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
and Procedure CP-01-01, effective 11/14/2016; 12/27/13
12/27/13; Rev. 11/14/16
I. BWC 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 and employer.
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 risk and/or claim related matters
associated with the employer’s policy number.
Insured Representative: A type of authorized
representative designated by an employer to represent the employer on a specific
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
B. Representative 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) 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.
C. Claimant Representative Authorization
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
d. The claimant’s name, address and phone
e. The representative’s name, address and phone
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
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 BWC.
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 Representative:
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).
A. Representative Identification Numbers
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 documentation.
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
B. Claimant Authorized Representative
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
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
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.