Case Filed Challenging MCO Practice

Case Filed Challenging MCO Practice

Posted: May, 1998

State, ex rel. Haylett v. Ohio Bureau of Workers’ Comp., Supreme Court Case No. 98-675.

NOTE: The Supreme Court ruled in favor of the MCOs in this case.

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:

  1. 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;
  2. 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;
  3. 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.
Information courtesy of the Ohio Workers’ Compensation Bulletin. Subscribe to the Ohio Workers’ Compensation Bulletin to keep informed about the Ohio workers’ compensation system.