Policy and Procedure Name:
Orders, Waivers, Appeals and Hearings
O.R.C 4123.511, 4121.36, 4121.35, 4123.57, 4123.512,
4123.511 and 4123.522
O.A.C 4123-6-16, 4121-3-09, 4123-3-18, 4121-3-30,
4123-3-09, 4123-3-36 and 4123-3-32
Ann M. Shannon, Chief of Claims Policy and Support
Policy # CP-15-01, effective 11/14/16 and Procedure # CP-15-01.PR1,
Previous versions of this policy are available upon
Orders, Waivers, Appeals, Hearings Table of Contents
I. POLICY PURPOSE
Parties to a Claim
B. Types of BWC Orders
D. Appeals to BWC Orders
A. General Claim Note and
B. BWC Orders
D. Appeals to BWC Orders
E. Industrial Commission
Hearings and Claims with the Attorney General’s Office
F. Issuing Payment of
Comp/Med Benefits After Issuance of an IC or BWC Order
The purpose of this policy is to ensure that BWC publishes
and/or executes orders, waivers and appeals in compliance with law and
This policy applies to all BWC staff.
A formal request for a change in, or reconsideration of, a decision.
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’ compensation issues.
The written notification of a decision made by BWC or the IC from the evidence
gathered in a claim.
Parties to a
Claim: Claimant, claimant representative, employer, employer
representative, and BWC.
A document or formal statement signed by parties to a claim agreeing to
immediate implementation of 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.
1. It is
BWC’s policy to process and publish BWC orders and waivers, process appeals,
and perfect IC Orders in accordance with legally mandated timeframes.
2. A BWC
Order is required for all initial and subsequent determinations in claims in
which BWC has jurisdiction.
3. It is
BWC’s policy to perfect only signed court orders or IC Court Unit memos.
Types of BWC Orders
: Refer to section V.B.3.a-j for
specific information about individual order types and their uses.
1. When all
parties agree in writing to waive their right to appeal an order, it is BWC’s
policy to consider the order as immediately effective.
2. If the
employer of record is out of business or in a final cancelled status, it is
BWC’s policy that a waiver is not required from the employer of record.
1. Who 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
How to Appeal:
of Appeal (IC-12) form;
b. On a
letter that contains all elements of the IC-12;
at www.ic.ohio.gov through the Industrial Commission Online Network (I.C.O.N.);
appeals shall be in writing.
3. The appeal
periods for BWC Orders are:
Orders - The objection (appeal) period expires twenty (20) days from the
printing of the TO;
b. All other
orders - 14 days after the date of receipt of the Order.
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.);
evidence is submitted after an appeal is filed and the appeal is not withdrawn,
BWC no longer has jurisdiction to reconsider that decision. However, BWC can
obtain additional evidence during the hearing process to support its position.
Claim Note and Documentation Requirements
1. BWC staff
shall refer to the Standard
Claim File Documentation and Altered Documents policy and procedure for
claim note and documentation requirements; and
follow any other specific instructions for claim notes and documentation
included in this procedure.
1. Creating a
services staff shall generate the BWC order through the claims management
services staff shall display and review the order prior to publishing.
services staff shall include the following in all orders:
request/issue the order is addressing.
relied upon to make the decision on the request/issue must be stated in the
order including a detailed description of specific factual and/or medical
evidence used as the basis for the decision.
services staff shall not paraphrase from a medical report; only exact quotes
shall be used.
services staff shall avoid providing an opinion or comment on the weight,
credibility or significance of a medical report unless advised to do so by BWC
declared amount of the full weekly wage (FWW)/average weekly wage (AWW) following
the Wages policy and procedure when:
information is available;
has or will be requested;
iii. A request
to set wages has been submitted; and
iv. Wages haven’t already
e. The type
of compensation to be paid and the period of the award.
information included in the sections below on specific orders.
