After a workplace injury, you should seek medical treatment immediately, and file a workers’ compensation claim as soon as possible thereafter. While employers are obligated to reimburse subsequent medical bills through workers’ compensation insurance, not all treatments are covered.
Treatment for a ‘seemingly’ unrelated health issue may be prescribed by the physician, but nevertheless, the insurer refuses to reimburse the worker. Does this mean the injured worker is personally responsible for the medical bills related to the treatment? Where does the Bureau of Workers’ Compensation draw the line?
Miller v. Industrial Commission
A woman was injured on the job, and although her weight was not factor in the injury, her doctor believed her weight was hampering recovery. As a result, he recommended she begin a weight loss program. Her employer would not cover the cost of the program.
The plaintiff appealed. In the 1994 Ohio Supreme Court case State ex rel. Miller v. Industrial Commission, the Ohio Supreme Court imposed a legal requirement called the “Miller Criteria,” which is a 3-pronged test used to determine if a workers’ compensation medical service should be authorized or denied.
- “The requested medical services are reasonably related to the industrial injury;
- The requested services are reasonably necessary and appropriate for the treatment of the industrial injury (allowed conditions); and
- The costs of the services are medically reasonable.
All three parts of the test must be met to authorize reimbursement of medical services.”
The treatment for the workplace injury must be necessary—not just helpful or recommended. For example, if an eye injury occurred, losing weight will not impact recovery, however, if an ankle was broken, excess weight may impact recovery.
If questions about coverage arise, the same 3-pronged criteria will be applied to any treatment in question.
When in doubt, call a workers’ compensation attorney
If you have been denied reimbursement for a medical treatment related to your workers’ compensation claim, call Dworken & Bernstein! Our highly experienced Workers’ Compensation attorneys can help. Our attorneys will advocate for your rights, and ensure your injury related medical treatment is covered.
Call us today for assistance with your claim.
