When should an MCO be considered for a worker?

An MCO, or Managed Care Organization, should be considered for a worker when there is no clear diagnosis for ongoing symptoms. This is because MCOs are often engaged to help manage complex cases where traditional treatment methods have not yielded satisfactory results. When a worker presents with ongoing symptoms but no definitive diagnosis, an MCO can facilitate a comprehensive evaluation and ensure that the worker has access to a broader network of healthcare professionals who may offer specialized services or further diagnostic testing.

In situations where there is no clear diagnosis, these organizations can coordinate care among various providers, potentially leading to a correct diagnosis and appropriate treatment plan. This approach aims to address the ambiguity surrounding the worker's symptoms and improve their recovery outcomes.

Other scenarios, such as returning to work or having had successful treatment, typically indicate that the worker is on a positive path and may not require the additional oversight or resources an MCO can provide. Similarly, the absence of medical records complicates the case but does not necessarily prioritize MCO involvement over seeking clarity on the ongoing symptoms.