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  1. #1
    Join Date
    Mar 2017

    Default Pyschological Claim

    My claim was opened in summer 2015 and was allowed. Over that summer I worked with the MCO to add a pysch evaluation. I got so frustrated with them that after 3 months of trying to add to the claim I gave up. I paid the copays and we filed it with my insurance company because the account fell behind waiting for BWC to help add this. Is it too late to add it? Would there be any benefit in adding it? I was diagnosed with adjustment disorder.from the trauma of the accident. The letters from the dr are in the casefile.

  2. #2
    Join Date
    Apr 2012

    Default Re: Pyschological Claim

    The reason the MCO wouldn't approve the psych evaluation is that psych evaluations are only allowed if (1) the claim is allowed for a psych condition or (2) the evaluation is needed for treatment of an allowed physical condition (such as a surgical psych clearance). I realize this sounds completely backwards since for physical conditions you can get a consult approved for non-allowed conditions. For example, you could get an ortho consult approved for a back sprain claim to determine if there were herniated discs. But when it comes to psych conditions you have to do the consult on your own (and pay for it) then you can use the consult records/report to request an additional allowance for the psych condition itself.

    Have you continued to get treatment for the adjustment disorder? If you only went once back in 2015 it would be hard to get it added to the claim, but if you've had ongoing treatment it may be possible. But there is a time limit that could be approaching quickly so if you don't have an attorney already you really should contact one.
    Kristin A. Cool
    Ohio Workers' Compensation Attorney
    Practicing in Northeast Ohio, Central Ohio, and Mahoning Valley
    Workers' Compensation Blog

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