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OhioBWC - Basics:  Services provided by Disability Evaluators' Panel (DEP) physicians

               
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Services provided by Disability Evaluators' Panel (DEP) physicians

Permanent partial disability examinations
The purpose of the exam is to provide an unbiased, objective estimate of the whole-person, percent impairment for a given allowed condition. This must be based on the most current edition of the American Medical Association's (AMA's) Guides to the Evaluation of Permanent Impairment, using the available medical documentation, history and physical examination. Examining physicians should generate reports, which identify the appropriate tables or figures from the guides that they used to reach their conclusions. There is no decision making process other than interpretation of the medical exam, medical records and history, and applying this information to the guides. Most physicians who perform these exams must receive additional training that explains the process, since these examinations are not routinely performed in medical residency. The more examinations a physician performs, the better the physician becomes at the process. Primary issues are objectivity of the examiner and appropriately using the guides. In some areas of the state there are shortages of qualified examiners for particular specialties.

File reviews for requests to increase permanent partial disability benefits
This review requires the physician to visit the local BWC customer service office and review medical files with newly submitted medical documentation from the injured worker to determine whether to grant additional impairment. It does not require clinical decision making in terms of alternative treatment, diagnosis or examination of the patient. It requires a good knowledge and application of the Guides to the Evaluation of Permanent Impairment. These physicians may be involved in auditing and dispute resolution of permanent partial issues in the C-92 Quality Assurance Program.

90-day, 200-week and independent medical examinations
These exams require the physician to review medical records, obtain a history and examine the injured worker to answer questions raised by a party in the workers’ compensation process. It does not require the use of the American Medical Association guides. Typically, questions address continuation of treatment, recommendation of future treatment or procedures, determination of maximum medical improvement or return-to-work issues. Ideally, physicians performing these exams should be experts in their specialty and up to date on treatment options. An active clinical practice, which includes treatment of injured workers, would be preferred.

Medical file review
This review usually requires the physician to review medical records at the local BWC customer service office to answer specific questions about treatment continuation, specific treatment requests, appropriateness of medication or claim allowance. Physicians should be knowledgeable of appropriate treatment and up to date on commonly accepted practice guidelines. They do not need to have a current clinical practice. In fact, many may have retired or quit performing surgical procedures.

Alternative dispute resolution (ADR)
Physicians involved in the ADR process are frequently specialists and sub-specialists, who help resolve difficult dispute resolution issues such as whether requested medical services are medically necessary and appropriate based on the allowed conditions in the claim. They should be in active clinical practice and highly regarded in the medical community performing up-to-date procedures and practices. Spine surgeons, hand surgeons, joint replacement orthopedists, and physical medicine and rehabilitation physicians are some examples. Many of these physicians will not perform medical file reviews or permanent partial disability evaluations.

Click here to learn more about reviewing the BWC online claims documents.


 
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