How do I file a claim?
An injured worker or their attorney, employers and medical providers can file a claim by manually completing the First Report of Injury (FROI) form and file it with any BWC office. A claim can also be filed online at the BWC’s Website.
What is an injury?
“An injury whether caused by external or accidental means or accidental in character and result received in the course of and arising out of employee’s employment.”
What is an occupational disease?
An occupational disease is a disease that is peculiar to a particular industrial process to which an employee is not generally subjected or exposed to. It has to be contracted in the course of employment. These types of conditions are usually contracted in the course of employment and contracted over a period of time. Examples: asbestosis.
How long do I have to file a claim?
Two years from the date of injury or death, unless it is an occupational disease.
Is there a limit for filing an occupational disease claim?
Yes. Either two years after the disability due to the disease began, six months after the date of diagnosis of the disease by a physician, or two years from death due to the disease. The date of disability due to an occupational disease begins on the most recent of the following dates:
- When you first become aware of the disease through a medical diagnosis
- When you are first treated for the disease
- When you first quit work due to the disease
Will I be paid benefits for the complete period I am off work?
You are eligible for temporary total disability benefits if you lose more than seven days of work due to your injury. Benefits begin on the eighth day unless you are off for 14 consecutive days – then the first seven days are payable.
How is my weekly rate of pay determined?
The first 12 weeks of disability are based upon your full weekly wage. The full weekly wage is determined by taking an average of your earnings for the six weeks prior to your injury or the earnings for the week prior to your injury, less overtime. The higher of these two figures is your full weekly wage. Your weekly rate of pay is determined by taking 72% of your full weekly wage. The rate of payment after the first 12 weeks of disability is based upon your average weekly wage. The average weekly wage is determined based upon an average of the earnings for the entire year prior to your injury. The rate of pay is determined by taking 66.66% of your average weekly wage. Please note that there are minimum and maximum rates applicable to the year you were injured.
How do my medical bills get paid?
Once your claim is allowed, the medical providers (with the exception of pharmacies) who have treated you for your injury should submit their bills for payment to your MCO. The MCO reviews the bills and then sends them electronically to the BWC, who then disburses payment to the medical providers. If you receive a bill, contact the medical provider and advise them the treatment was for a work-related injury. Give them the name and address of your MCO and ask that they send the bill there.
How do I get reimbursed for medications for which I have paid?
If the pharmacist sent the bill information to RxNet then you do not need to do anything. You will be reimbursed once your claim is allowed. If you paid cash for your prescription and the bill information was not sent to RxNet, you will need to have your pharmacist complete and submit a C-17 form.
What is the difference between an MCO and the BWC?
The BWC is the Ohio agency that is responsible for Ohio’s workers’ compensation system. The MCOs are private companies either selected by or assigned to each state-funded employer to medically manage the employer’s workers’ compensation claims. The Bureau of Workers’ Compensation makes decisions regarding claim allowances and issues payment of benefits. The MCOs make treatment decisions and coordinate medical care.
Must I attend an examination scheduled by the BWC?
Yes. The BWC can suspend all activity in your claim, including the payment of compensation, if you do not attend.
Does every claim require a hearing?
No. Hearings are held only if there is a dispute between the injured worker and the employer.
How will I be notified of a hearing?
Notice will be sent to you at least 14 days prior to the date that for which the hearing has been scheduled.
How will I be notified of the hearing decision?
After the hearing, a copy of the decision of the hearing officer will be sent to all parties.
What happens to my claim if a move out of state?
Although hearings are only held on your claim in Ohio, medical and compensation benefits are paid regardless of where you live.
Can I be reimbursed lost wages as a result of attending medical examinations and hearings?
You will not be reimbursed mileage or lost wages for attending a hearing. You can, however, be reimbursed mileage for attendance at examinations scheduled by your employer or the Bureau of Workers’ Compensation, or if you must travel outside the area in which you reside to attend medical appointments scheduled by your physician of record if you cannot obtain such services in the area in which you live. The only time you can be reimbursed for lost wages is for attendance at a medical examination scheduled by the employer.
What is the difference between the Bureau of Workers’ Compensation and a self-Insured employer?
The Bureau of Workers’ Compensation makes claim decisions and payments of claims for employers who are covered under the state fund. A self-insured employer has the authority to make initial decisions on allowance, treatment and payment of some forms of compensation and medical bills. Any disputes between parties are referred to the Industrial Commission for a hearing.