Types of BWC Orders
when granting the initial allowance of a claim for payment of medical benefits
a) For a
medical only claim, this order shall address claim allowance and the payment of
b) For a lost
time claim, this order shall address claim allowance, the payment of medical
benefits and payment of compensation.
following issues may also be addressed:
a) Setting 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
Claims services staff shall address all valid conditions alleged on the
First Report of Injury (FROI).
services staff shall only allow conditions that are causally related to the
injury and have supporting medical documentation. However, medical
documentation may not be required for minor injuries as noted in the Medical
Evidence for Diagnosis Determinations (MEDD) policy and procedure.
services staff shall deny conditions that are not supported by medical
documentation or are not causally related.
Claims services staff shall not deny a condition when some evidence is
submitted but it is not conclusive enough to support the condition unless it is
the only condition requested.
the evidence is inconclusive, the order shall include a statement that this
condition is neither allowed nor disallowed but shall be considered upon
submission of additional proof and a formal request if required.
additional supporting documentation is filed within the appeal period, claims
services staff shall reconsider conditions that were requested on the FROI but
were not previously allowed or denied. If the documentation is submitted after
the appeal period has expired, claims services staff shall follow the Additional
iv. If compensation
is requested after the initial allowance order has been issued but no appeal
has been filed and the appeal period has not expired, claims services staff may
vacate the initial allowance order and issue a new order addressing
Claims services staff shall ensure:
description of the injury is in in the order.
description includes information received on the FROI and/or during the
description is spelled correctly and is grammatically correct.
vi. Claims services
staff shall use the “based on” texts in the Initial Allowance Order.
a) The first
“based on” text is for specific information relied upon to make the decision.
An example of language to be used in the “based on” text for the decision:
"This decision is based on the medical report from Dr. W. Zimmerman, D.O.,
dated 05/13/19, and the MRI report dated 05/13/19, which states the diagnosis
of herniated lumbar disc L4-5 is directly and causally related to the
industrial injury of 05/10/19.”
b) The second
“based on” text is the “compensation based on” section and shall be used if
wages are being set or if compensation is being ordered. An example of language
to be used in the “compensation based on” text: “The information regarding
salary continuation was based on the signed C-55 dated 9/10/2019”; or, “wages
were set based on the 52 weeks of earnings received from the employer of record
and the injured worker’s part time job at City Window Cleaning”; or, “TT
compensation was based on the C-84 dated 09/03/2019 from Dr. Jones.”
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;
claim status is systematically updated to “Allow.”
parties retain their appeal rights.
Initial Denial Order
when denying an initial allowance of a claim.
services staff shall include a description of the injury in the BWC Initial
Denial Order. The description shall include information received on the FROI
and/or during the investigation.
iii. The most
common reasons BWC will deny a claim include:
employee did not sustain an injury in the course of and arising out of
b) There is
no evidence to support the injury or occupational disease, e.g., claim is
alleged for exposure only;
c) There is
no medical relationship between the diagnosed condition and the described
d) There is
no Ohio jurisdiction;
e) There is
not an employee/employer relationship.
iv. Claims services
staff may also deny a claim for any reason found in the Initial Denial Order
inserts on COR.
Abate Order – Claims services staff shall use this order to notify the
dependent that the claim application has been abated by the death of the
Subsequent Decision Order
subsequent decisions are published when granting a request for action after the
initial claim determination or when issues are identified after the initial
allowance of the claim;
only available for accident and occupational disease claims;
following are types of issues that staff may address in a BWC Subsequent
b) Payment of
Temporary Total Disability compensation used for new periods of TT for lost
time claims or for medical only changeovers when the appeal period for the
Initial Allowance Order has expired;
information, including setting AWW for payment of a Percent of Permanent
Partial Impairment (C-92) award;
d) Wage Loss;
allowance of an additional condition;
Partial (including loss of use, amputation, loss of vision, loss of hearing);
Total Disability (PTD) rate adjustment;
amount and reason for the injured worker’s overpayment;
of Record (POR) or treating physician has submitted a statement that the IW has
reached maximum medical improvement (MMI) for all allowed conditions;
or treating physician has submitted a statement that the IW is released to the
former position of employment without restrictions.
iv. BWC does not
have authority to deny a subsequent request except for requests for medical treatment
(via Alternative Dispute Resolution Order), lump sum advancement, medication
reimbursement, and travel reimbursement (via Miscellaneous Order.)
