Managed Care

What to Do When an Employee Gets Injured at Work

Ella Baker
What to Do When an Employee Gets Injured at Work
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Published on Jun 19
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Ensure a quick and compliant response

With an estimated 114,600 recordable cases of non-fatal workplace injuries and illnesses reported in 2016, it is nearly inevitable that your business will have to address an employee injury at some point. Acting swiftly to get your employee the medical attention they need and remaining Ohio Bureau of Workers’ Compensation (BWC) compliant should be your key focuses at the time of these incidents.

At the time of injury

Your management staff must be prepared to respond in the event of an employee injury. While getting an employee the medical attention they need is always your top priority, the BWC also expects that employers will remain compliant during these events.

The first step after an injury is the completion of First Report of Injury, Occupation Disease or Death (FROI). While the form can be completed by the injured employee, their representative, your company’s authorized representative, or the health care provider, the person completing the form should provide as much detail as possible. The required information includes:

  • Injured worker’s name, social security number, date of birth, and gender
  • Injured worker’s home mailing address and telephone number
  • Date of injury and date employer was notified of injury
  • Occupation or job title
  • A description of the accident, including place of accident or exposure on employer’s site
  • Type of injury or disease and part(s) of body affected
  • Employer policy number
  • Date of hire

Unlike doctors, injured workers do not have a 24-hour time limit to file a claim. The time frame for reporting an injury and filing a claim depends on the nature of the injury, but employees should be encouraged to report all injuries as soon as they occur. Once your employee is seen by a medical professional, the provider is required to submit a claim within 24 hours or one business day of the initial visit or treatment.

Post-injury claims management

The BWC mandates that all state-fund employers work with a managed care organization (MCO) to manage their claims. Employers may select a BWC-approved MCO directly or have one assigned to them by the BWC. The cost of your MCO is built into your BWC premiums. MCOs ensure that injured workers receive prompt treatment to return to work as safely and quickly as possible. Your MCO will also work with the BWC on your behalf to ensure that all necessary information is submitted in a timely manner to allow the bureau to make a determination on the claim.

Your company, the injured worker, and their provider will need to send all medical information regarding the claim to your MCO. In the BWC system, all MCOs are assigned a toll-free fax number for sending this information and the BWC automatically captures the information at the same time it is sent to the MCO.

Your MCO manages the medical and return-to-work services of your employee’s claim. The MCO will approve all required treatments and surgeries, payment of medical bills, and rehabilitation referrals. The MCO works directly with your employee’s health care provider to ensure that the injured worker is receiving appropriate medical care and is able to return to work as soon as they are able.

MCOs also pay all medical bills for the injured employee if the claim is allowed by the BWC. If an employee losses eight or more days from work, the BWC will pay lost-time wages directly to the employee. The BWC provides direct deposit for all payments unless there are extenuating circumstances. If the employee doesn’t have a personal bank account, they may elect to receive funds through electronic benefits transfer via the Key Bank debit card program.

BWC response

Your employee will receive a notification letter and BWC ID card by mail containing information pertinent to their claim, including the name and contact information for the claims service specialist (CSS) assigned to their case. Upon receiving the FROI and all required information, the BWC has 28 days to issue a notice on the determination of your injured employee’s claim. The CSS makes the determination on your employee’s claim and issue a BWC order showing the decision in the case as Allowed, Denied, or Dismissed.

Workplace injuries and your MCO

Providing medical case management for the duration of the claim, the MCO obtains the initial claim date, works with the medical provider to obtain medical records and physical restrictions, and assists with getting injured workers back to work safely. The MCO monitors all claims and approves the payments throughout the process.

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