-19) with the explanation of benefits code 771 referenced; and
b. Reimburse the
IW, employer or other third party.
2. If it is
determined the service is not payable, the MCO shall notify the party