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 Total
c. Motion (C-86).
Communications that serve to grant permission.
a. A Power of Attorney;
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 by:
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.
B. Claim 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 shall:
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.
C. Absent 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.