OhioBWC - Basics: (Policy library) - File

Policy Name:

Motions

Policy #:

CP-19-02

Code/Rule Reference:

R.C. 4123.511(A); O.A.C. 4123-3-16; 4123-3-09(C); 4121-3-34(C)(3)(c)

Effective Date:

09/06/18

Approved:

Kevin R. Abrams, Chief Operating Officer

Origin:

Claims Policy

Supersedes:

Policy #CP-19-02, effective 06/04/15

History:

New 06/04/15

 

 

I. POLICY PURPOSE

 

The purpose of this policy is to ensure that BWC consistently and appropriately processes motions received by BWC.

 

II. APPLICABILITY

 

This policy applies to BWC staff.

 

III. DEFINITIONS

 

Application: A form or other means of communicating to BWC a request, authorization or agreement.

 

Motion: For purposes of this policy, a written request, typically submitted on BWC form Motion (C-86), requesting an action from BWC or the Industrial Commission (IC).

 

Parties to a claim: The injured worker (IW), IW representative, employer, employer representative and BWC.

 

Physician file review: A review and evaluation of the medical documentation in a claim by a qualified medical specialist who has met BWC credentialing requirements to conduct independent medical exams.

 

Preponderance of the evidence: A standard of proof which is met when a party’s evidence on a fact indicates that it is “more likely than not” that the fact is as the party alleges it to be.

 

IV. POLICY

 

A.      It is the policy of BWC that a motion shall be submitted:

1.       In writing;

2.       By a party to the claim;

3.       To request an action on a claim;

4.       On any matter that is not otherwise addressed by statute or rule with its own procedure and/or form requirements (e.g., an application for approval of a lump sum settlement; motions for drug related issues).

 

B.      Pursuant to O.A.C. 4123-3-16 it is the applicant’s responsibility to:

1.       Not use a motion as a substitute for a timely filed appeal;

2.       Clearly and fully state the issue and the requested action;

3.       Include with the motion substantial competent proof to support the request as established by O.A.C 4123-3-09(C);

4.       Provide citations to any legal authority relied upon;

5.       Ensure the motion is signed by the applicant or the applicant’s authorized representative;

6.       Establish entitlement to the request by a preponderance of the evidence; and

7.       Unless the issue addressed in the motion does not affect the rights of the non-filing party, mail a copy of the motion to the non-filing party and provide acknowledgement to BWC or the IC that a copy has been so mailed.

 

C.      Processing the Motion

1.    Upon the filing of a motion BWC will comply with any specific requirements based on the subject matter of the motion.

2.    Absent specific requirements for the particular subject-matter:

a.    BWC will notify the non-filing party that a motion has been filed;

b.    If the non-filing party has not been provided a copy of the motion by the filing party or for any other reason the non-filing party requests, BWC will provide a copy of the motion and any accompanying proof to the non-filing party. BWC may also direct the non-filing party to www.bwc.ohio.gov to view the motion and accompanying evidence.

c.     BWC will provide the non-filing party the opportunity to respond and submit any proof within its possession bearing upon the issue to BWC within ten (10) days from:

i.        Being notified by BWC of the motion by phone; or

ii.      From the date of any mailed, faxed or emailed notification from BWC.

d.    BWC may require the filing of additional proof or legal citations by either party.

e.    BWC may conduct any other additional investigation, including requesting a physician file review or independent medical exam.

f.      BWC will issue a decision within:

i.      Twenty-eight (28) days of receipt of the motion; or

ii.     If a physician file review or IME has been requested, within fourteen (14) days of receipt of the report.

3.    Motions Filed Prior to Initial Determination of the Claim Becoming Final

a.    When a motion is filed after an order has been issued but before the expiration of the appeal period and no appeal has been filed, BWC may:

i.      Vacate the initial order and issue a new order which includes decision on the motion; or

ii.     Suspend acting on the motion until final determination of the claim (all appeal periods have expired).

b.    When a motion is filed after an order has been issued and an appeal has been filed BWC will suspend acting on the motion until the initial determination has become final.

b.    If action on the motion has been suspended and the claim is subsequently disallowed, BWC will dismiss the motion as moot.

4.    Motion Suspended Pending Resolution of Other Related Issue:

a.    If an action requested in a motion cannot be determined until a related pending issue is resolved or determined, BWC will suspend the motion.

b.    Once the related issue is resolved or determined, BWC will process the motion.

5.    Referral to the MCO: BWC will refer motions requesting medical treatment or vocational services to the MCO for resolution. If a motion requests medical treatment or vocational services as well as other issues, the medical treatment or vocational issues will be referred to the MCO and BWC will process the remaining issues.

6.    Dismissed and Reinstated Motions:

a.    BWC will dismiss a motion by Miscellaneous Order when:

i.      The filing party has requested to withdraw the motion;

ii.     The motion does not comply with the requirements of this policy and OAC 4123-3-16, including but not limited to when:

a)       There is no evidence to support the request, even after reasonable attempts to obtain evidence; or

b)      The requested action is not clear, despite reasonable attempts to clarify the request.

b.    A party to the claim may refile a dismissed motion.   

7.    Issuing an Order: BWC will issue an order if the request in the motion is within the jurisdiction of BWC and there is no conflict of evidence. See the Orders, Waivers, Appeals and Hearings policy for further information.

8.    IC Referral

a.    BWC will refer the motion to the IC when:

i.      The request is not within the jurisdiction of BWC;

ii.     There is a conflict of evidence; or

iii.    Multiple issues have been presented in one motion and one or more of the issues are not within the jurisdiction of BWC.

b.    See the Notice of Referral policy for further information.

 

BWC staff may refer to the corresponding procedure for this policy entitled “Motions” for further guidance.