Who can file a claim with the Ohio Bureau of Workers’ Compensation (BWC)?
Injured workers, employers, authorized representatives, and designees can file claims with BWC. MCOs and medical providers can also file claims.
How long does it take to process my claim?
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.
How do I know what I am eligible for?
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, read Available Benefits to Injured Workers.
Who is the BWC Customer Service Specialist (CSS) that is handling my claim?
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. Find your assigned CSS.
What does the date of injury mean?
The date of injury refers to the date an injured worker sustained an injury, occupational disease, or death in a given claim.
Is there a statute of limitations for filing an occupational disease claim?
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)
- Six months after the date of diagnosis by a physician
- 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
Is there a statute of limitations on the lifetime of my claim once it has been filed?
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 on or after Oct. 20, 1993 are statutorily closed six years from the date of last payment of medical benefits
- Lost-time claims are statutorily closed ten years from date of last payment of medical benefits or compensation or from the date of death.
What is an occupational disease?
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 occurring over a period of time. An example of an occupational disease is asbestosis.
Why was my claim disallowed?
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.
Can I go to any doctor I want?
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.
How do my medical bills get paid?
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.
What is the difference between the Bureau of Workers’ Compensation (BWC) and a managed care organization (MCO)?
BWC is the Ohio governmental agency responsible for Ohio’s workers’ compensation system. The MCOs are private companies selected by or assigned to each state-funded Ohio employer to medically manage the employer’s workers’ compensation claims. BWC makes decisions regarding claim allowances and issues benefit payments. The MCOs coordinate medical care and make treatment decisions.
Who is the MCO for my claim?
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.
How do I get reimbursed for prescriptions I paid for?
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 and the bill information was not sent to the PBM, then you would need to have your pharmacist complete BWC Form C-17, Outpatient Medication Invoice.
What if I paid more for the prescription than I am reimbursed?
BWC reimburses for all medical services according to the approved fee schedule. If you paid more for your prescription than what is reimbursed, you will want to contact your pharmacy.
Will I be paid for the entire period of time I am off work?
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.
How does the BWC determine how much I will be paid while I am off work?
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.
Why do the amounts of my checks vary?
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. Per Rule 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.
How long before my money goes directly to my bank?
Once BWC processes the authorization, it takes about six business days for your bank to verify the bank account information. The BWC 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.
How do I sign up for direct deposit?
To sign up for direct deposit, complete the ACT enrollment form, attach a voided check or deposit slip and mail to:
PO Box 15429
Columbus OH 43215-0429
Or fax the form to 614-752-8439
What is Temporary Total Disability?
While you are off work for more than seven days because of your injury and while you are getting better, you should receive temporary total disability benefits. Temporary total disability (TT) is a tax free benefit paid based upon your earnings before the injury. In most instances, TT will closely approximate you weekly earnings before the accident. Make sure you discuss all your earnings from any job before the injury with an NRS staff member. We will likely ask for ALL W-2s, pay stubs and tax returns from the two years before your injury in order to ensure that you are being paid at the correct rate. If you are being paid at a rate substantially less than the rate you were be paid when working, make sure you ask NRS to investigate. There may be a reason or the rate may not have been set properly or we may have to fight to get your rate increased. Please make sure you attend every doctor visit and follow you doctor’s treatment recommendations. TT is ONLY paid if you are certified off of work by a certified workers’ compensation doctor. Failure to see you doctor or failing to follow your doctors recommended treatment plan, could result in delays or termination of your benefit.