and Procedure Name:
4123.06; R.C. 4123.88; O.A.C.4121-2-01; O.A.C. 4123-3-22; O.A.C. 4123-3-24
R. Abrams, Chief Operating Officer
Procedure CP-01-01, effective 05/24/17; 11/14/2016; 12/27/13
12/27/13; Rev. 11/14/16; 05/24/17; 07/17/18
staff shall refer to the Standard Claim File Documentation and Altered
Documents policy and procedure for claim-note requirements and shall follow
any other specific instructions included in this policy and procedure.
II. POLICY PURPOSE
purpose of this policy is to ensure that BWC staff properly identifies and
enters into the claims management system an authorized representative of a claimant
policy applies to claim services staff.
an individual, company, union or firm designated and authorized by the claimant
or employer to represent his or her interests before BWC and the Industrial
Representative: A type of authorized representative designated
by an employer to represent it in policy and/or claim related matters
associated with the employer’s policy number.
A type of authorized representative designated by an employer to represent the
employer on a specific claim.
A. It is the policy of BWC
to recognize representatives properly designated and authorized by a claimant
or an employer, including providing electronic access to the claim and notices
of claim actions.
Identification Number (RIN)
1. All authorized
representatives of claimants or employers must have a BWC-issued RIN, obtained
by filing an Application for Representative Identification Number (R-4)
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.
C. Claimant Representative
1. A claimant must file an
Injured Worker Authorized Representative (R-2) form or equivalent with
BWC to appoint an authorized representative. The authorization must include:
a. The claim number;
b. The date of injury;
c. The name of the employer
at the time of injury;
d. The claimant’s name,
address and phone number;
e. The representative’s
name, address and phone number; and
f. The representative’s RIN.
2. The authorization must
be signed by the claimant. Only the claimant may authorize a representative
except when the claimant has a guardian. See the Custody, Guardianship,
Power of Attorney and Incapacitation policy for more information.
3. A claimant may have
multiple authorized representatives but only one legal representative (one
attorney or one law firm) and/or one union representative.
4. A claimant may update
his or her authorized representative information by:
a. Telephone - a claimant
may contact BWC by telephone to update his or her authorized representative
information, but must follow up with submission of a new R-2 or signed equivalent;
b. Fax - the updated
information may be faxed to BWC;
c. Letter – the claimant
may mail the updated information to BWC;
d. Email – the claimant
may scan a signed, written notification of updated information and email it to
5. The submission of an
authorization for a new legal or union authorized representative will replace
any prior legal or union representative. If a legal or union representative withdraws
or is removed by the claimant, the claimant must file a new authorization;
prior authorized representatives will not automatically be reinstated.
6. It is the
responsibility of the claimant to notify new and former authorized
representatives of any changes.
7. 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,
the claimant must cancel in writing any previously filed C-230 and 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.
8. Having representative
authorization from BWC does not excuse the representative from complying with
all Industrial Commission requirements for representation.
D. Employer Authorized
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
1. The BWC Customer
Service Desk (also known as the “Attorney Representative desk”) 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 when the representative submits a completed Application for
Representative Identification Number (R-4) and other required
a. If a W-9 is submitted
with the R-4, customer service 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.
b. If the representative
is an out-of-state attorney not admitted to the Bar in Ohio, customer service
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.
2. The customer service staff
will notify the representative if there is any discrepancy between a submitted
W-9 and the information provided on the R-4, or if the necessary W-9 has not
been provided. BWC will not issue an RIN until all the needed taxpayer
information and documentation is complete.
3. 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, customer service staff shall consult with a BWC
attorney to determine appropriate action.
B. Claimant Authorized
1. Claim services staff
shall add 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.
2. Claim services staff
shall also update the participant record to indicate the participant type as
Legal Representative or Union Representative.
3. Claim services staff
shall update a claimant’s authorized representative information when the
claimant submits written notification of a change. If the claimant is changing
legal representatives, claim services staff shall ensure the previous legal
representative is expired in the claims management system as a participant on
4. 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 decedent’s authorized representative as a
participant in the claim.
5. When a new request is
filed (typically for death benefits or accrued compensation) during that 30 day
period, claims services staff shall:
the file to determine if the decendent’s authorized representative has been
chosen to represent the filing party. In order 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 for the surviving spouse or other
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.
In either event, the claims service staff shall immediately expire the
decedent’s previously authorized representative. An authorization made by the
decedent does not carry-over and apply to a new claimant, such as the decedent’s
surviving spouse or dependent child, unless the new claimant chooses to
designate and authorize the same representative to represent them.
C. Employer Authorized Representative:
Upon receipt of an R-1 form, claim services staff shall enter or update the employer
representative authorized for a specific claim in the claims management system.
If the claims management system does not allow the R-1 information to be
entered into a claim, claim services staff shall contact the Customer Service
Desk (also known as the Attorney Representative desk) to resolve.