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OhioBWC - Common - Service:  (Self-insured claim overview)

Self-insured claim overview - what injured workers should know

As an employee of a self-insuring employer, we want to help you understand the claims process. If you file a claim for a workplace injury, your employer makes the initial determination and subsequent decisions regarding additional allowances. If you or your employer has a dispute regarding your claim, either one of you may file a Motion (C-86) to request a hearing before the Industrial Commission of Ohio (IC).

Claim number assignment
Injuries resulting in seven or fewer calendar days of disability do not need a BWC claim number unless the employer denies the claim.

The IC
The IC is a separate agency from BWC and hears all disputed issues in your claim. A hearing will be scheduled within 45 days from the date of referral to the IC.

Resolving medical issues
Your employer will pay fees for health-care services directly related to your workplace injury.

  • Prior authorization is usually required for medical services, such as hospital stays, consultations, surgery and physical therapy, except for emergency situations.
  • The provider or injured worker must submit all medical bills within two years of the date of service to be considered for payment.
  • Employers must pay medical bills within 30 days of receipt, unless additional information is needed or the bill is being denied.
  • If your employer denies a medical bill, you may file a C-86 to request a hearing before the IC. You can obtain/submit a copy of the C-86 on this Web site under Injured worker, Forms.
  • If the health-care provider treats you for a condition not recognized in your claim, neither BWC nor your employer is responsible for payment. If you believe the condition is related to your claim, you may file a request with your employer to have to condition recognized. If your employer denies the request, you will need to submit the C-86 to the IC. Attach copies of the employer’s decision.

Compensation
Temporary total disability benefits are usually the first form of compensation awarded during your recovery from a work-related injury. Disability resulting from an injury must be documented by the treating physician before benefits will be initiated.

  • Temporary total benefits begin on the eighth calendar day following the accident. However, if you are off work for 14 consecutive days, your employer will pay you for the first seven days of disability. The employer issues this compensation on a biweekly basis. Once you return to work, temporary total disability benefits cease.
  • Please contact your employer or visit our Injured worker glossary for an explanation of the different types of workers’ compensation benefits.

Rehabilitation services
If you are interested in vocational rehabilitation services, please contact your employer. Your employer is required to provide rehabilitation services that are equal to or greater than BWC.

About BWC's self-insured department
If you have any questions regarding your claim, you must first contact your employer. BWC's self-insured department is available to address your concerns. Be sure to note the name and phone number of the person you spoke to. Our self-insured department also accepts and processes complaints filed against self-insuring employers. To file a complaint against a self-insuring employer, submit a Filing Of Allegation Against A Self-Insured Employer (SI-28) using the self-insured complaint process.



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