Are you positive that your employee’s injury happened on the job? For business owners, that can be a tough question to answer. In fact, many business owners accept all workers’ compensation claims out of fear of prosecution or damaging their reputation.

Here’s the problem —  employees filing workers’ compensation claims for past injuries is more common than you think. The National Insurance Crime Bureau estimates that businesses lose around $30 billion to fraudulent workers’ compensation claims. One of the most popular types of workers’ compensation fraud is claim-related fraud — which happens when a worker fakes an injury, exaggerates an injury, or claims that a past injury was due to a recent event.

Luckily, if you’re a business in Ohio that’s suspicious of your employee’s injury, you have the right to request their medical records to look for discrepancies. Here’s how Ohio medical record claims for workers’ compensation works, and why you should leverage your TPA and HR team to look for any inconsistencies in employee medical claims.

The Process of Requesting Medical Records for Workers’ Compensation Claims in Ohio

In Ohio, employers have the right to request medical records pertaining to any workplace injury related to a workers’ compensation claim. These records can be an invaluable resource in the claim investigation process. In fact, requesting medical records is common practice in Ohio workers’ comp cases. Your TPA will use the information to ensure that employees are making fair and accurate claims.

It is also important to note that, according to the BWC, employees can’t refuse an Authorization to Release Medical Information. Those who do can have their “claim suspended by the IC Hearing Administrator.” In other words, the BWC will not processes compensation or medical treatment until an employee authorizes the release of their medical information.

The Value of Past Medical Records

There are many situations where medical records can assist during the process of a workers’ compensation claim. For example, past medical records can show:

  • If an employee had similar injuries previously
  • If an employee has a pre-existing condition that could be related to the injury
  • If an employee already had the identical injury that they are attempting to claim
  • If an employee discussed the real nature of his or her injury with their doctor — which could be noted.

In cases where an employee already had the specified injury or had a pre-existing condition that led to the injury, you can engage with the BWC to reduce or eliminate the claim.

How Your TPA Can Help

Your TPA will act as your ambassador for workers’ compensation claims. Not only will your TPA assist you with medical records retrieval for any ongoing workers’ compensation claims, but they will also create the proper systems to facilitate a simple, straightforward claims process.

Here are a few ways a TPA can help you with the medical release process before and during workers’ compensation claims. They will:

  • Leverage medical claim cost analysis to give you deep insights into your claims
  • Assist in evidence gathering
  • Establish the proper HR workflows
  • Create systems that modernize and streamline workers’ compensation claims
  • Distribute employee resources to help reduce the number of fraudulent claims
  • Provide a wealth of experience handling workers’ compensation claims
  • Decode the intense language of workers’ compensation
  • and more!

Medical Releases for Workers’ Compensation Claims FAQs

What kinds of medical records are employees required to release?

According to the BWC, employees are a required to release “medical, psychological and/or psychiatric information (excluding psychotherapy notes) that are related causally or historically to physical or mental injuries relevant to the workers’ compensation claim.”

This means that employees are required to release everything directly relevant to their workers’ compensation claim, and nothing more. You cannot request information outside of the scope of the claim. For example, if the employee injured their ankle, you cannot request records pertaining to their back. The medical issues listed on the claim and medical records must be similar. That being said, you can get access to all relevant records from their listed injury — which includes things like chiropractic records.

Can I request that an employee takes a medical examination?

Yes! In addition to past medical records, you can request that an employee submits to an independent medical examination of their injury for a second opinion. This is much less common than retrieving past medical records, and you should consult with your TPA before requesting medical examinations.

Are You Ready to Stop Worrying About Your Workers’ Compensation Claims?

With rising premiums, fraudulent workers’ compensation claims, and increasingly complex compliance, handling workers’ compensation claims can be tough. At Sheakley, we understand that you’re a business owner, not a workers’ compensation expert. Let our experienced TPA assist you with your claims and help you keep your premiums as low as possible. So you can worry about what matters most — growing your business.

Contact us today to learn about how our TPA can help you stay compliant or how our PEO service can remove all of those HR headaches that you’re tired of dealing with. You love what you do. We love what we do. Let’s help each other grow!

For more information on the nature of medical records and workers’ compensation claims in Ohio, check out these resources: