The Ohio Supreme Court Tuesday ruled that the Ohio Bureau of Workers’ Compensation can’t recover costs for a doctor’s review in a case to recover proceeds from a third-party lawsuit filed by a worker injured in a vehicle accident initially covered by workers comp.
Lamar Thomas, whose initial claim was paid by the BWC, sought to have his injury expanded to include an aggravation of his preexisting degenerative disc disease and spondylolisthesis, according to Thomas v. Logue. The BWC denied the claim, contending the subsequent conditions were unrelated to the accident.
The BWC hired a doctor to review Mr. Thomas’ medical records, resulting in a determination that the additional conditions were degenerative and unrelated to the injury. The Industrial Commission upheld the decision to deny the claim’s expansion.
After Mr. Thomas pursued a civil suit against the motorist at fault for the accident, the BWC asserted a right of subrogation and attempted to collect the fees it had paid for a medical examination related to expanding the claim.
Mr. Thomas subsequently filed a class-action lawsuit against the BWC, seeking a declaration that the subrogation recovery practices were unlawful.
The Court of Claims ruled in favor of the BWC’s practice, but the Court of Appeals reversed.
The Ohio Supreme Court affirmed in a 4-3 decision that the fees cannot be part of subrogation because the BWC’s interest is “statutorily” defined as the “past, present and estimated future payments of compensation, medical benefits, rehabilitation costs or death benefits” and that the medical review “expense was not for medical treatment, nor was it any other form of cognizable compensatory expense that Thomas could have presented in his third-party tort case to recover as damages.”
The dissenting judges argued that the BWC’s obtaining an independent medical review is in the best interest of claimants and should be recoverable in third-party lawsuits.
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