How Does the Ohio Bureau of Workers’ Compensation Handle Claims?

Mar 06, 2020
How Does the Ohio Bureau of Workers' Compensation Handle Claims

The Ohio Bureau of Workers’ Compensation (BWC) is very much a bureaucracy. It’s staff processes mounds of paperwork each day in order to issue life-changing decisions about the replacement of wages lost to work-related and injuries and occupational illnesses, as well as the coverage of medical treatments. BWC staff apply strict rules when deciding to approve or reject claims, and appealing denials can take months.

Figuring out how the Ohio BWC does its work can help make its processes work for you. Having spent decades helping injured and ill workers in Columbus and across the state has given us a pretty good sense of the bureau’s operations. We cannot possibly put everything we have learned into a blog post like this, but we are happy to share essential information regarding the processing of applications, paying claims, and contacting an actual person at BWC.

How the Ohio BWC Decides on Workers’ Comp Claims

The bureau requires everyone who opens a case to visit its website and create an online account. Here is the direct link for doing that.

Keep in mind that an application must be submitted within one year of the day on which a workplace accident occurred. The statute of limitations for an Ohio workers’ comp claim related to an occupational illness runs from either the day on which the illness was diagnosed or the day on which symptoms caused the applicant to miss multiple consecutive days of work. Missing the applicable deadline for filing a claim will result in an automatic denial of benefits with practically no right to appeal.

Setting up an account with BWC allows injured or ill workers to complete their applications for medical coverage and temporary total benefits, which is what the bureau calls replacement wages. Each application must include a description of the work-related accident or exposure to toxic substances, medical documentation, and contact information for the applicant. Signing up to receive email updates on claim status and the payment of benefits is an option.

The BWC promises to issue its initial decision on a first-time claim within 28 days of when it receives a completed application. If the bureau denies a claim, the applicant can appeal. Several rounds of official appeals are allowed, and the case can go to court if all other options are exhausted. We provide more details on appealing workers’ comp denials here.

How the Ohio BWC Pays Approved Claims

The bureau starts paying approved claims in about two weeks. Injured or ill workers will receive temporary total benefits first. The money can be paid via weekly check or direct deposit, or the applicant can request a single lump-sum payment. Note, however, that the BWC will only approve payments for lost wages when applicant misses at least eight days of work and when a doctor submits a form called a MEDCO-14 that documents a temporary inability to return to work.

Medical claims are paid directly to doctors and other health care providers through a managed care organization (MCO). Workers can find lists of physicians and specialists who accept workers’ comp MCO payments on the BWC website. For workers whose employers are self-insured, the choice of doctors and the medical payments goes through the company plan.

Other types of workers’ comp benefits can also be claimed, including a one-time settlement for an amputation or financial support for retraining. Discussing your case with a BWC official and a workers’ comp attorney will clarify whether such additional benefits are available.

How to Contact an Actual Human at the Ohio BWC

The bureau stresses the use its website and web forms. Workers can still request assistance with applications or appeals by calling (800) 644-6292. This phone number for the Ohio Bureau of Workers’ Compensation is answered from 7:30 am to 5:30 pm each Monday through Friday.

Workers who have already had their claims approved can also call the BWC Ombudsman at (800) 335-0996.

Get Legal Help With Your Workers’ Comp Claim

Workers’ compensation attorneys at the Columbus offices of Agee Clymer Mitchell & Portman are available to help with completing applications, ensuring claims are paid in a timely fashion, and handling appeals. We offer free consultations, and we take appointments online. To speak with a lawyer directly, call us at (614) 221-3318 or (800) 678-3318.

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Worker’s Comp Lawyers Columbus, Ohio - Agee Clymer

140 E. Town St. #1100
Columbus, OH 43215