Injured worker questions and answers (Q&A)
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Basic Claim Questions
Medical
Compensation
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Claims - Filing a Claim |
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1Q. How do I file a claim? |
1A. An injured worker can file a claim by manually
completing the First Report of Injury (FROI) and mailing it to any BWC
service office, or the FROI can be completed on-line. Most Ohio
workers compensation claims are filed by the managed care
organization (MCO) after being notified of the work-related injury or
occupational disease by the health-care provider or the employer. If you
have been treated for a work-related injury, a claim may have been filed
for you already. To check this you may contact BWC.
Click here to file a
claim online
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2Q. Who can file a claim with BWC? |
2A. Injured workers, employers, authorized
representatives and designees can file claims with BWC. MCO's and medical
providers can also file claims.
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Claims - General Claim Information |
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1Q. Can I look up my claim information using my Social Security number (SSN)? |
1A. Yes, injured workers can look up claim information
using their Social Security number.
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2Q. Can anyone else look up my claims information with my SSN? |
2A. Injured worker representatives and designees,
employers, their designees and their representatives, as well as medical
providers can enter a Social Security number and view the claims that are
associated with that number. However, they will be limited to viewing only
the claims that they are associated with.
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3Q. Can I view those claims that BWC has combined? |
3A. If a claim has been combined, only the surviving
claim will be displayed.
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4Q. How long does it take to process my claim? |
4A. Immediately after receiving the First Report of
Injury, BWC begins the process of gathering information and investigating
the claim. A decision will be made to allow or deny the claim within 28
days.
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5Q. How do I know what I'm eligible for? |
5A. All injured workers with allowed workers'
compensation claims are entitled to payment of medical bills for treatment
related to the injury or occupational disease. Following are five of the
most common compensation benefits injured workers with allowed workers'
compensation claims may be entitled to:
- Payment of temporary total compensation for injured workers who are
100 percent disabled for a temporary period of time as a result of
the injury or occupational disease;
- Payment of wage loss compensation to injured workers who are working
with restrictions caused by the injury which cause a reduction in
earnings or who are actively seeking but are not able to find work
within their physical capabilities;
- Payment of a percentage of permanent partial disability award for
residual impairment resulting from an injury or occupational disease;
- Payment of permanent total disability (PTD) compensation to injured
workers who have been declared permanently and totally disabled by the
Industrial Commission of Ohio. A declaration of PTD means that the
injured worker is not capable of returning to the former position of
employment or of engaging in any sustained remunerative employment;
- Payment of a lump sum settlement award to injured workers who have
agreed with their employer to settle the workers' compensation claim.
To learn more about additional benefits that may be available, click below.
Available Benefits to Injured Workers
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6Q. Who is the BWC Customer Service Specialist that is handling my
claim?
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6A. The name and contact number of the BWC CSS is
included on the injured worker identification card that was attached to
the claim number notification letter. Or if you know your claim number
you can view your claim assignment online. Click here to find your
assigned CSS.
Claim Assignment
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7Q. How do I get my address changed? |
7A. Injured workers can change their address online by
linking to claim demographics. However, due to security limitations, only
an injured worker can update an address online. A designee or authorized
representative does not have authorization to update an address online.
To link to demographics and change your address, click here.
Demographics Information Or you can change your address by calling
BWCs customer assistance line at 1-800-OHIOBWC, and follow the options. Or you can
complete BWC form
Change of address notification (C-77) and mail to:
BWC
30 W. Spring St.
Columbus, OH, 43215-2256
or fax the form to
1-877-520-6446
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8Q. What information can be accessed using a Social Security number? |
8A. The claim number, injured worker name, claim status,
benefit type, employer policy number, employer name, MCO and date of
injury are all displayed. A user can link to additional information
specific to a particular claim from this window.
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9Q. What does the date of injury mean? |
9A. The date of injury refers to the date an injured
worker sustained an injury, occupational disease or death in a given
claim.
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10Q. Is there a statute of limitations for filing an occupational
disease claim?
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10A. Yes. Per ORC 4123.85, an occupational
disease claim must be filed according to the following guidelines:
- Two years after the disability due to the disease began
(i.e., date of disability - see below);
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Six months after the date of diagnosis by a physician;
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Two years after a death due to the disease.
Date of disability due to occupational disease begins on the most recent of the following
dates:
- When the injured worker first became aware of the disease through medical diagnosis;
- When the injured worker was first treated for the disease;
- When the injured worker first quit work due to the disease.
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11Q. Is there a statute of limitations on the lifetime of my claim
once it's been filed?
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11A. The statute of limitations on a claim is determined
by the date of injury, disability or death, and the claim type.
- Medical-only claims with dates of injury prior to Oct. 20, 1993, are statutorily closed six years from the date of injury.
- Medical-only claims with dates of injury from Oct. 20, 1993, to August 2006 are statutorily closed six years from the date of last payment of medical benefits.
- Lost-time claims with dates of injury prior to August 2006 are statutorily closed 10 years from date of last payment of medical benefits or compensation, or from the date of death.
