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OhioBWC - Basics: (Policy library) - File

Policy Name:

Self-Insured Claim Management

Policy #:

CP-19-06

Code/Rule Reference:

R.C. 4123.56, 4123.53; O.A.C. 4123-19-01, 4123-3-03, 4123-3-09, 4121-3-13, 4123-19-09

Effective Date:

12/06/2013

Approved:

Rick Percy, Chief of Operational Policy, Analytics & Compliance

Origin:

Claims Policy

Supersedes:

All policies, directives or memos regarding self-insured claim management that predate the effective date of this policy.

History:

New

 

 

I. POLICY PURPOSE

 

The purpose of this policy is to ensure BWC’s role and responsibilities as liaison between the injured worker (IW), self-insuring (SI) employer and the Industrial Commission (IC) are identified and detailed.

 

II. APPLICABILITY

 

This policy applies to Field Operations staff.

 

III. DEFINITIONS

 

Disputed Issue: An unresolved objection or non-response to a request.

 

Self-Insuring Employer: Employers who have been granted the privilege by BWC of administering their own workers’ compensation programs and who pay compensation and benefits directly to the IW.

 

Subsequent Application: Applications for compensation and/or benefits filed after the initial determination request.

 

IV. POLICY

 

A.    It is the policy of BWC to properly fulfill and perform its responsibilities and role as liaison between the IW, SI employer and the IC in a claim filed with a SI employer.

 

B.    It is the policy of BWC to carry out the following responsibilities in the processing of SI claims:

1.    Assign a claim number and maintain information from an initial determination request, such as a First Report of an Injury, Occupational Disease or Death (FROI), in the claim management system;

2.    Provide the claim number and other information to the IW regarding the management of a claim filed with an SI employer;

3.    Ensure subsequent applications and other correspondence sent to BWC are directed to the SI employer, as appropriate;

4.    Ensure all documentation and other information received by BWC is maintained in the claim management system;

5.    Refer disputed issues to the IC;

6.    Process a filed Application for Determination of Percentage of Permanent Partial Disability or Increase of Permanent Partial Disability (C-92) pursuant to the Percentage Permanent Partial Awards policy;

7.    Process requests for artificial appliances/prosthetics pursuant to the Artificial Appliance Requests policy;

8.    Ensure proper handling of vocational rehabilitation claims;

9.    Schedule independent medical exams:

a.    Upon the request of the employer for:

i.      Ninety-day exams; and

ii.     Two-hundred week exams -  to ensure the exam is completed prior to the end of the two hundred weeks of temporary total disability compensation, the SI employer must request at least sixty days prior to that date;

b.    As instructed by the IC; or

c.    For determination of percentage of permanent partial disability.

 

BWC staff may refer to the corresponding procedure for this policy entitled “Procedure for Self-Insured Claims Management” for further guidance.

 


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