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OhioBWC - Basics:  Medically Necessary

Medically Necessary

The provision and reimbursement of medical services given to injured workers is grounded in the concept of medical necessity. While it is the managed care organization’s responsibility to make this determination, evaluating medical necessity is legally dictated, particularly by the case State ex. rel. Miller v. Indus. Comm. 71 Ohio St. 3d 229 (1994). The Miller case affirmed that medical necessity, as well as relatedness and cost, need to be considered in all medical service decisions made by the Ohio workers’ compensation system.