- Medical-only AND lost-time claims with dates of injury after August 2006 are statutorily closed five years from the last medical bill or compensation paid
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12Q. What is an occupational disease? |
12A. An occupational disease is a disease peculiar to a
particular industrial process to which an employee is not generally
subjected or exposed and is contracted in the course of employment.
Occupational diseases are generally contracted in the course of and
arising out of employment, usually occuring over a period of time.
An example of an occupational disease is asbestosis.
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13Q. Why didn't I receive a particular piece of correspondence? |
14A. Check to make sure BWC has your correct mailing
address.
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Claim - Processing a claim |
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1Q. What information is needed to allow my claim? |
1A. The answer to this question will vary based on each
individual claim and circumstances. The following information is usually
needed to make a claim determination:
- Name and address of injured worker;
- Employer name and workers compensation policy number;
- Detailed accident description;
- Medical diagnosis of an injury;
- Medical documentation to support the relationship of the treatment
to the work-related injury or occupational disease;
- Information regarding disability.
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2Q. Who is responsible to obtain the needed information to allow my
claim?
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2A. The MCO serves as the link between BWC and the
health-care provider in obtaining and sending in medical information.
However, BWC will accept information from any source, whether its
the injured worker, a legal representative, a health-care provider or the
employer.
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Claims - Hearing process |
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1Q. Why was my claim disallowed? |
1A. The answer to this question will vary based upon
the individual circumstances in the claim. If a claim is denied, it is
often because of a lack of information. BWC has 28 days to issue a
decision. If the information received at that time is not sufficient to
allow the claim, then the claim will be disallowed. The specific reason
for the disallowance should be documented on the BWC order. If you need
assistance understanding the order you may contact BWC.
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2Q. How do I file an appeal? |
2A. Once you receive the BWC order, you have 14
days to file an appeal if you disagree with the decision. You can file
the appeal online through the
Industrial Commission Online Network (I.C.O.N). Just follow the log in
instructions. You also can file the appeal in writing. Download and print the
Notice of Appeal (IC-12),
fill it out and send it to any Industrial Commission service office. In addition, the
form is available from any IC our BWC customer service office, or by calling 1-800-OHIOBWC and following
the options. Once the IC receives your appeal, the IC will notify you of the time,
date and location of your hearing.
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3Q. What is a waiver? |
3A. A waiver allows the appeal period to be cancelled and
any benefits payable as a result of the order can be immediately approved.
Click here to access Waiver of Appeal (C-108).
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Medical - Physicians |
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1Q. How do I change doctors? |
1A. An injured worker wishing to change physicians
should notify the managed care organization of this request. Note: If
your employer is self-insured the request to change physicians should be
sent directly to the employer. Click here to access
Notice to Change
Physician of Record (C-23).
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2Q. Can I go to any doctor I want? |
2A. The rules governing the HPP program provide that an
injured worker has the right to be treated by the doctor of their choice as
long as the doctor is a BWC certified provider. Note: If your employer is
self-insured, you should contact the employer to obtain information
concerning choosing a physician.
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3Q. How will I know if a doctor is a BWC certified provider? |
3A. You can contact BWC to see if a doctor is certified
or you can click below to access BWCs Certified Provider Look-up.
Certified
Provider Look-up
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4Q. What if I can't find a BWC certified doctor in my area? |
4A. Contact the MCO for assistance in finding a
physician.
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5Q. Who is the doctor of record for my claim? |
5A. Contact BWC or the MCO to find out the doctor of
record.
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6Q. Has my doctor sent in my disability papers (C-84)? |
6A. To see if your C-84 has been received, click here.
Issue tracking
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Medical - Treatment and/or medical bills |
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1Q. How do my medical bills get paid? |
1A. Once the claim is allowed the providers (other than
pharmacies) who have treated you for the work-related injury should submit
their bills to the MCO. The MCO reviews and prices the bills and forwards
them electronically to BWC. BWC pays the MCO who in turn disburses payment
to the providers. To view your medical bill payment history, click here.
Medical Payment Information
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2Q. What should I do if I receive a bill? |
2A. Contact the provider who sent you the bill and
advise that the treatment was for a work-related injury. Give the
provider the name and billing address of the MCO and request that a bill
be sent to them.
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3Q. Has the request for treatment been received from my doctor? |
3A. Contact the MCO to obtain this information.
Requests for treatment are forwarded to the MCO for consideration.
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4Q. Has the request for treatment been approved? |
4A. Contact the MCO to obtain this information. The
MCO reviews all medical treatment requests and issues approval or denial.
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Medical - Managed care organizations (MCOs) |
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1Q. What's the difference between BWC and an MCO? |
1A. BWC is the State of Ohio government agency
responsible for Ohios workers compensation system. The MCOs
are private companies selected by or assigned to each state-funded Ohio
employer to medically manage the employers workers compensation
claims. BWC makes decisions regarding claim allowances and issues
benefit payments. The MCOs coordinate medical care and make treatment
decisions.
