BWC Adopts Pilot Immediate Allowance Program
O.A.C. 4123-3-36 establishes a pilot program to permit the immediate allowance and payment for specified medical conditions by the Administrator.
The Administrator acts under R.C. 4123.511 to investigate and determine the allowance of a claim.
For the specified conditions, the Administrator may grant immediate allowance and make immediate payment of medical bills, regardless of receipt of medical reports or employer certification. This rule does not affect the employer’s report to contest the claim. If the claim is disallowed, payments for medical treatment will be charged to the surplus fund.
This pilot program became effective on December 17, 2001 and is effective until April 10, 2004.
The specified conditions involve open wounds of certain body parts, first degree burns and certain eye injuries. The program covers the following conditions:
ICD Code — ICD Description
- 692.79 — SOLAR DERMATITIS NEC
- 872.02 — OPN WOUND AUDITORY CANAL
- 872.69 — OPEN WOUND OF EAR NEC
- 873.21 — OPEN WOUND NASAL SEPTUM
- 873.22 — OPEN WOUND NASAL CAVITY
- 873.65 — OPEN WOUND OF PALATE
- 878.0 — OPEN WOUND OF PENIS
- 878.4 — OPEN WOUND OF VULVA
- 878.8 — OPEN WOUND OF GENITAL NEC
- 879.4 — OPN WND LATERAL ABDOMEN
- 879.6 — OPEN WOUND OF TRUNK NEC
- 880.01 — OPEN WOUND OF SCAPULA
- 880.02 — OPEN WOUND OF AXILLA
- 922.33 — CONTUSION OF INTERSCAPULAR REGION
- 930.2 — FB IN LACRIMAL PUNCTUM
- 940.3 — ACID BURN CORNEA/CONJUNC
- 941.13 — 1ST DEG BURN LIP
- 941.14 — 1ST DEG BURN CHIN
- 941.16 — 1ST DEG BURN SCALP
- 942.10 — 1ST DEG BURN TRUNK NOS
- 942.19 — 1ST DEG BURN TRUNK NEC
- 943.14 — 1ST DEG BURN AXILLA
- 943.15 — 1ST DEG BURN SHOULDER
- 943.19 — 1ST DEG BURN ARM-MULT
- 945.11 — 1ST DEG BURN TOE
- 945.19 — 1ST DEG BURN LEG-MULT
- 877.0 — OPEN WOUND OF BUTTOCK
- 940.1 — BURN PERIOCULAR AREA NEC
- 941.12 — 1ST DEG BURN EYE
- 872.01 — OPEN WOUND OF AURICLE
- 943.12 — 1ST DEG BURN ELBOW
- 941.11 — 1ST DEG BURN EAR
- 883.0 — OPEN WOUND OF FINGER
- 944.14 — 1 DEG BURN FINGR W THUMB
- 942.12 — 1ST DEG BURN CHEST WALL
- 881.00 — OPEN WOUND OF FOREARM
- 879.2 — OPN WND ANTERIOR ABDOMEN
- 881.02 — OPEN WOUND OF WRIST
- 918.0 — SUPERFIC INJ EYELIDS
- 944.15 — 1ST DEG BURN PALM
- 882.0 — OPEN WOUND OF HAND
- 914.6 — FOREIGN BODY HAND
- 873.44 — OPEN WOUND OF JAW
- 921.3 — CONTUSION OF EYEBALL
- 913.6 — FOREIGN BODY FOREARM
- 873.64 — OPN WND TONGUE/MOUTH FLR
- 930.0 — CORNEAL FOREIGN BODY
- 930.1 — FB IN CONJUNCTIVAL SAC
- 890.0 — OPEN WOUND OF HIP/THIGH