4123.01 and 4123.53.
4123-3-09, 4123-3-16 and 4123-5-18.
Joint Resolutions R-03-1-01, R-92-1-1 and R-94-1-12.
Percy, Chief of Operational Policy, Analytics and Compliance (Signature on
02/05/13; Rev. 07/15/13; 02/26/14
purpose of this policy is to ensure BWC appropriately allows psychiatric conditions
in accordance with the law and rules.
policy applies to Field Operations, Medical Services and Legal Division staff.
for purposes of this policy and related procedure, means where the injured
worker’s psychiatric conditions have arisen from sexual conduct in which the
injured worker was forced by threat of physical harm to engage or participate.
Injury: for purposes
of this policy and related procedure, includes psychiatric conditions when the
injured worker’s psychiatric conditions have arisen from an injury or
occupational disease sustained by that injured worker, or where the injured
worker’s psychiatric conditions have arisen from forced sexual conduct.
for purposes of this policy and related procedure, means vaginal intercourse
between a male and female; anal intercourse, fellatio, and cunnilingus between
persons regardless of gender; and, without privilege to do so, the insertion,
however slight, of any part of the body or any instrument, apparatus, or other
object into the vaginal or anal cavity of another. Penetration,
however slight, is sufficient to complete vaginal or anal intercourse.
A. General policy statements
1. It is the policy
of BWC to evaluate initial and additional allowance requests for a psychiatric
condition(s) in a claim that arise from:
a. An injury or
occupational disease sustained by the injured worker when a compensable
physical injury sustained by the claimant causes the mental condition. Armstrong
v. John R. Jurgensen Co., Slip Opinion No. 2013-Ohio-2237; or
b. Forced sexual
2. It is the policy
of BWC that for recognition of a psychiatric condition(s) the request is
accompanied by supporting medical documentation consisting of the following:
a. The medical
report is submitted by a:
iii. Licensed Professional
Clinical Counselor (LPCC); or
iv. Licensed Independent
Social Worker (LISW).
b. The medical
report is detailed and includes the following:
i. The specific
psychiatric condition(s) diagnosis with narrative description and the
appropriate diagnosis code;
iii. The psychiatric
explanation of the causal relationship of the diagnosed psychiatric condition
to the work-related injury or occupational disease;
v. Information that
is clearly reasoned and rationalized.
c. The medical
report verifies the psychiatric condition(s) arose from an injury or
occupational disease sustained by the IW or forced sexual conduct.
d. The medical
report addresses each psychiatric condition(s) requested.
3. It is the policy
of BWC that a request for a psychiatric condition(s) will not be based on a
medical report from an:
a. Advanced Practice
Registered Nurse (APRN), or
b. Advanced Practice
4. It is the policy
of BWC that BWC may obtain a psychiatric independent medical examination or
physician file review to provide a medical opinion on the following:
a. The presence of
a psychiatric condition in a claim as an initial determination or an additional
b. The necessity
and appropriateness of psychiatric treatment;
c. The extent of a
B. Initial determination
request for a psychiatric condition(s)
1. BWC may receive
an initial determination request for psychiatric condition(s) on a First
Report of an Injury, Occupational Disease or Death (FROI-1) concurrent with
the request for a physical injury or as a result of forced sexual conduct.
a. An initial
determination requesting a psychiatric condition(s) as a result of forced
sexual conduct is treated the same as any other claim for an initial determination.
b. A request for
psychiatric condition(s) arising out of forced sexual conduct is the only
instance where the law allows for the initial determination of psychiatric,
emotional or stress claim absent a physical injury.
2. It is the policy
of BWC that an injured worker must sign and date the FROI-1 application
requesting a psychiatric condition(s).
3. BWC does not
require an injured worker declaration statement for a psychiatric condition(s) filed
for an initial determination request.
allowance request for a psychiatric condition(s)
1. BWC must receive
an additional allowance request for a psychiatric condition(s) on a Motion
2. For each
requested psychiatric condition, BWC must receive a signed and dated
declaration statement from the injured worker that says, “I am aware that this
motion is being filed to request that the bureau or commission recognize my
emotional problem, nervous condition, or psychiatric disability as being a
result of the injury for which this claim is allowed.”
3. BWC will not
process requests for a psychiatric condition(s) recommended by a treating
physician on a Physician's Request for Medical Service or Recommendation for
Additional Conditions for Industrial Injury or Occupational Disease (C-9).
D. BWC may approve
and/or reimburse for psychiatric evaluations and/or treatment when an injured
condition is allowed in the claim;
independent medical examination is scheduled by and for BWC purposes;
condition is allowed in the claim and the injured worker or provider previously
paid for an examination performed to provide evidence to support the Motion
and/or treatment is part of an approved vocational rehabilitation or
catastrophic treatment plan;
5. Evaluation is
part of an authorized pre-admission evaluation for an approved chronic pain
and/or treatment is part of an authorized chronic pain program;
and/or treatment is part of an authorized detoxification or substance abuse
conditions and compensation
1. Specialties licensed
to treat and who can certify periods of disability based on psychiatric
a. Medical Doctors
b. Doctors of
Osteopathic Medicine (D.O.), and
licensed to treat without the supervision of a psychiatrist or psychologist
(i.e., they may work independently to request treatment and provide
medical/psychiatric services to an injured worker), but who cannot certify
periods of disability or sign any forms used for compensation (e.g., MEDCO-14)
Independent Social Workers (LISW); and
Professional Clinical Counselors (LPCC).
F. Psychiatric conditions
and self-insured claims
1. It is the policy
of BWC not to schedule exams for psychiatric condition(s) requested in self-insured
claims unless the Industrial Commission (IC) orders such an exam.
2. If an exam is
ordered, the self-insured employer is responsible for the cost of the
psychiatric condition(s) independent medical examination scheduled at the
request of the IC by BWC.