OhioBWC - Basics:  Alternative Dispute Resolution (ADR)

Alternative Dispute Resolution (ADR)

ADR is a process facilitating resolution of disputed medical issues — medical treatment issues only, not reimbursement grievances. Ohio workers’ compensation laws and rules require BWC and managed care organizations (MCOs) to have an ADR process. MCOs must have a medical dispute resolution process that includes one level of review. BWC provides a second level of review for disputes not resolved at the MCO level.

The MCOs' dispute resolution processes must contain peer review conducted by an individual(s) licensed pursuant to the same section of the Ohio Revised Code as the health-care provider requesting the disputed issue. Additionally, ADRs conducted by the MCOs must be completed within 21 days of written receipt of notice of a dispute. MCOs must notify in writing the parties involved in the dispute and their representatives of the decision at the conclusion of the dispute resolution process. If the injured worker, employer or provider still disagrees, he or she may request, within seven days of receipt of written notice of the MCO’s decision, a second level of dispute resolution. The MCO will refer the dispute to BWC for an independent review. The MCO must refer the requested dispute to BWC within seven days of written notice of the request.

BWC’s ADR unit handles the second level of the ADR process and keeps the customer service team informed of progress and outcomes. If a disagreement still exists after the second level of review by BWC, the injured worker, employer or their representatives may file an appeal with the Industrial Commission of Ohio (IC). The IC hears the medical disputes only if the two levels of ADR have been exhausted.