OhioBWC - Basics: What happens after I file a claim?

OhioBWC - Basics: What happens after I file a claim?

What happens after I file a claim?

No matter what the injury, each claim at BWC goes through certain steps to determine compensability. Your BWC-assigned claims service specialist (CSS) will handle your claim. You should have received an ID card with your CSS's contact information. If not, you can look it up here.

Initial investigation
Your CSS will begin the initial investigation by requesting the following information:

Medical documentation from all medical providers for the alleged injury;
Documentation from the medical provider if you have restrictions in work activities.
Providers use the Physician's Report of Work Ability (MEDOCO-14) to document this;
A Request for Temporary Total Compensation (C-84) if you're restricted from work for more than seven calendar days;
Wage documentation from any of your employers for the 52 weeks prior to your date of injury. You can report the required wage information by submitting the Injured Worker Earnings Statement

The CSS will give your employer the opportunity to certify the claim i.e., agreeing with the alleged injury, or rejecting the claim, i.e., disagreeing with the alleged injury. While the employer's certification or rejection of the claim is considered, it's NOT a determining factor.

BWC has up to 28 days to determine the allowance of a claim but that time line can be shorter, if we receive all documentation required to make a decision.

Determination
Once the CSS completes the investigation, he or she will issue a written notice on the decision to allow or deny the claim.

Allowed - Be sure to read the details of the order to ensure you are in total agreement.
Denied - If you or your employer disagree with the decision, either of you may file an appeal within 14 days of the date the decision is received.
Dismissed - If you voluntarily withdraw the application before the CSS issues the order or during an appeal period, the CSS will dismiss the claim.
You have two years to re-file the claim if you wish.

Appeal
If you disagree with the decision, you have 14 days from the date you received the initial order to file an appeal. You can use the Notice of Appeal (IC-12) or send a written notice to your assigned CSS by mail, fax or hand delivery with the following information:

You and your employer's name;
Your claim number;
The date of the order you're appealing;
The reason you're appealing
Your signature and date on the appeal.