Steps to Take Filing a Workers Compensation Claim, FROI Report
Understanding the FROI Report
Ohio [workers’ compensation claims](/cincinnati-ohio-workers-compensation-attorney) are filed for various injuries and diseases. These claims are initiated using the [First Report of Injury form](https://info.bwc.ohio.gov/forms-and-publications/froi), known as the **FROI**. This form is submitted to the Bureau of Workers’ Compensation **(BWC)**.Several parties can file a claim, including an injured worker, their employer, a workers’ compensation lawyer, a doctor, or a managed care organization **(MCO)**.
Ohio Workers’ Comp ICD-9 Codes
If a claim is approved by the Ohio BWC or the self-insured employer, it will include one or more **ICD-9 codes**. These codes classify the type of injury recognized in the claim. ICD-9 stands for “International Classification of Diseases, Ninth Edition.”
Example: Workplace Auto Accident
Consider an Ohio employee injured in an auto accident while making a work delivery. The employee sustains significant neck and back injuries and is transported to the emergency room.
X-rays reveal no broken bones, leading to a diagnosis of (1) lumbar sprain/strain and (2) cervical (neck) sprain/strain. The Ohio workers’ compensation claim is then opened and allowed for (1) 847.2 (lumbar sprain/strain) and (2) 847.0 (cervical sprain/strain).
Persistent Lumbar Pain
Imagine the employee's neck and back pain continues for several months and worsens. The doctor orders MRIs of both spinal areas. The MRIs show disc herniation/displacement and degenerative disc disease.
Consequently, the claim is amended to include (3) 722.52 (degeneration of lumbar disc), (4) 722.4 (degeneration of cervical disc), and (5) 722.10 (lumbar intervertebral disc displacement without myelopathy). Similar situations can arise with shoulder, knee, or ankle injuries.
What is Miller Criteria?
It is crucial for injured workers to have their BWC claim allowed for all diagnoses resulting from the workplace injury. Failing to do so can lead to non-payment for medical treatment.
For instance, if an employee’s work comp claim is allowed only for a lumbar sprain, but their back problem deteriorates over three months, a pain management specialist might recommend injections. These injections may not be covered if they do not meet the **“Miller Criteria”** for medical treatment payment.
Passing the Miller Test
To pass the Miller test, the injured worker must demonstrate the following:
- The requested medical services are reasonably related to the industrial injury.
- The requested services are reasonably necessary and appropriate for the treatment of the industrial injury (allowed condition).
- The costs of the services are medically reasonable.
In the example above, points (1) and (3) would likely be met. However, to satisfy (2), the claim would need to be allowed for a more significant diagnosis, such as ICD-9 code: 738.4 (Spondylolysis/Spondylolisthesis), before the injections would be paid through workers’ compensation.
Hiring an Ohio Work Injury Lawyer
Engaging an Ohio workers’ compensation attorney who understands claim allowances and additional conditions can help ensure a claim is approved for all appropriate diagnoses.
McKenzie & Snyder LLP attorneys have practiced workers’ compensation law in Ohio for 25 years.
“We don’t get paid until You get paid!”
