2011 BWC Budget Bill (H.B. 123) Contains a Few Gems for Self-Insured Employers

Contained within the recently enacted BWC budget bill are several provisions that impact the obligations of self-insured employers and the payments they must make to health care providers. Under the budget bill, Ohio Revised Code (RC) §4123.52(B) has been amended to include language that requires that all medical bills and bills for vocational rehabilitation be submitted for payment no more than one year after the date the services were rendered. The prior law had allowed the bills to be submitted up to two years after the date of service. This represents a significant change in the law and should be helpful to self-insured employers as they manage the medical costs and expenses associated with active workers’ compensation claims.
RC §4123.512 was also amended to help clarify when a self-insured employer is still obligated to pay medical bills on a claim initially allowed by the Industrial Commission but later denied or overturned on appeal. According to the amendment, a self-insured employer will now be obligated to pay any medical bills submitted for services rendered prior to the final determination that denied the claim. This is true even when the bills are submitted after the order denying the claim is released. The key is when the services were provided. In other words, did the medical provider provide the medical services under a good faith belief that the claim was allowed and would be covered?
Therefore, a self-insured employer can no longer avoid or deny payment of a medical bill submitted after an order is issued that denies a workers’ compensation claim so long as the services were provided when there was still a pending order that had allowed the claim. The self-insured employer can then deduct the amount of the medical bills from the paid compensation it reports to the Administrator annually under its self-insured assessment.

Contact: Charles D. Smith

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