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2Q. Who is the MCO for my claim? |
2A. The name, address and phone number of the MCO is
printed on the injured worker identification card that was attached to the
claim number notification letter. You may contact BWC or your employer for
the MCO information or you can access this information through
BWC's
Employer/MCO Look-up. Or if you know your claim number you can find
your MCO by clicking here.
Claim parties' contact info
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Medical - Prescriptions |
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1Q. How do I get reimbursed for prescriptions I paid for? |
1A. If the pharmacist sent the bill information to
the PBM when dispensing your prescription you do not need to do anything.
You will be reimbursed once your claim is allowed. If you paid for your
prescription as a "cash customer" and the bill information was
not sent to the PBM, then you would need to have your pharmacist complete
BWC Outpatient
Medication Invoice (C-17).
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2Q. My health insurance paid for my prescription but I had to pay a
copayment. Can I be reimbursed for this?
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2A. No. Any prescriptions relating to the work injury
should be submitted to the PBM. BWC cannot reimburse you for co-payments.
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3Q. If a medication is denied for requiring a prior authorization,
how can I obtain the correct prior authorization form?
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3A. The prescriber should contact BWC's Pharmacy Benefits Manager,
ACS State Healthcare at 1-800-644-6292, and listen to the options, or
click Medical Providers, Forms on this website to print the MEDCO-31 or MEDCO-32.
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Compensation - General Compensation Questions |
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1Q. Will I be paid for the entire period of time I'm off work? |
1A. You will be eligible for lost time benefits if you
lose more than seven days of work. Also, the first seven days are not
payable until you lose 14 consecutive days. Other than these
exceptions, most injured workers are usually paid for the entire period of
time they are off. If an injured worker is off work for three months (90
days) a medical exam may be scheduled. Continued payment of temporary
total disability will be dependent on the outcome of the independent
medical exam.
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2Q. How does BWC determine how much I will be paid while I am off
work?
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2A. Compensation rates are based on your earnings prior
to the injury taking into account the minimum and maximum rates applicable
to the year you were injured. For claim specific rate inquiries contact BWC.
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3Q. What if I return to work after being declared permanently and
totally disabled?
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3A. As implied by the name, the expectation is that the
injured workers inability to work is permanent. Should an injured
worker who has been declared PTD return to work, the injured worker must
notify BWC immediately. Benefit payments would cease at that time.
Continued receipt of PTD benefits after a return to work is illegal in most
cases and could subject the injured worker to prosecution for workers
compensation fraud.
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4Q. What is lump sum advancement? |
4A. A lump sum advancement is an advancement of funds
for a specified purpose available to injured workers who are receiving PTD
or scheduled loss awards. A lump sum advancement may be used to pay
attorney fees ($8000 maximum) or to pay miscellaneous expenses such as
household bills, purchases and repairs. The payment of a lump sum
advancement results in a rate reduction.
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5Q. When will my PTD rate go back up (after payment of lump sum
advancement)?
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5A. The rate reduction that occurs after a lump sum
advancement is paid is permanent. The reduction is based on the existing
rate, the amount of the advancement, the injured workers age and
life expectancy.
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6Q. What is DWRF? |
6A. DWRF is an acronym that stands for Disabled Workers
Relief Fund. This fund was created to assist injured workers who have been
declared permanently and totally disabled whose compensation rates have
not kept pace with inflation and the cost of living. DWRF eligibility is
determined automatically for every injured worker who is declared PTD. No
action on the part of the injured worker is needed. DWRF eligibility is
based on the combined total of permanent total disability and Social
Security disability received by the injured worker.
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Compensation - Checks |
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1Q. Has my check been mailed? |
1A. If you know your claim number, you can click here to
see if your check has been mailed.
Compensation payment history If you have specific question
regarding your check, contact BWC.
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2Q. Why do the amounts of my checks vary? |
2A. There are many reasons why the amounts of your
workers compensation checks may vary. Generally, workers compensation
benefits checks are paid in two-week increments. Sometimes due to the
beginning and ending dates on the form completed by your physician, there
may be a variance in the amount of the checks received. Also, after the
first 12 weeks of temporary total the rate usually changes, and this
will cause the check amount to be different.
*(Ohio Revised Code 4123.56) Many types
of workers compensation benefits are subject to family support, and this
will cause a rate reduction as well. Also, different types of
compensation benefits have different applicable rates. If you have a
specific question about the amount of your check or the period of time it
is paying for, contact BWC.
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3Q. How do I sign up for direct deposit? |
3A. To sign up for direct deposit, complete the
ACT Enrollment and Direct Deposit Authorization (A-12).
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4Q. How long before my money goes directly to my bank? |
4A. Once BWC processes the authorization, it takes
about six business days for your bank to verify the bank account
information. We will send you a letter explaining the effective date of
your authorization. After that date, any payments made to you by BWC will
be deposited into your account.
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5Q. What if I have direct deposit and I want to change my bank? |
5A. Complete and submit BWC form
Direct Deposit ACT Bank Change (A-35). Wait until you receive confirmation of the
change before closing the old account.
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6Q. What benefits are eligible for direct deposit? |
6A. Most benefit types are eligible for direct deposit.
An exception to this would be death benefits that are being paid to an
injured workers dependents.
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