OhioBWC - Basics: My claim is allowed, now what?
Medical-only vs. Lost-time claims
Medical-only claims: Medical-only claims are identified as minor
injuries that may or may not include lost time from the workplace up to seven
days. The managed care organizations (MCOs) are required to automatically send all hard
copy medical evidence gathered from the physician of record/treating provider
to BWC upon receipt, prior to initial claim determination
for a select group of ICD codes.
These International Classification of Diseases (ICD-9) codes comprise BWC's top 30 ICD-9s as identified in the
Diagnosis Determination Guidelines. This information will aid the medical-only claims service specialist (CSS) in making accurate, timely initial claim determinations as well as in
investigating the claim for potential subrogation.
The following minor injuries (always
medical-only claims) do not necessarily require medical evidence for
the CSS to determine if the claim is compensable:
- First degree burns, less than 10 percent of the body;
- Superficial lacerations/contusions;
- Insect stings;
- Minor animal/human bites;
- Superficial foreign body in eye;
- Corneal abrasion;
- Superficial injury/abrasion.
Lost-time claims: If you are off work for eight days or longer due to your allowed injury or
occupational disease, your claim will be considered a lost-time claim. If you miss fourteen days or more due to your
allowed injury or illness, you will be compensated for the entire period of time you are disabled as
a result of your injury/occupational disease.
Compensation for lost wages can be paid after medical evidence is submitted which
supports your disability and BWC issues an order approving payment.