services staff shall issue a BWC Subsequent Decision Order to address
compensation allowances if compensation is requested after an initial order has
been issued and the appeal period has expired.
vi. A BWC Subsequent
Decision Order should not be issued while the allowance of the claim is under
appeal. However, one possible exception is to issue an order for wages if there’s
a hearing order that grants compensation and wages have not been set.
vii. The print location for
this order defaults to central printing, but “Print to S.O.” can be selected. Claims
services staff shall only print to the service office if it is necessary to
attach additional documentation to the order.
viii. When setting wages and paying a
C-92 award at the same time, claims services staff shall issue two separate
a) A BWC
Subsequent Decision Order is issued to set the wages, and a BWC Tentative Order
(TO) is issued to pay the Percentage of Permanent Partial Disability (%PP)
separate orders are issued because of the difference in the appeal periods. The
Tentative Order has a 20-day objection (appeal) period and the Subsequent
Decision Order has a 14-day appeal period.
following are types of issues that staff shall address in a BWC Miscellaneous Order:
in vocational rehabilitation (including Living Maintenance);
c) LMWL; and
d) Any other
issue not covered specifically by any other order.
shall refer to the individual policy and procedures for specific instructions.
BWC Death Allow Order
services staff shall publish the BWC Death Allow Order to:
death benefits and apportion benefits between dependents, either as the initial
decision in the claim or as a subsequent decision on an existing claim; and
death benefits between dependents and to award accrued compensation in claims
where death benefits have been allowed.
Staff shall refer to the Death policy and procedures for specific
Death Deny Order
services staff shall publish the BWC Death Deny Order 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
services staff shall refer to the Death policy and procedures for
Alternative Dispute Resolution (ADR) Order
orders are published to communicate the determination of medical disputes.
needed to generate an ADR order is entered by the MCO on behalf of BWC and the
order is printed and mailed by central printing.
DWRF (Disabled Workers’ Relief Fund) Order
to communicate a decision on the IW’s entitlement to DWRF benefits per the PTD
and DWRF policy and procedure.
of issues that may be addressed in the BWC DWRF Order are:
Security Disability Rate;
Total Disability (PTD) Declared Rate;
for increase or decrease in the DWRF Rate;
of DWRF Benefits;
Tentative Order (TO)
to either grant or deny an initial determination or subsequent increase of
percentage of permanent partial disability.
a 20-day objection period;
services staff shall refer to the Percentage
of Permanent Partial Awards policy and procedures for specific
an Order and Issuing a New Order
a. Claims services staff
may vacate the order and issue a new order when:
and changed circumstances, corrections to specific conditions and/or body parts,
and/or clear clerical errors have occurred after issuance of the order. Common
reasons to vacate a BWC order and issue a new order include:
a) Changes to
compensation payments (type, period or rate);
b) Changes to
the original decision (allow/deny);
c) Changes to
d) Changing the
part of body from right to left or left to right;
an employer of record;
a date of injury;
the diagnosis/condition. The ICD
Modification policy shall be followed.
evidence is received after the determination has been issued via a BWC Order but
no appeal has been filed, and that evidence changes the decision;
iii. Or all
b. Claims services staff may
vacate an order and issue a new one within the following time periods:
Appeal Period and No Appeal Filed
services staff shall review the evidence received and determine if the evidence
supports a change to the BWC Order.
evidence is submitted within the appeal period, no appeal has been filed, and
all parties to the claim agree, claims services staff can vacate the BWC Order
and issue a new, corrected BWC order.
c) In all
situations except those involving initial determination, when all parties do
not agree to the modification, claims services staff shall refer the claim to
Appeal Period and Appeal has been Filed
services staff shall review the new evidence to determine if the evidence
changes the published decision. At that time, although the IC has jurisdiction,
BWC may approach the parties and discuss the parties’ option to withdraw the
appeal so that BWC can issue a new order. If the parties agrees, staff may
vacate the original order and issue a new order.
appeal must be withdrawn in writing during the appeal period.
the appeal is withdrawn and all parties to the claim agree, claims services
staff shall vacate the BWC Order and immediately issue the new, corrected BWC
iii) If the
withdrawal is received by BWC and the claim is currently at the IC, BWC shall
notify the IC. If the withdrawal is received at the IC, the IC shall notify
iv) If the appealing
party does not wish to withdraw the appeal, the IC shall process the appeal. Claims
services staff shall ensure the new evidence is made available for the IC’s
consideration of the appeal.
services staff shall follow the Notice
of Referral policy if evidence is submitted after an appeal is filed
and the appeal is not withdrawn.
