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Policy and Procedure Name:
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Authorized Representatives
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Policy #:
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CP-01-01
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Code/Rule Reference:
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RC 4123.06;
4123.88
O.A.C. 4121-2-01;
4123-3-22; 4123-3-24; 4123-3-29
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Ohio Industrial Commission (IC) Resolution/Memo
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R07-1-01
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Effective Date:
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01/22/2020
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Approved:
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Ann M. Shannon, Chief of Claims Policy & Support
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Origin:
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Claims Policy
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Supersedes:
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Policy # CP-01-01, effective 07/17/18
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History:
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Previous versions of this policy are available upon
request.
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Table of Contents
I. POLICY PURPOSE
II. APPLICABILITY
III. DEFINITIONS
Authorized Representative
Demographic Information
Employer Representative
IV. POLICY
A. General Policy
Statements
B. Representative
Identification Numbers (RIN)
C. Representative
Assignment to Claim
D. Employer Authorized
Representative
V. PROCEDURE
A. Standard Claim File
Documentation
B. Representative
Identification Numbers (RIN)
C. Claimant Requests
Assignment of Authorized Representative
D. Representative
Assignment to Claim
E. Employer Authorized
Representative
F. Claimant Representative
Demographic Changes
G. Structural Business
Changes for Claimant Representatives
H. Representative Death or
Attorney Disbarment
The purpose of this policy is to ensure that BWC staff
properly identify and enter into the claims management system an authorized
representative of a claimant and employer.
This policy applies to claims services and attorney representative
desk staff.
Authorized Representative: An individual,
company, union or firm designated by the claimant or employer to represent his
or her interests before BWC and the Industrial Commission.
Demographic
Information: For purposes of this policy, demographic information
refers to the representative’s business address, contact information (e.g.,
phone and fax numbers, and email address).
Employer
Representative: A type of authorized representative designated by an
employer to represent it in policy or claim-related matters associated with the
employer’s policy number.
1. It is the policy
of BWC to recognize representatives properly designated and authorized by a
claimant or an employer.
2. BWC shall ensure
authorized representatives receive:
a. Electronic
access to the claim; and
b. Notices of claim
actions.
3. Representative
Demographic and Structural Business Changes
a. It is the policy
of BWC to maintain up to date records pertaining to the demographics and
business structure (e.g., mergers and splits) of representatives; and
b. To make timely
updates to all affected customer records.
4. Death or
Disbarment of a Representative: It is the policy of the BWC to update customer
records when BWC receives notification of a representative’s death or
disbarment.
1. All authorized
representatives of claimants or employers must have a BWC-issued RIN, obtained
by filing an Application
for Representative Number (R-4) with BWC.
2. If the
representative anticipates payment from BWC, the representative must provide a Request
for Taxpayer Identification Number and Certification (IRS form W-9) with
the R-4. The name and taxpayer identification number provided on the R-4 must
match the name and number on the W-9. BWC will make payment based on the
taxpayer identification number provided on the R-4 and W-9.
3. If the applicant
is an out-of-state attorney, the attorney must also submit a “Certificate of
Pro Hac Vice Registration” from the Supreme Court of Ohio’s Office of Attorney
Services.
1. A claimant must
file an Injured
Worker Authorized Representative (R-2) form or equivalent with BWC to
appoint an authorized representative.
a. The
authorization must include the:
i. Claim
number;
ii. Date of
injury;
iii. Claimant’s name,
address, and phone number;
iv. Representative’s name,
address and phone number; and
v. Representative’s
RIN
b. The
authorization must be signed by the claimant.
i. Only
the claimant may authorize a representative except when the claimant has a
guardian.
ii. See the Custody,
Guardianship, Power of Attorney and Incapacitation
policy for
information.
2. Upon request, a claimant
may have multiple authorized representatives.
a. A claimant may
have only one legal representative, one attorney or law firm.
b. In addition to
a legal representative, a claimant may have a union representative at the same
time.
c. This
request shall be documented in claim notes.
3. A claimant may
change or dismiss an authorized representative at any time.
a. The submission
of an authorization for a new legal or union representative will replace any
prior legal or union representative.
b. If a
representative withdraws or is removed by the claimant and the claimant hires a
new representative, the claimant must file a new authorization.
4. It is the
responsibility of the claimant to notify new and former authorized
representatives of any changes.
5. The changing of
an authorized representative does not automatically update any previously filed
Authorization
to Receive Workers’ Compensation Payment (C-230).
a. If the claimant
desires the new authorized representative to also receive a workers’
compensation payment on behalf of the claimant, the claimant must:
i. Cancel,
in writing, any previously filed C-230; and
ii. File a new
C-230 identifying the newly authorized representative as authorized to receive
a workers’ compensation payment.
b. See the Authorization
to Receive Workers’ Compensation Payment policy for further
information.
6. Having
representative authorization from BWC does not excuse the representative from
complying with all Industrial Commission (IC) requirements for representation.
