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OhioBWC - Basics:  (Claims process) - Roles and responsibilities

Roles and responsibilities in the claims process

Injured worker

  • Report all workplace injuries
  • Notify your employer if a claim is filed
  • Timely provide BWC or the MCO with all requested information related to a claim
  • Follow medical restrictions given by the provider of record
  • Keep your employer informed of progress and obstacles encountered
Employer
  • Report workplace injuries
  • Investigate workplace accidents promptly
  • Timely inform BWC on a decision to certify or reject the claim
  • Monitor the status of an injured worker if there is time off work
  • Coordinate remain-at-work/return-to-work strategies with the managed care organization, medical providers and BWC.
BWC
  • Investigates reported claims and makes claim determinations
  • Determines allowed conditions
  • Manages and pays compensation benefits
  • Determines eligibility for rehabilitation services
  • Assists with bringing a claim to resolution
Managed care organization (MCO)
  • A private company that partners with BWC and the employer to manage the medical portion of the claim
  • Approves or denies treatment requests
  • Pays medical bills
  • Works closely with the employer and BWC to assist in returning the injured employee to work as quickly and safely as possible
Third party administrator (TPA)
  • Assists an employer in the management of claims
  • Employers may use the services of a TPA; however, it's not required. So not all employers will have a TPA.



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