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BWC Claim Processing Deadlines
No matter what the injury, each claim at BWC goes through certain steps to determine compensibility.
Once you have reported an injury and filed a claim application for Ohio Workers' Compensation benefits with the OhioBWC:
1. The BWC assigns a claim number. This is a tracking number. The injured worker, employer and treating physician receive a letter notifying them of that number. Getting a claim number does not mean your claim is allowed for benefits or compensation, it is simply a tracking number.
2. Medical providers submit information to the BWC, if you have any attorney (and you should have for your legal protection) your attorney will also gather critical information needed to speed your claim processing along. The BWC then reviews the documentation provided to it and makes an initial decision whether to allow or deny your work injury claim. The BWC is supposed to make its decision within 28 days. Once the BWC makes its determination, it will issue a written legal notice, called a BWC Order and/or BWC Tentative Order, to the injured worker, employer and their legal representatives. In a Self-insured Claim, the Self-Insuring employer makes the initial decision as to whether or not it will pay the claim benefits within 30 days.
3. If the injured worker or employer disagrees with the decision, either party may file an appeal with the Industrial Commission of Ohio. That appeal MUST be filed within 14 days of the receipt of that decision. The appeal form can be obtained here. Once printed out an completed, the appeal can be faxed to the BWC at this toll free fax number 1-877-520-OHIO which is 1-877-520-6446 . Please make certain that you retain a copy of the Fax Transmittal Verification to prove that you timely fax/filed your appeal to the BWC order. The appeal can be filed online by utilizing the Industrial Commission of Ohio's website. Again, make sure you retain a copy of the filing verfication to prove that you timely filed your appeal to the BWC order.
Failure to file your appeal within that 14 day period is a bar to appealing the decision, which can have grave effects on your OhioBWC claim.
If any aspect of your claim is denied, you should immediately file an appeal to protect your legal rights. Gruhin & Gruhin believes that you should retain a Certified Workers' Compensation Specialist Attorney to represent you in your BWC claim.
4. If your claim is ultimately allowed, BWC will pay your managed care organization (MCO) who will pay your doctor for medical services related to the allowed condition. If you are so seriously injured that you cannot return to work for eight or more days, BWC may also pay a percentage of the wages you have lost. Self-insuring employers will pay medical and compensation benefits.
5. If your claim is disallowed, you will be responsible for any medical bills that incur as a result of your injury or occupational disease. In addition, you will not be eligible for any types of compensation available through BWC.
6. If you are disabled for 90 days or more, medical exams may be scheduled to evaluate your progress. These exams are done to determine if ytou are still eligible for Temporary Total Disability (TTD), if you are unable to work, and, as the BWC intimates to ensure that you are getting the proper treatment. IN our opinion, these exams are simply to try to terminate your benefits to medical care and continuing TTD.
7. The BWC does have Rehabilitation programs that are coordinated by the MCO's. Although the BWC intimates that anyone can refer an injured worker to a rehabilitation program with services tailored to the individual needs of the injured worker, all such referrals must be done through the doctor's office on a C-9 Form Request for Authorization. Gruhin & Gruhin also recommends seeing if there can be better rehabilitation in conjunction with the Ohio BVR (this is a seperate state governmental agency). BWC Rehabilitation is essential to receive living maintenance compensation, but there is potential to utilize the OhioBWC and the Ohio BVR. Check out links to Ohio BVR under our comphrehensive Workers' Compensation Menu Selection.
This following charts (State Fund Claim Chart and Self-Insured Claim Chart) attempt to provide an understanding of the the maximum administrative timeframes allowed for processing a state fund/public employer workers' compensation claim in Ohio, once you file your application for workers' compensation benefits with the OhioBWC.
State Funded Employer Processing/Hearing Track
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7 days
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For the administrator to contact both sides
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28 days
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For the administrator to investigate and issue an order
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14 days
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From the receipt of the BWC administrator's Tentative Order for the parties to file an appeal from that order to the Industrial Commission
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7 days
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After receipt of the appeal for the administrator to send the file to the Industrial Commission for hearing before a District Hearing Officer
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45 days
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From the date the appeal is filed for the District Hearing Officer to hear the appeal
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7 days
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From the date the appeal is heard for the District Hearing Officer to ssue the order from the appeal hearing
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14 days
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After the DHO's order for the parties to file an appeal from that order
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45 days
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From the date the appeal is filed for the Staff Hearing Officer to hear the appeal
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7 days
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From the date the appeal is heard for the Staff Hearing Officer to decide the appeal
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14 days
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After the Staff Hearing Officer’s order for the parties to file their appeal from that order to the IndustrialCommissioners
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45 days
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After the appeal to the Staff Hearing Officer’s Order, should the Industrial Commissioners determine to setthe appeal for hearing.
[However, refusals to hear the appeal by the Industrial Commissioners are to be issued within 14 days.]
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7 days
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From the date the appeal is heard for the Industrial Commission to issue its decision
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60 day
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From the date of the Commission's order for the parties to appeal to court pursuant to R.C. Section 4123.512
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Self Insured Employer Processing/Hearing Track
This chart provides the maximum administrative times for processing a
Self-Insured Employer workers' compensation claim in Ohio.
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30 days
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From the filing of the claim for the self-insurer to inform the claimant and Bureau in writing as to what conditions it has recognized or refuses to recognize according to Rule 4123-19-03(L)(10)
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7 days
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For the administrator to send the file to the DHO
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45 days
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From the date the appeal is filed for the District Hearing Officer to hear the appeal
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7 days
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From the date the appeal is heard for the District Hearing Officer to decide the appeal
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14 days
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After the DHO's order for the parties to file an appeal from that order
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45 days
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From the date the appeal is filed for the Staff Hearing Officer to hear the appeal
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7 days
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From the date the appeal is heard for the Staff Hearing Officer to decide the appeal
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14 days
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After the SHO's order for the parties to file an appeal from that order
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45 days
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After the appeal to the Staff Hearing Officer’s Order, should the Industrial Commissionersdetermine to setthe appeal for hearing.
[However, refusals to hear the appeal by the Industrial Commissioners are to be issued within 14 days.
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7 days
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From the date the appeal is heard for the Industrial Commission to issue its decision
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60 days
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From the date of the Commission's order for the parties to appeal to court pursuant to Ohio Revised CodeSection 4123.512
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If you believe that your self-insured employer has failed to follow its obligations under the rules of the OhioBWC, you may file a self-insured complaint against the employer. The form for filing the complaint can be accessed here.
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