1. An employer may
appoint an authorized representative for an individual claim by filing an Authorization of
Representative of Employer (R-1) with BWC.
2. The R-1 must be
signed by an individual within the business with the authority to make such
authorizations (e.g., Human Resource Manager, Safety Director, Chief of
Operations).
1. BWC staff shall
refer to the Standard
Claim File Documentation and Altered Documents policy and procedure for
claim note requirements; and
2. Shall follow any
other specific instructions for claim notes included in this procedure.
1. When a
representative submits a completed Application for
Representative Identification Number (R-4) and other required
documentation requesting a RIN, the BWC attorney representative desk staff
shall verify that no current record exists for the requestor, and if not, issue
an RIN and enter the representative as a business customer into the claims
management system .
2. If a W-9 is
submitted with the R-4, BWC attorney representative desk staff shall ensure
that the name and taxpayer identification number on the R-4 matches the name
and taxpayer identification number on the W-9.
a. The BWC attorney
representative desk staff shall notify the representative if there is a
discrepancy between a submitted W-9 and the information provided on the R-4, or
if the necessary W-9 has not been provided.
b. BWC will not
issue an RIN until all the needed taxpayer information and documentation is
complete.
3. If the
representative is an out of state attorney not admitted to the Bar in Ohio, BWC
attorney representative desk staff shall ensure that a “Certificate of Pro Hac
Vice Registration” from the Supreme Court of Ohio’s Office of Attorney Services
is included with the R-4.
4. If the attorney
registration number or a registration certificate is not provided and has not
been supplied upon request, or if there is any other reason to question the
attorney’s credentials, BWC attorney representative desk staff shall consult
with a BWC attorney to determine appropriate action.
1. Claimant may use
an R-2 or signed equivalent form to request an authorized representative be
attached to a claim.
2. This request may
be completed via fax, letter, or email attachment.
1. Attorney
representative desk staff shall:
a. Add or update an
authorized representative as a “Claimant Representative” or “Dependent
Representative” participant (as appropriate) to a claim when the claimant has
filed an R-2 form or equivalent to BWC that meets the requirements in section
V.C.
b. Update the
participant record to indicate the participant type as Legal Representative or
Union Representative.
c. If the
claimant is changing legal representatives, attorney representative desk staff
shall ensure the previous legal representative is expired in the claims
management system as a participant on the claim.
2. When a claimant
dies, claims services staff shall set a task for thirty (30) days from the date
BWC received notice of the death to expire the dependent’s authorized
representative in the claim.
a. When a new
request is filed (typically for death benefits or accrued compensation) during
the 30-day period, attorney representative desk staff shall:
i. Review
the file to determine if the decedent’s authorized representative has been
chosen to represent the filing party. For the decedent’s authorized
representative to represent the new claimant, the new claimant must sign and
submit a new R-2 (the representative will then be identified in the claims
management system as the representative of the spouse or other dependent);
ii. Review the
file to determine if another authorized representative has been selected with a
new R-2, or whether the new claimant does not have an authorized representative;
iii. In either event,
attorney representative desk staff shall immediately expire the decedent’s
previously authorized representative. An authorization made by the decedent
does not carry over to apply to the new claimant (i.e., surviving spouse or
dependent child) unless the new claimant chooses to designate and authorize the
same representative to represent them.
b. In the event
the 30-day period expires and no new R2 is filed, claims services staff shall
make the authorized representative inactive in the claims management system
within the identified claim.
1. Upon receipt of
an R-1 form, attorney representative desk staff shall enter or update the
employer’s representative authorized for a specific claim in the claims
management system.
2. For more
information, BWC staff may refer to the Employer
Authorized Representative policy.
1. Upon written
notice from a claimant representative of a demographic change request, the attorney
representative desk staff shall update the customer record for the
representative in the claims management system.
2. A representative
may request an update to their demographics by attaching and sending the
request via fax, letter, or email correspondence.
3. Attorney
representative desk staff shall reference the Authorized Representative job aid
and follow the steps outlined to complete the necessary changes.
1.
Upon written notice to change information related to a RIN due to a structural
business change (e.g., a law firm splitting up into two or more entities) the attorney
representative desk staff shall review the notice to determine if the following
information has been submitted:
a. Name of original
business entity;
b. Name of new
business entity;
c. Any
changes to demographic information for the new business entity;
d. Claims that are
affected by this change;
e. Any other
information that may be necessary to address the structural business change.
2. If there are any
questions regarding the representative’s request, the attorney representative
desk shall attempt to contact the representative in order to address.
3. Attorney
representative desk staff shall reference the Authorized Representative job aid
and follow the steps outlined to complete the necessary changes.
1.
When BWC is notified of an authorized representative’s death or
disbarment the attorney representative desk staff shall review the notice to
determine if all the necessary information has been submitted.
2. Attorney
representative desk staff shall reference the Authorized Representative job aid
and follow the steps outlined to remove the representative from the claims
management system.