Payment for Treatment of Concussion Injuries - Ohio Administrative Code (OAC) 4123-6-34
This rule governs BWC’s reimbursement for services in an allowed claim related to concussion. The rule describes concussion as a physical injury to the brain caused by an external force such as a bump or blow to the head or jolt or hit to the body.
It acknowledges the variability in clinical manifestations of concussion, which occur within eight defined clinical domains described in the rule. The clinical manifestations related to one or more of the eight clinical domains must manifest themselves within six weeks from the injured worker’s date of injury.
This rule supersedes clinical guidelines and allows authorization of medical treatment reimbursement requests relating to these clinical domains submitted within six months from the date of injury, in an allowed claim, without disclaimer, when:
- The documented mechanism of injury in the claim included a bump or blow to the head, or a jolt or hit to the body.
- The documented clinical manifestations, also recognized as signs or symptoms, related to the clinical domains have manifested within six weeks from the date of injury.
- The requested medical treatment is determined to be medically necessary and appropriate, and reasonably related to treatment of concussion, based on the documented medical evidence.
- If signs or symptoms still manifest and require ongoing treatment beyond six months; additional allowances may be requested.
- All parties reserve their rights to appeal.
To develop these parameters in treating injured workers who suffer from concussion or concussion-related symptoms, BWC created a concussion subcommittee of the Health-Care Quality Assurance Advisory Committee with various health-care professional stakeholders and BWC staff.
By implementing this rule, it provides an opportunity to improve outcomes for injured workers with allowed claims related to concussion. It also gives us an understanding of what services are appropriate early in the claim to treat the clinical manifestations related to these injuries.
Clinical Domains are groupings of clinical manifestations by body part or system, which include:
• Anxiety & Mood.
• Cognitive Fatigue.
• Cognitive Impairment.
Characteristics of clinical manifestations, or signs or symptoms, associated with a work injury or illness include:
- Any alteration in mental state.
- Any loss of consciousness.
- Any retrograde amnesia.
For more information, visit our Frequently Asked Questions fact sheet about this rule.