4123-7-05 Treatment by more than one physician.

Medical fees shall not be approved for treatment by more than one physician for the same condition over the same period of time, except where a consultant, anesthetist or assistant is required, or where the necessity for treatment by a specialist is clearly shown and approved by the bureau, by the industrial commission or its medical section, or in self-insuring employers’ claims by the self-insuring employer, in advance of such treatment, except in cases of emergency. (For definition of “emergency” see rule 4123-7-16 of the Administrative Code.)

(A) The assistance of another physician is not ordinarily considered necessary in the application of a cast or for operation on fingers, thumbs, or toes. If there are any unusual conditions which require such assistance, a fee will be paid to the assistant (or ordered to be paid by the self-insuring employer in self-insuring employers’ claims) only on full explanation and upon approval of the industrial commission’s medical section.

(B) Reports of consultations and laboratory procedures must be submitted before fees for the same are approved.

(C) In cases where the consultant continues treatment, a fee for first treatment will be paid to the consultant rather than a consultant’s fee unless it is affirmatively shown that the referral by the attending physician for treatment by the consultant followed the receipt and evaluation of the consultant’s report.

(D) If a licensed practitioner receives a case in which the first treatment has been rendered by another physician, the physician is entitled to the usual, customary and reasonable fee (as determined under rule 4123-7-03 of the Administrative Code) for the first service.

R.C. 119.032 review dates: 10/27/2004 and 03/01/2009

Promulgated Under: 119.03

Statutory Authority: RC 4121.12, 4121.30, 4121.31, 4123.05

Rule Amplifies: RC 4121.121, 4121.30, 4121.44

Prior Effective Dates: 1/1/78