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How an Ohio Workers’ Comp Whistleblower Suit Could Affect New Claim

Man in factory

Photo by Spencer Davis

If you were recently injured on the job and are in the early stages of filing a workers’ compensation claim, it is important to learn more about a new whistleblower claim concerning the Ohio Bureau of Workers Compensation (BWC). According to a recent report from NBC 4 News, a whistleblower has come forward and has alleged that the BWC “is sitting on a study that claims the state is ‘vastly’ overpaying for the BWC’s multi-billion dollar payout system.” While the whistleblower’s allegations may not have any immediate impact on workers’ compensation claims in Cleveland or elsewhere in the state, the allegations could lead to increased scrutiny.

Workers’ Compensation Claims Have Declined in Ohio, but Costs Have Remained the Same

The whistleblower alleges that the BWC’s payments to managed care organizations (MCOs) are too high given the overall rate of workers’ compensation claims in the state. As an article in the Center Square details, “worker compensations claims have steadily gone down from 1.4 million in 2008 to about 700,000 in 2017.” However, despite a reduction in the overall number of workers’ compensation claims filed in the state, MCOs have continued to receive a disproportionate amount in payments. 

According to the study leaked by the whistleblower, MCOs “have consistently stayed between $600 million and just over $700 million annually.” Moreover, the total amount paid to MCOs for each worker’s claim rose from approximately $1,200 to about $2,000.

Understanding MCOs and Implications for Injured Workers

What is an MCO? As the Ohio Bureau of Workers Compensation explains, MCOs are companies selected by the employer but are distinct from an employer’s health insurance provider. To be sure, the MCO does not provide insurance to injured workers, but rather manages the medical aspects of an injured employee’s workers’ compensation claim. Accordingly, MCOs perform a variety of tasks. Those tasks may include evaluating the medical needs of the injured worker, approving a treatment plan for an injured worker, paying the medical bills of an injured worker, and occasionally providing referrals for rehabilitation. 

Employers choose an MCO, and then the injured worker must know the name of the MCO in order to get medical benefits at a doctor’s office or other healthcare facility through the workers’ compensation system. Despite the fact that the report leaked by the whistleblower suggests that MCOs are being significantly overpaid, it also concludes that “MCOs are doing a good job of processing medical claims for injured workers and getting them back to work as soon as possible.”

Why should an injured worker care if an MCO is being overpaid? While the complaint ultimately may not impact an injured worker or her claim, the allegations could lead to increased scrutiny and longer timelines for processing claims.

Seek Advice from an Ohio Workers’ Comp Attorney

If you have questions about filing a workers’ compensation claim or obtaining benefits after a workplace injury, an experienced Cleveland workers’ compensation attorney at our firm can get started on your claim. Contact Nager, Romaine & Schneiberg, Co., L.P.A. today for more information about how we can help with your case.

Disclaimer: The information in this blog post (“post”) is provided for general informational purposes only, and may not reflect the current law in your jurisdiction. No information contained in this post should be construed as legal advice, nor is it intended to be a substitute for legal counsel on any subject matter. No reader of this post should act or refrain from acting on the basis of any information included in, or accessible through, this Post without seeking the appropriate legal or other professional advice on the particular facts and circumstances at issue from a lawyer licensed in the recipient’s state, country or other appropriate licensing jurisdiction.
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