Expiration of the Appeal Period and no Appeal was Filed
a) A new
original order may be issued after the expiration of the appeal period with
agreement from all parties of the claim.
Claim was originally allowed for shoulder sprain based on the medical
documentation submitted by the emergency department. One week after the
expiration of the appeal period the orthopedic surgeon submits office notes and
an MRI report indicating the IW did not suffer a strain but instead diagnoses
the IW with a rotator cuff tear. Claims services staff shall follow the ICD
Modification policy and if the parties agree, the original order shall
be vacated and a new original order shall be issued.
c) If claims
services staff believes that the original order contains an error, but all
parties do not agree to a change, claims services staff shall consult with the
local BWC attorney as to whether a motion for continuing jurisdiction is
warranted (i.e., a mistake of fact, mistake of law, clerical error or new and
a motion for continuing jurisdiction is completed by the BWC attorney, claims
services staff will complete the “Notice of Referral” (NOR) referencing the BWC
documentation shall be imaged, and the IC will obtain all claim information
though a systematic transfer of information prior to the IC hearing.
c. Creating the New Order
After the Order has been Vacated
services staff shall always vacate an order when it is being replaced with a
new order. All issues that were addressed in the original order must be
repeated in the new order.
vacating an order and issuing a new order, claims services staff shall use the
“Vacated” button, which will automatically insert a paragraph stating the
original order is being vacated and allows claims services staff to choose the
reason the order is being vacated.
iii. For orders
that do not have the “Vacated” button option available, claims services staff
shall enter the following statement in the free form text area of the order:
“This order replaces the BWC Order dated <enter date> which is now
vacated because <<reason order is being vacated>>.”
iv. The new order
shall cite specific changes to the previous order and include in the “based on”
text area the new information or evidence that was received which changed the
new BWC Order shall begin a new appeal period.
5. Time Frames for Publishing a BWC Order
a. Claims services staff
shall publish the BWC Initial Allowance or BWC Initial Denial Order no later
than twenty-eight (28) days after claim notification (the date the Initial
Notification Letter is sent in the claims management system).
b. If a medical
examination is statutorily required for an initial determination, the time
limit for the BWC Order shall be extended. The examination should be promptly
scheduled and the BWC Order published no later than twenty-eight (28) days from
receipt of the examination report.
c. An order may be issued
once the investigation of the claim is complete and BWC has reached a decision,
regardless of employer certification. However, BWC shall continue to actively
pursue employer certification during the initial investigation of the claim.
d. ADR orders are
systematically generated within seven (7) days after the MCO’s receipt of the
ADR IME report.
e. Claims services staff
shall follow any Claims Services directives regarding time frames for orders.
f. Prior to completing a
task on the claims management system, staff shall review all open orders with
overlapping or concurrent appeal periods and ensure they are completing the
1. Who can
and IW/Claimant representative;
and Employer representative;
c. BWC attorney
can waive an IC notice of hearing or IC order.
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.
3. How to
of Appeal Period (C-108);
that contains all elements of the C-108;
at www.bwc.ohio.gov/or www.ic.ohio.gov.
4. How to
delivery of the waiver to BWC or the IC.
5. To release
payment prior to the expiration of an appeal period, parties to the claim must
waive in writing. If the award relates to compensation only, no waiver is
required from the IW.
6. The waiver
does not affect any past or future orders pertaining to the claim.
services staff shall enter notes summarizing the waivers and shall update the
order status in the claims management system.
services staff shall process an appeal and stop any payments during an appeal
period even if a waiver was previously received by the appealing party.
services staff shall review the appeal for timeliness, incorporating the Mailbox
Rule policy, so that BWC can assign the appropriate claim status prior to
the appeal being heard by the IC.
