OhioBWC - Basics:  Medical Documentation

Medical Documentation

When a workers’ compensation claim is filed, Ohio law authorizes BWC and Managed Care Organizations (MCOs) to receive all related medical documents, which will be used to research and determine the claim. Medical providers who undertake treatment of an injured worker are required by Ohio Administrative Code (OAC) 4123-6-20 to submit initial and subsequent medical reports to the injured worker’s MCO. Legally, by filing a claim, the injured worker authorizes the release of all information associated to the work-related injury or occupational disease (OD). Therefore, a specific release of information form does not need to be completed.

Initial reports
Initial reports are all documents provided to a managed care organization (MCO) when, or shortly after, the First Report of Injury, Occupational Disease or Death (FROI) form is submitted. Initial reports include, but are not limited to, emergency room reports, MRIs, CAT scans, accident reports, physician statements, operative reports, progress notes, diagnostic reports, and x-ray interpretations. Medical providers have up to 5 days after rendering services to an injured worker to submit initial reports to the MCO. Meeting this requirement has a number of advantages, including assisting BWC in expediting the processing of the claim. The MCO is responsible for gathering and providing medical evidence to support the initial decision in a timely manner. In most cases, the sooner the MCO sends initial medical documentation to the customer service team, the sooner the claim can be allowed.

Subsequent reports
Subsequent reports must be submitted to the MCO during the course of the injured worker’s treatment. Some examples of when subsequent reports must be submitted include, but are not limited to, updates to treatment plans, notification that an injured worker missed an appointment, diagnostic test findings are received, or there has been an emergency room visit. Subsequent reports must be submitted to the MCO within 5 days of the service being delivered, or the MCO requesting the information.

Medical documentation is also referred to as “medical evidence,” “medical reports,” or “medical.”