and Procedure Name:
Requirements on Applications
1306.01; O.A.C. 4125-1-02
R. Abrams, Chief Operating Officer
Requirements on Applications policy and procedure dated 04/18/13.
purpose of this policy is to ensure that claim services staff are informed of
the required signatures on applications and the appropriate action to take when
a required signature is missing.
policy applies to all claim services staff involved in the processing of
Application: A form or other
means of communicating to BWC the following:
Communications requesting an initial or subsequent action be taken.
a. Application for
Payment of Lump Sum Advancement (C-32);
b. Request for Temporary
c. Motion (C-86).
Communications that serve to grant permission.
a. A Power of
b. Injured Worker
Authorized Representative (R-2);
c. Authorization to
Receive Workers’ Compensation Check (C-230); or,
Communications that serve as a contract between the parties.
a. Settlement Agreement
and Application for Approval of Settlement Agreement (C-240);
Electronic signature: An
electronic sound, symbol, or process attached to or logically associated with a
record and executed or adopted by a person with the intent to sign a record.
Signature: Any symbol executed
or adopted with the intention to indicate knowledge, approval, acceptance,
receipt or obligation. In most cases this will be an individual signing his or
her name to a document, but may include stamped signatures and various forms of
Subject-Matter Specific Policy: A
BWC policy that addresses a particular topic and may include specific direction
and requirements for the signatures required on related applications (e.g., Medical
Evidence for Diagnosis Determinations).
A. It is the policy of
BWC to ensure all submitted applications are signed by the appropriate individual,
consistent with the applicable subject-matter specific policy or the
instructions on the applicable form.
B. To the extent a subject-matter
specific policy or form does not exist or does not address signature
requirements, the signature requirements of this policy shall apply.
C. General Application
1. Requests shall be
signed by the party or individual seeking the benefit of the request (e.g., the
injured worker (IW) must sign a Request for Temporary Total Compensation
2. Authorizations shall
be signed by the party or individual making the authorization (e.g., the IW is
the only individual that can authorize an attorney as the IW’s representative).
3. Agreements shall be signed
by the parties to the agreement (i.e., those parties or individuals that intend
to be bound by the agreed terms).
D. Unless a
subject-matter specific policy provides otherwise, an application not signed by
the appropriate party or individual shall be dismissed.
E. It is the policy of BWC
to accept scanned, faxed or other electronically submitted documents containing
an image of the hand-written signature of the appropriate party or individual.
F. BWC may accept electronic
signatures on applications when the electronic signature is submitted in a
manner expressly provided for and approved by BWC or the Industrial Commission
(IC) (e.g., when an injured worker (IW) signs into his or her e-account at www.ohiobwc.com and submits a BWC
G. It is the policy of
BWC that if a party is physically unable to provide a signature but is
otherwise competent to act on his/her own behalf:
1. BWC will accept any
mark (e.g., an “x”) the party is able to produce; or
2. If the party cannot
physically provide any type of signature, another person may sign on behalf of
the party, with a statement that the party is physically unable to sign. BWC
will contact the party to validate any such signature;
A. When claim services
staff receives an application, he or she shall review the application to confirm
it has been properly signed by the party or individual whose signature is required
1. Law (primarily Ohio
Revised Code and Ohio Administrative Code);
2. The subject-matter
3. The instructions on
the form, as applicable; or
4. Absent a subject matter
specific policy or form, this policy.
services staff shall attempt to contact a party whenever there is a missing
signature or the validity of a signature is in question. Claim services staff
1. Request a properly
signed document if the required signature is missing;
2. Verify that the
signature in question was provided by the party indicated; or
3. If the application
was signed by another individual with the indication the party is unable to
sign, verify that the party is in agreement and aware that the other party
signed on his/her behalf.
subject-matter specific policy instructions to the contrary, if claim services
staff is unable to obtain a properly signed application after making reasonable
attempts to do so, BWC shall dismiss the application.