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RETURN TO WORK MANAGEMENT
Medical management and cost containment services are services provided by an MCO pursuant to its contract with BWC, including return to work management services that promote the rendering of high quality, cost-effective medical care that focuses on minimizing the physical, emotional and financial impact of a work-related injury or illness and promotes a safe return to work.
An MCO must use the Official Disability Guidelines to assist in medical and claims case management. A three-part test must be applied when considering requests for authorizations and/or denials of medical treatment requests. Requests are evaluated using the Miller Test; all of which must be met to either allow or deny treatment authorizations.
VOCATIONAL REHABILITATION SERVICES
Vocational rehabilitation is an individualized and voluntary program for an eligible injured worker with a lost time claim who needs assistance in safely returning to work or in retaining employment. Vocational rehabilitation emphasizes restoring or maximizing the injured worker’s abilities and minimizing long debilitating absences from work. When an injured worker quickly returns to work, feelings of self-worth stay high and ties to the job and work community stay strong. The employer may also benefit from vocational rehabilitation services when an experienced worker remains productive reducing the cost associated with hiring and training a new employee are reduced. If a return to work at the original employer is not possible, rehabilitation services may help the injured worker identify skills and abilities to secure a new job with another employer.
AultComp MCO has established a process in order to assure appropriate referrals into AultComp MCO’s vocational rehabilitation program. The initial referral to be evaluated for possible participation in the vocational rehabilitation program may be initiated by anyone, including: the Provider, the injured worker or their representatives, the employer or their representatives, the AultComp MCO medical case manager, the Ohio BWC or the Industrial Commission.
Medical management and cost containment services are services provided by an MCO pursuant to its contract with BWC, including return to work management services that promote the rendering of high quality, cost-effective medical care that focuses on minimizing the physical, emotional and financial impact of a work-related injury or illness and promotes a safe return to work.
An MCO must use the Official Disability Guidelines to assist in medical and claims case management. A three-part test must be applied when considering requests for authorizations and/or denials of medical treatment requests. Requests are evaluated using the Miller Test; all of which must be met to either allow or deny treatment authorizations.
VOCATIONAL REHABILITATION SERVICES
Vocational rehabilitation is an individualized and voluntary program for an eligible injured worker with a lost time claim who needs assistance in safely returning to work or in retaining employment. Vocational rehabilitation emphasizes restoring or maximizing the injured worker’s abilities and minimizing long debilitating absences from work. When an injured worker quickly returns to work, feelings of self-worth stay high and ties to the job and work community stay strong. The employer may also benefit from vocational rehabilitation services when an experienced worker remains productive reducing the cost associated with hiring and training a new employee are reduced. If a return to work at the original employer is not possible, rehabilitation services may help the injured worker identify skills and abilities to secure a new job with another employer.
AultComp MCO has established a process in order to assure appropriate referrals into AultComp MCO’s vocational rehabilitation program. The initial referral to be evaluated for possible participation in the vocational rehabilitation program may be initiated by anyone, including: the Provider, the injured worker or their representatives, the employer or their representatives, the AultComp MCO medical case manager, the Ohio BWC or the Industrial Commission.
- The vocational rehab case manager utilizes the BWC medical stability, referral and feasibility guidelines to evaluate when vocational rehabilitation intervention may be appropriate.
- The medical file is reviewed to verify and recommend for vocational rehabilitation services when appropriate.
- Once approval is received, an assessment will be completed and vocational rehabilitation services organized, along with the development of a comprehensive rehabilitation plan.
- To work one-on-one with you to manage the vocational rehabilitation portion of the claim.
- To provide rehabilitation services in accordance with the Ohio Administrative Code and BWC Guidelines.
- To educate providers and employers about return-to-work goals and outcomes.
- To ensure a quick and efficient return to work.
