4123-5-18 Medical proof required for payment of compensation.

(A) Except as provided in paragraph (B)(1)(b) of rule 4123-3-09 of the Administrative Code, no payment of compensation shall be approved by the bureau in a claim unless supported by a report of a physician duly licensed to render the treatment.

(B) In evaluation of sufficiency of medical proof the following criteria shall be considered:

(1) The nature and type of injury or occupational disease;

(2) The consistency of the diagnosis with the description of events resulting in the injury or occupational disease, as shown by proof of record;

(3) Whether the disability is based solely on the condition or conditions for which the claim is recognized;

(4) Whether the disability is based on objective symptoms of disability as a direct result of the injury or occupational disease in the respective claim; "objective symptoms" means those signs and indications which a physician discovers from an examination of the patient, as distinguished from subjective symptoms which the physician learns from the patient;

(5) Whether the physician stated a reason or reasons for the physician's opinion .

(C) Whenever payment of compensation cannot be made due to lack of medical proof, the claimant shall be immediately advised of the necessity to submit appropriate medical proof, as specified in paragraph (A) of this rule.

(D) In cases of continued temporary disability as a result of the allowed injury or occupational disease it shall be the duty of the claimant to submit signed requests for temporary total disability compensation on form C-84 or equivalent and to ensure the physician submits periodic medical reports on form MEDCO-14 or equivalent completed in accordance with rule 4123-6-20 of the Administrative Code to support disability to assure regular payment of compensation.Except to correct clerical errors, a previously submitted MEDCO-14 or equivalent shall not be altered, in any manner, and resubmitted to satisfy the requirement of this rule. The frequency of filing such reports depends on the type and nature of the injury or occupational disease and the degree of disability.

Effective: 09/01/2014
R.C. 119.032 review dates: 06/10/2014 and 08/01/2019
Promulgated Under: 119.03
Statutory Authority: 4121.12 , 4121.121 , 4121.30 , 4121.31
Rule Amplifies: 4123.05
Prior Effective Dates: 1/9/67, 1/16/78, 11/5/09