What Medical Proof is Required for Payment of Compensation in Ohio?

Youngstown, OH (WorkersCompensation.com) -- When it comes to payment of compensation, the proof might be in the pudding, but it definitely has to be in the medical evidence.

As Simply Research subscribers know, that medical information in Ohio goes like this:

The Rule

No payment of compensation shall be approved by the bureau of workers' compensation in a claim unless supported by a report of a physician duly licensed to render the treatment.

What Makes it Enough?

When evaluating the sufficiency of medical proof, the following criteria shall be considered:

(1) The nature and type of injury or occupational disease;

(2) The consistency of the diagnosis with the description of events resulting in the injury or occupational disease, as shown by proof of record;

(3) Whether the disability is based solely on the condition or conditions for which the claim is recognized;

(4) Whether the disability is based on objective symptoms of disability as a direct result of the injury or occupational disease in the respective claim; "objective symptoms" means those signs and indications which are discovered from an examination of the claimant, as distinguished from subjective symptoms which are reported by the claimant;

(5) Whether a reason or reasons for the medical opinion are stated.

Lack of Proof

Whenever payment of compensation cannot be made due to lack of medical proof, the claimant shall be immediately advised of the necessity to submit appropriate medical proof.

What Forms?

In cases of continued temporary disability as a result of the allowed injury or occupational disease it is the duty of the claimant to submit signed requests for temporary total disability compensation on form C-84 or equivalent and to ensure periodic medical reports on form MEDCO-14 or equivalent, are submitted to support disability and assure regular payment of compensation. Except to correct clerical errors, a previously submitted MEDCO-14 or equivalent cannot be altered, in any manner, and resubmitted. The frequency of filing such reports depends on the type and nature of the injury or occupational disease and the degree of disability.

During the first six weeks after the date of injury, medical reports on form MEDCO-14 or equivalent completed and signed by a physician, certified nurse practitioner, clinical nurse specialist, or physician assistant who has examined the claimant may be considered sufficient medical proof to support payment or non-payment of disability for no more than six weeks of disability.

For subsequent periods of temporary disability, to be considered sufficient medical proof to support payment or non-payment of disability, medical reports on form MEDCO-14 or equivalent must be:

(a) Completed and signed by a physician who has examined the claimant, or

(b) Completed by a certified nurse practitioner, clinical nurse specialist, or physician assistant who has examined the claimant and co-signed by a physician who has reviewed medical documentation of the examination of the claimant by the certified nurse practitioner, clinical nurse specialist, or physician assistant.

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