client bulletin - CompManagement Health Systems

March 6, 2019

Exposure to harmful substances and BWC policy

Exposure issues present an awkward challenge in the Ohio workers’ compensation system. The Ohio Bureau of Workers’ Compensation (BWC) will cover the medical expenses for allowed claims that include a diagnosed injury or illness. However, if an employee’s exposure to a potentially harmful substance does not result in a medical condition, there would not be an allowed workers’ compensation claim through which any medical evaluation or preventative treatment would be covered.

The employees who are most at risk for exposure-related conditions are our first responders. We value their work and we are thankful for all they do to help injured citizens and those in danger. Ohio SB 223/Ohio Revised Code 4123.026 is a law that provides for payment for post-exposure medical services and testing of covered Ohio employees who come into contact with blood or other bodily fluids should the incident not result in an allowed workers’ compensation claim. The language limits this benefit to peace officers, firefighters and emergency medical workers whose exposure incident involved a “splash or splatter in the eyes or mouth, or possibly to a puncture wound, recent cut or other opening in the skin.” Airborne exposures to a disease are not covered under this provision.

Process for harmful substance exposure

CompManagement Health Systems (CHS) has a process in place to assist clients when a first responder employee is involved in an exposure incident that fits the criteria set forth in SB 223. It seems counterintuitive, but the claim actually needs to first be disallowed by BWC because there is no physical injury. Once this occurs, CHS can reprocess the medical bills for the exposure testing and treatment that may have occurred. This takes a little longer, but the CHS provider services team closely manages this process from beginning to end with BWC to minimize the impact on the employer and employee.

If the first responder ultimately tests positive and is diagnosed with a condition, then the claim will go through the BWC allowance process as an occupational disease claim. If allowed, all approved medical would be paid under the workers’ compensation claim.

In cases not involving first responders, when a worker experiences an exposure incident, the Occupational Safety and Health Administration (OSHA) and the Public Employers Risk Reduction Program (PERRP) require that the employer facilitate an immediate, confidential medical evaluation for the employee. OSHA/PERRP language indicates that this will be at no cost to the worker and essentially renders the employer directly responsible for associated costs.

Provision for opioid exposure

The opioid crisis in Ohio has caused BWC to take steps to limit the impact of this serious problem. According to the Centers for Disease Control and Prevention, Ohio ranked 2nd behind West Virginia in the number of drug and opioid involved deaths in 2017 with a total of 4,293; this is up from 3,613 in 2016. Since SB 223 does not apply to opioids such as fentanyl, BWC has begun providing coverage for medical costs associated with potential exposure to opioids by employees handling the current crisis. BWC issued a policy alert last year entitled “Ohio BWC Claims Handling for Potential Exposure to Opioids.”

Fentanyl is estimated to be 50 times more powerful than pure pharmacy-grade heroin. BWC will continue to allow claims for injured workers with conditions such as narcotic poisoning. In cases where a worker was exposed to opioids, but was not diagnosed with a medical condition, BWC will provide reimbursement for medical care related to the incident. In similar cases, BWC will disallow the claim, but the emergency room care and any diagnostic testing or treatment costs will be paid by BWC out of the surplus fund account.

For more information

This is a relatively new BWC policy and there are only a few cases that have met the criteria and are being handled in this manner. If you have questions, please contact your CHS account executive. To learn more, see the following resources:

By Mike Stadtmiller
Client Services Representative

 CompManagement Health Systems
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