Waivers, Appeals and Hearings
4123.511, 4121.36, 4121.35, 4123.57, 4123.512, 4123.511 and 4123.522
4123-6-16, 4121-3-09, 4123-3-18, 4121-3-30, 4123-3-09, 4123-3-36 and
Percy, Chief of Operational Policy, Analytics & Compliance (Signature on
# CP-15-01, effective 09/12/2014
09/12/2014; New 11/08/2013
purpose of this policy is to ensure that BWC publishes and/or executes orders,
waivers and appeals in compliance with law and administrative rules.
policy applies to all BWC staff.
Appeal: a formal
request to a higher authority requesting a change in or reconsideration of a
a meeting wherein the parties to a claim are afforded an
opportunity to present evidence and be heard before the Industrial Commission
(IC) of Ohio, the statutorily-mandated adjudicatory body for workers’
Order: the written
notification of a decision made by the BWC or the IC from the evidence gathered
in a claim.
Parties to a claim:
Injured Worker (IW), IW representative, employer, employer representative and
Waiver: a document or
formal statement signed by parties to a claim giving up their appeal rights to
orders issued by BWC and the IC. The waiver does not affect any past or future
orders pertaining to the claim file; only the order currently being waived.
is BWC’s policy to process and publish BWC orders and waivers, process
appeals, and perfect IC Orders in accordance with legally-mandated
B. A BWC Order is
required for all initial determinations and subsequent determinations in claims
in which BWC has jurisdiction.
of BWC Orders:
a. Published when
granting the initial allowance of a claim for payment of medical benefits
a medical only claim, this order shall address claim allowance and the payment
of medical benefits.
a lost time claim, this order shall address claim allowance, the payment of
medical benefits and payment of compensation.
b. The following
issues may also be addressed:
of the full weekly wage (FWW) and average weekly wage (AWW);
Total Compensation (TT);
seven days of lost time;
employers (no coverage);
Loss Compensation Awards (loss of use, amputation, loss of vision, and loss of
2. Initial Auto
Adjudication Allowance Order
systematically by the claims management system when an initial claim meets a
set of criteria that causes the claims management system to automatically
generate this allowance order;
b. The claim status
is systematically updated to “Allow.”
3. Initial Denial
– Published when denying an initial allowance of a claim.
4. BWC Abate Order
– Published to notify the dependent that the claim application has been abated
by the death of the claimant.
a. Published when
granting a request for action (written or verbal) after the initial claim
determination or when issues are identified after the initial allowance of the
b. Is only
available for accident and occupational disease claims;
c. BWC does not
have jurisdiction to deny a subsequent request per the Crabtree court
decision except for requests for medical treatment (via Alternative Dispute
Resolution Order), lump sum advancement, medication reimbursement and travel
reimbursement (via Miscellaneous Order.) State ex rel. Crabtree v. BWC
(1994), 71 Ohio St.3d 504.
6. BWC Death Allow
a. Published to
grant death benefits and apportion benefits between dependents, either as the
initial decision in the claim or as a subsequent decision on an existing claim;
b. Published to
reapportion death benefits between dependents and to award accrued compensation
in claims where death benefits have been allowed.
7. BWC Death Denial
- Published to communicate BWC’s decision to deny death benefits, either as the
initial decision in the claim or as a subsequent decision in an existing claim
8. BWC Alternative Dispute
– Published to communicate the determination of medical disputes.
9. BWC DWRF
(Disabled Workers’ Relief Fund) Order
a. Published to
communicate a decision on the IW’s entitlement to DWRF benefits.
b. Types of issues
that may be addressed in the BWC DWRF Order are:
i. Entitlement to
iii. Social Security
iv. Permanent Total
Disability (PTD) Declared Rate;
v. Adjustment for
increase or decrease in the DWRF Rate;
vi. Overpayment of
vii. Stopping DWRF.
10. BWC Tentative
– Published to either grant or deny an initial determination or subsequent
increase of percentage of permanent partial disability.
and/or IW/Claimant representative;
b. Employer and/or
third party administrator (TPA) or other non-lawyer legally cannot
independently waive proper notice of hearing or waive the right to appeal on
behalf of any party. They may submit a waiver but the waiver shall indicate
they are doing so at the direction of the employer and not at the independent
discretion of the TPA.
a. Waiver of Appeal
b. Letter that
contains all elements of the C-108;
c. Online at
ohiobwc.com or ohioic.com.
4. How to submit
b. Scanned and
5. Parties to the
claim must waive in writing in order to release payment prior to the expiration
of an appeal period. If the award relates to compensation only, no waiver is
required from the IW.
6. When all parties
agree to waive the appeal rights on an order, the appeal period automatically
7. The waiver does
not affect any past or future orders pertaining to the claim.
Appeals to BWC Orders
can appeal: A party to the claim who disagrees with the BWC Order may
appeal the decision to
the IC, thereby asking that a hearing be held to
further evaluate the merits of the claim.
2. How to Appeal:
a. Notice of Appeal (IC-12) form;
b. On a letter that
contains all elements of the IC-12;
c. Online at
www.ic.state.oh.us through the Industrial Commission Online Network (I.C.O.N.);
d. All appeals
shall be in writing.
3. The appeal
periods for BWC Orders are:
a. Tentative Orders
- The objection (appeal) period expires twenty (20) days from the printing of
b. All other orders
- 14 days after the date of receipt of the Order.
4. Appeal timeline
a. Faxes not received by the IC or the BWC during core business hours shall
be considered received and filed on the next business day (core business hours are
from 8:00 a.m. to 5:00 p.m.);
b. When an appeal is received at BWC, BWC sends appeal to IC and images
supporting documentation for review;
c. If evidence is
submitted after an appeal is filed and the appeal is not withdrawn, BWC no
longer has jurisdiction. The documentation shall be imaged and the IC shall
obtain all claim information through a systematic transfer of information prior
to the IC hearing.
BWC will not perfect a court
order or an IC Court Unit memo until it receives the signed order or memo.