Information received indicates that, effective 1-1-2010, the Ohio BWC will impose NEW rules regarding BWC settlement offers: Read the rest of this entry »
Posts Tagged BWC
The current atmosphere at the OhioBWC is anti-injured worker. The MCO’s continue to deny requested medical treatment, the BWC is actively making settlements of claims more onerous.
It’s bad enough to get hurt on the job, but fighting the system that is supposed to protect injured workers is downright demoralizing.
The BWC is now forcing settlement allocations between compensation, future medical expense, and protection of Medicare interests. That would not be bad but when the BWC forces allocation in a settlement for an injured worker who will not be eligible for Medicare benefits until age 65 or 66, it becomes absurd.
As a result of an internal audit performed late in 2008, the BWC decided that, in order to clean house, it would reduce settlement offers to injured workers, utilize co-morbidity tables (taking a persons whole medical history into account in the settlement of a broken leg, for example), and use the current economic situation to ’squeeze’ low settlement amounts for workers’ in economic distress (terminated due to economy, etc.)
So much for a system that makes a ‘Plegde’ of Service to injured workers.
Now, the Ohio Senate is considering bringing privatization to workers’ compensation in Ohio. Anyone who is injured in the service of a self-insured employer knows the extra nightmare of claim battles. Bringing privatization into the BWC arena will increase the battle between the injured worker and the benefits to which he/she is entitled.
![wrong-way[1]](http://ohiolaw.com/wp-content/uploads/2009/10/wrong-way1.jpg "wrong-way[1]")
Self-insured claim overview – what injured workers should know (as published on the OhioBWC Website)
QUOTE ”As an employee of a self-insuring employer, we want to help you understand the claims process.
Claim number assignment – Injuries resulting in seven or fewer calendar days of disability do not need a BWC claim number unless the employer denies the claim.” ENDQUOTE
WRONG WRONG WRONG - If you do not file your claim with the OhioBWC, you do not get a claim number. Without a claim number, your injury does not exist as far as the OhioBWC is concerned. If you do not file your claim application (FROI-1)with the OhioBWC within the statutory mandated time limit (Statute of Limitations) you will be precluded from filing your claim. You will not obtain the injury award for the damage done to your body.
YOU DO NOT HAVE TO LOSE 7 DAYS OF WORK TO BE ENTITLED TO YOUR INJURY MONEY AWARD AND MEDICAL BENEFITS! Don’t be misled!
ALSO, your claim will NOT be delayed if you file your injury application with the BWC. That starts the statutory process. You can also give your self-insured employer a copy of the BWC claim application (FROI-1). But, if, for whatever reason you do not want to obtain legal representation, make sure you file the form with the OhioBWC as soon as possible. You can fax the form to the BWC 1-877-520-OHIO (6446) or you can bring it to the BWC office nearest to your home or work.
Many times, our clients say “But the BWC CSS told us that we should do it this way, not the way you are doing it”. Based on the above, would you bet your claim on a BWC employed CSS or on your attorney, who is working for you, and who is trained in the law and the BWC procedures?
Remember, your lawyer only gets paid if he/she obtains an award benefit on your behalf. The CSS, employer by the BWC, has the BWC’s interests in mind – saving money on claim payouts.
If you don’t already have a board certified specialist attorney representing you in your BWC claim, GET ONE. Remember, the BWC has it’s lawyers (to protect it and save it from paying out money) and the Employer has its lawyers (to fight claims to keep their premium payments as low as possible). So, who is representing you?
You’ve moved and you didn’t inform Ohio Workers’ Compensation that you have a new address. Your benefits are at risk when the BWC has your incorrect address!
If orders are issued regarding your claim and you don’t appeal in a timely fashion, your benefits could end. There is a mechanism to correct the situation, but that might take months. If orders are issued that you do not receive, you will have to file a motion with the BWC requesting Ohio Revised Code § 4123.522 relief. This motion will be forwarded to the Ohio Industrial Commission for adjudication. This is a scenario that takes time, during which your benefits – temporary total disability – medical treatment – might be suspended. Don’t let that happen.
You can easily notify the OhioBWC that you have a new address by filing a C-77 Form, Notification of Change of Address.
Once you download the form from this link, you can Fax the form to the OhioBWC using their Toll Free Fax Number 1-877-520-OHIO (6446) or you can mail the form to BWC 30 W. Spring St. Columbus, OH 43215-2256.
Just remember to keep the BWC and your lawyer up to date with your new address and any new phone number you have.
I was called by a prospective client about her BWC claim and the fact that she could not get authorized for treatment. After talking to her for a few minutes it became obvious that I needed to speak with her doctor. So, I call the doctor and ask about the treatment that he requested on the C9 authorization form. I was dumbfounded by his comments during the conversation! Here is the skinny on our discussion.