2. If BWC
estimates an appeal has been filed within the appeal period:
a. Claims services staff shall
image and index any appeal stamped “Tracked on IR” in application tracking.
When the appeal is stamped “Tracked on IR” it has already been processed with
the IC and does not need to be forwarded to them. When the appeal appears on
the claims services staff’s work list, a note/task shall be entered indicating
the issue, party filing, and date.
b. The IC shall obtain all
claim documents through a systematic transfer of information prior to the IC
c. If claims services staff
receives evidence which might cause the appealing party to reconsider,
(especially issues involving clear clerical error) he/she shall contact the
party that filed the appeal to discuss the evidence received and provide an
opportunity for the party to withdraw the appeal. The party can withdraw the
appeal, in writing, during the appeal period. If the withdrawal is received by
BWC, the withdrawal shall be imaged into the claim file and a NOR must be completed.
If the withdrawal is received at the IC, the IC shall notify BWC. The IC should
send BWC a copy of the ex parte order officially recognizing the withdrawal of
the appeal or a notice that the hearing on the issue has been cancelled.
d. If the claim was
certified and compensation was being paid at the time of the appeal, claims
services staff shall place the claim in Hearing status and stop compensation
until a District Hearing Officer (DHO) decision is issued.
3. If BWC
estimates an appeal has been filed after expiration of the appeal period:
a. Claims services staff
shall ensure the appeal is imaged into the claim.
b. Shall complete a NOR if
the appeal has not been stamped as “Tracked on IR”.
c. Claims services staff
shall keep the claim in the status as determined by the Initial Determination
d. Claims services staff
shall rename all documents imaged in the claims management system.
1. If claims
services staff believes there is an error in an IC order that needs to be corrected:
a. Claims services staff
shall staff clerical errors on IC orders with the supervisor.
b. If the supervisor
determines the error may need to be corrected, the supervisor may discuss the
issue with the local BWC attorney.
c. If further discussion
or clarification is needed the local BWC attorney or the supervisor may contact
the IC Regional Manager.
d. BWC shall file the Request
for Corrected Order (IC-13) if the BWC attorney determines a corrected
order is necessary.
2. If a
subsequent request is filed with BWC when a claim is at the Attorney General’s
office on appeal, claims services staff shall refer to the chart Processing
Subsequent Requests for Attorney General Appeals to determine when a
subsequent request for action can be processed.
services staff shall implement a court order only upon the receipt of the
signed IC Court Unit memo.
a. For information about
emergency hearings or to request an emergency hearing, claims services staff shall
notify the IW to contact the IC.
b. Claims services staff
may notify injured workers experiencing financial emergencies that the IW may
be eligible for certain federal and state benefits in addition to workers’
c. Claims services staff
may suggest that the IW contact his or her attorney or the county Ohio
Department of Jobs and Family Services (ODJFS) for information regarding
financial assistance that may also be available.
d. Claims services staff
shall notify BWC of any emergency hearing so that BWC Law may determine if BWC
hearing representation is necessary.
services staff shall pay all compensation except Percent of Permanent Partial
Impairment beginning the earlier of the following:
a. The expiration of the
appeal period if no appeal to an order has been filed, following the Mailbox Rule policy;
b. The date when the
employer has waived the right to appeal a decision;
c. Upon issuance of the
Initial Allowance Order if the claim is certified by the employer or an
employer waiver is received; or,
d. The date the DHO, Staff
Hearing Officer (SHO), or IC Order is received by the employer.
services staff shall pay Percent of Permanent Partial Impairment when the order
granting the award becomes final or upon receipt of the SHO order.
3. Payment of
medical benefits begins the earlier of the following:
a. The date the order is
issued by an SHO or,
b. The date of the final
administrative or judicial determination. This includes the date the appeal
rights are waived by the employer.
4. If the
claim meets the Fast Response criteria as defined in the Initial
Determination policy, immediate payment can be made upon issuance of the
BWC Order regardless of employer certification.
services staff shall issue an order and hold payment of compensation and
benefits until the expiration of the appeal period or a written waiver from the
employer is received if the undetermined claim is not certified by the
employer. A waiver from the injured worker is not required to pay compensation.
information can be found on the Orders Quick Reference Guide.