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OhioBWC - Basics: (Policy library) - File

Policy Name:

Standard Claim File Documentation and Altered Documents

Policy #:

CP-19-03

Code/Rule Reference:

N/A

Effective Date:

07/11/16

Approved:

Rick Percy, Chief of Operational Policy, Analytics & Compliance

Origin:

Claims Policy

Supersedes:

Policy CP-19-03, effective 03/06/13

History:

Rev. 04/11/16; New 03/06/13

 

I. POLICY PURPOSE

 

The purpose of this policy is to ensure BWC staff enter appropriate, accurate and complete information into claims.

 

II. APPLICABILITY

 

This policy applies to BWC staff.

 

III. DEFINITIONS

 

Altering documents: Making a mark or markings that change the meaning, intent or facts presented in a document.

 

Claim files: Individual claim information maintained on BWC’s claim management system or any remaining paper claim files.

 

Electronic storage media: Any electronic device that can be used to store data. This includes but is not limited to internal and external hard drives, CDs, DVDs, Floppy Disks, USB drives, ZIP disks, magnetic tapes and SD cards.

 

Evidence: Any document or claim note used to support or disprove allegations or facts of a claim.

 

Hard copy evidence: Evidence that cannot be imaged into a claim or can be imaged but significant detail is lost in the imaging process (e.g., CDs, DVDs, memory cards, photographs, X-rays).

 

MAFIL: The main file room for BWC, housing hard copy claim files and hard copy evidence.

 

Tampering with evidence: Altering, destroying, concealing, or removing evidence that is relevant to an investigation or decision in a claim.

 

IV. POLICY

 

It is the policy of BWC to ensure claim files contain a complete and accurate record of all claim activity. Claim files shall not include BWC attorney/client privileged information, fraud investigation information, or other confidential information unless specifically authorized.


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