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OhioBWC - Basics: (Policy library) - File

Policy and Procedure Name:

INDUSTRIALCOMMISSION SUSPENSIONS

Policy #:

CP-09-05

Code/Rule Reference:

R.C. 4123.651; R.C. 4121.36; O.A.C. 4121-3-09

Effective Date:

08/22/17

Approved:

Kevin R. Abrams, Chief Operating Officer

Supersedes:

All Injury Management policies, procedures, directives and memos regarding IC suspensions that predate the effective date of this procedure.

History:

New 07/30/14, Rev. 08/22/17

Review date:

07/30/19

 

 

I.      POLICY PURPOSE

 

The purpose of this policy is to ensure that BWC refers employer requests to suspend claim activity to the Industrial Commission of Ohio (IC) and that BWC executes IC orders granting suspension.

 

II.    APPLICABILITY

 

This policy applies to BWC Field Operations staff.

 

III.   DEFINITIONS

 

None

 

IV.  POLICY

 

BWC shall refer to the IC all employer requests for claim suspension due to the injured worker’s (IW) failure to appear for an employer-requested exam or refusal to sign a medical release.

 

V.   PROCEDURES

 

A.    BWC staff shall refer to the Standard Claim File Documentation policy and procedure for claim-note requirements and shall follow any other specific instructions included in this procedure.

 

B.    Claim staff shall refer the employer’s Motion (C-86) or request to suspend a claim to the IC on a Notice of Referral (NOR) when the employer is claiming that the IW:

1.    Failed to appear for an employer-requested exam; or,

2.    Refused to sign a medical release.

 

C.   Claim staff shall include in the NOR the employer’s reason for requesting claim suspension. Claim staff may refer to the Notice of Referral policy for additional information.

 

D.   If the IC issues a compliance letter denying the claim suspension, field staff shall continue to process the claim and address any pending applications.

 

E.    If the IC issues a compliance letter suspending the claim, claim staff shall:

1.    Enter a note titled “IC suspension of all claim activity” including the status of all allowed or disallowed conditions prior to updating the claim status reason.

2.    In lost time claims:

a.    Place any pending indemnity payments on hold to prevent any payment authorizations from being created.

b.    Update Claim Dates, Stop Payment Dates, to ensure no indemnity payments are released.

3.    Update the claim status reason to “Suspended by IC”.

 

F.    Removing a claim from suspension status.

1.    Once the IW satisfies the terms of the suspension, field staff shall remove the suspension status. The IC will not issue additional correspondence.

2.    Claim staff shall:

a.    Enter a note indicating the claim suspension is lifted.

b.    Update the claim status reason to the status prior to suspension of the claim.

c.    Expire the stop payment placed in Claim Dates, Stop Payment Dates, to ensure indemnity payments are able to be released.

d.    Process any outstanding compensation requests and/or medical bills that were filed during the period of the suspension.

 


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