Basic Claim Questions
• Filing a Claim
• General Claim Questions
• Processing a Claim
• Hearing Process
• Treatment and/or Medical Bills
• Managed Care Organizations (MCOs)
• General Compensation Questions
Claims - Filing a Claim
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.
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.
Claims - General Claim Information
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.
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.
3Q. Can I view those claims that BWC has combined?
3A. If a claim has been combined, only the surviving claim will be displayed.
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.
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.
6Q. Who is the BWC Customer Service Specialist that is handling my claim?
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.
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.
Or you can change your address by calling BWC’s customer assistance line at 1-800-644-6292, option 0. Or you can complete BWC form C77-Change of address notification and mail to:
30 W. Spring St. Columbus, OH, 43215-2256
or fax the form to
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.
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.
10Q. Is there a statute of limitations for filing an occupational disease claim?
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);
• 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.
11Q. Is there a statute of limitations on the lifetime of my claim once it's been filed?
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 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 10 years from date of last payment of medical benefits or compensation or from the date of death.
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.
13Q. Why didn't I receive a particular piece of correspondence?
14A. Check to make sure BWC has your correct mailing address.
Claim - Processing a claim
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.
2Q. Who is responsible to obtain the needed information to allow my claim?
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 it’s the injured worker, a legal representative, a health-care provider or the employer.
Claims - Hearing process
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.
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.
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.
Medical - Physicians
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.
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.
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 BWC’s Certified Provider Look-up.
4Q. What if I can't find a BWC certified doctor in my area?
4A. Contact the MCO for assistance in finding a physician.
5Q. Who is the doctor of record for my claim?
5A. Contact BWC or the MCO to find out the doctor of record.
6Q. Has my doctor sent in my disability papers (C-84)?
6A. To see if your C-84 has been received, click here.
Medical - Treatment and/or medical bills
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.
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.
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.
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.
Medical - Managed care organizations (MCOs)
1Q. What's the difference between BWC and an MCO?
1A. BWC is the State of Ohio government 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.
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.
Medical - Prescriptions
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 Form C-17, Outpatient Medication Invoice.
2Q. What if I paid more for the prescription than I am reimbursed?
2A. 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.
3Q. My health insurance paid for my prescription but I had to pay a copayment. Can I be reimbursed for this?
3A. No. Any prescriptions relating to the work injury should be submitted to the PBM. BWC cannot reimburse you for co-payments.
4Q. If a medication is denied for requiring a prior authorization, how can I obtain the correct prior authorization form?
4A. The prescriber should contact BWC's Pharmacy Benefits Manager, ACS State Healthcare at 1-800-OHIOBWC, and follow the prompts, or click Medical Providers, Forms on this Web site to print the MEDCO-31 or MEDCO-32.
Compensation - General Compensation Questions
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.
2Q. How does BWC determine how much I will be paid while I am off work?
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.
3Q. What if I return to work after being declared permanently and totally disabled?
3A. As implied by the name, the expectation is that the injured worker’s 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.
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.
5Q. When will my PTD rate go back up (after payment of lump sum advancement)?
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 worker’s age and life expectancy.
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.
Compensation - Checks
1Q. Has my check been mailed?
If you have specific question regarding your check, contact BWC.
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.
• (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.
3Q. How do I sign up for direct deposit?
3A. To sign up for direct deposit, complete the ACT enrollment form, attach a voided check or deposit slip and mail to:
Accounts Payable ACT
Bureau of Workers' Compensation
PO Box 15429
Columbus OH 43215-9609
or fax the form to:
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.
5Q. What if I have direct deposit and I want to change my bank?
5A. Complete and submit BWC form A-35 Direct Deposit Bank Change Notification. Wait until you receive confirmation of the change before closing the old account.
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 worker’s dependents.
BWC cares about the workers and employers in the State of Ohio, and we’re working hard to take the mystery out of the workers’ compensation claim process. BWC realizes an on-the-job injury can have far-reaching impacts to you and your family. That’s why we’ve made filing a claim quick and easy. The FROI is the application used to initiate a workers’ compensation claim, and it’s now available online. In addition to the FROI, injured workers can complete the Authorization to Release Medical Information (C-101). You can access that form by clicking on the link under Additional information.
In compliance with the Federal Trade Commission Children's Online Privacy Protection Rule, BWC will not collect any information from any person under the age of 13. Please do not submit any information to BWC if you are under the age of 13. Contact BWC with any questions.
The FROI meets Occupational Safety and Health Administration (OSHA) requirements and may be used in place of the OSHA 301 to report recordable injuries and illnesses to the federal government.
If you are an injured worker
|• Injured Worker Name
• Injured Worker SSN
• Injured Worker Mailing Address
• Injured Worker Home or Work Phone Number
• Date of Birth
• Date of Injury/Disease
• Occupation or Job Title
• Description of Accident
• Type of Injury/Disease and Part(s) of Body Affected
• Employer Policy Number (look-up function provided)