| The following
information is provided courtesy of the Ohio Workers'
Compensation Bulletin. For information about the Bulletin
click
here.
NOTE: The Supreme Court ruled in favor of the
MCOs in this case. To read about the Supreme Court's decision, click here.
Case
Filed Challenging MCO Practice
State, ex rel. Haylett v. Ohio BWC, Supreme
Court Case No. 98-675.
A case has been filed in the Ohio Supreme Court
challenging the practice of permitting Managed Care Organizations
(MCOs) to terminate medical treatment in workers' compensation claims.
The Complaint challenges the practice on three grounds:
- The decision to terminate medical treatment is a
decision-making function. The law does not provide authorization for an
MCO to terminate medical treatment. Additionally, an MCO is not
authorized under law to exercise decision-making authority. Therefore,
it is unlawful to permit an MCO to make the decision to terminate
medical treatment.
- The Bureau has adopted an appeal process which
applies where the MCO terminates medical treatment. Such an appeal
process is not provided for, nor is it authorized by, the law. The
appeal process adds delay to the time before an injured worker can
receive a hearing on their claim. The delay caused by this unauthorized
appeal process is unlawful and improper.
- The decision to terminate medical treatment is an
exercise of decision-making power. Permitting an MCO to make such a
determination, without holding a hearing, violates Due Process of Law
and Oh. Const. Art. II, Sec. 35.
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