OhioBWC - Basics: (Policy library) - File

Policy and Procedure Name:

Fraud/Special Investigations

Policy #:


Code/Rule Reference:

R.C. 4123.511(K); R.C. 2913.48

Effective Date:



Ann M. Shannon, Chief of Claims Policy and Support


Claims Policy


Policy # CP-06-01, effective 07/12/17


Previous versions of this policy are available upon request





The purpose of this policy is to ensure that allegations of workers’ compensation fraud are investigated, referred for prosecution when appropriate, and that any funds due to BWC are recovered by any and all legal means, including, but not limited to, establishing payment plans and filing liens.




This policy applies to all BWC staff.





Workers’ compensation fraud: A criminal offense pursuant to R.C. 2913.48, that states that no person with purpose to defraud or knowing that the person is facilitating a fraud shall do any of the following:

·         Receive workers’ compensation benefits to which the person is not entitled;

·         Make, present, or cause to be made or presented a false or misleading statement, with the purpose to secure payment for goods or services, or to receive benefits from BWC;

·         Alter, falsify, destroy, conceal, or remove any record or document that is necessary to fully establish the validity of any claim filed with BWC or a self-insuring employer, or necessary to establish the validity of goods and services for which reimbursement or payment was received or is requested from BWC or a self-insuring employer;

·         Enter into an agreement or conspiracy to defraud BWC or a self-insuring employer by making or presenting, or causing to be made or presented a false claim for workers’ compensation benefits;

·         Make or present, or cause to be made or presented, a false statement concerning information necessary to determine the actual workers’ compensation premium or assessment owed to BWC by an employer;

·         Alter, forge, or create a workers’ compensation certificate to falsely show current or correct workers’ compensation coverage; or

·        Fail to secure or maintain workers’ compensation coverage as required by R.C. 4123, with the intent to defraud BWC.




It is the policy of BWC and the Special Investigations Department to aggressively pursue cases of workers’ compensation claims fraud, medical provider fraud, and premium fraud, and to declare overpayments, identify savings, disallow claims, pursue prosecutions, and recover dollars in order to improve the effectiveness of BWC operations and decrease premium costs.