First I ask him what he filled out on the form. He told me that he asked for permission to provide therapy modalities over a multi week period. It was apparent to me, during the conversation with the prospective client and the doctor, that the claim was medically inactive. The request should have asked for claim reactivation.
If you are an injured worker, you must be informed and know that if you have an allowed BWC claim and you do not obtain medical treatment for a period of 14 months, your claim becomes inactive. Once that happens, you may have to prove – all over again - that your needed treatment is related to the original work injury. The doctor’s mistake was not requesting reactivation of the claim.
But now for the clincher to the conversation . . . . Then I ask the doctor when he sent the C9 Form to the MCO (Medical Care Organization). His reply, on the 5th (today is the 13th). I ask if he has a fax transmittal sheet to prove that he sent it on the 5th and that the MCO received the C9 on the 5th. He seemed surprised by the question. Well, if he was surprised by the question, I was dumbfounded that a medical provider – an OhioBWC Certified Medical Provider at that – would not be aware of the simple rules governing the time limits pertaining to authorization of treatment requested via the C9 Form.
I explain that there are rules and that the rules are printed right on the form. A state funded employer’s MCO has 3 days to respond to a C9. If there is no response, guess what – the requested treatment is authorized. For a self insured employer, there is a 10 day response time. I can’t tell y0u how many times MCO’s blow the response time. A C9 Form is attached to this article via hyperlink below so you can see it for yourselves.
In this instance, the doctor could not prove that he sent the C9 form to the MCO over 7 days before, without response.
Who suffers? The injured worker because here she is waiting for necessary treatment that could have started days before.
I then explained to the doctor that there is a rule regarding the submission of medical bills. A medical bill must be submitted to the MCO or OhioBWC within 2 years of the date of service. If the bill isn’t filed within the 2 year period, the BWC doesn’t have to pay the bill, even if the treatment was rendered for allowed claim conditions, because the bill is time barred. Who suffers in such situation? Both the doctor and the injured worker. But then I suppose the doctor eventually would sue the injured worker for payment of the bill even though the doctor failed to file his bill in a timely fashion.
Bottom Line – The Importance of a Fax Transmittal Sheet - I explained that the doctor needed to set his fax machine to spit out a transmittal sheet so he can prove when and to whom he sent the C9 for treatment approval and also to prove when and to whom he submitted his medical bills for payment.
Hopefully, the doctor learned what needs to be done.
Please check with your doctor to make sure that he/she can prove when documents, office notes, C9 authorization requests, and bills were filed with the BWC.
To make sure your claim is being handled correctly, call a Board Certified Ohio Workers’ Compensation Specialist. Get the protection you need and all of the compensation benefits and money you deserve.
“should any part of . . . my settlement or this agreement be challenged and found to be unconstitutional, unlawful, or invalid by a court of competent jurisdiction, the settlement and this acknowledgement and waiver shall remain in full force and effect.”
My fingers are buring as I type this entry. I am outraged by the current actions of the Ohio Bureau of Workers’ Compensation – not only in the recent low-balling of lump sum settlement top offers, but , insult on injury, requiring Ohio Injured Workers to sign the attached document.
As I review Bureau of Workers’ Compensation orders pertaining to Permanent Partial Disability Awards (PPD), I am amazed at how many orders are granting a ZERO percent impairment rating. Zero percent means the injured worker gets zero compensation for the injury sustained at work.
Today, I was blown away by the latest Bizarre BWC position with regard to ACS, the Ohio Bureau of Workers’ Compensation Pharmacy Vendor. The Governor of Ohio needs to take action and appoint a responsive person as Administrator of The Ohio Bureau of Workers’ Compensation.
$$ Older BWC Claims May Have Hidden Value $$
Don’t Walk Away From the Money Hiding in Your Claim. As the expression goes “There’s Gold in them thar Hills !”
As I review Bureau of Workers’ Compensation orders pertaining to Permanent Partial Disability Awards (PPD), also known as the “injury money”, I am amazed at how many orders are granting a ZERO percent impairment rating. Zero percent means the injured worker gets zero compensation for the injury sustained at work.
Injured Workers can file an appeal to a zero award order, but usually don’t because they don’t know what to do or how to do it.
If you have recived a zero PPD order, follow the instructions on filing your appeal. This can be done online, by fax notice to the BWC, or by going in person to your nearest BWC office and giving the counter file clerk your letter of appeal. You can call (800) OHIOBWC for information on finding the nearest office or for assistance in filing your appeal.
Remember, there is a 14 day appeal period from the date you receive your order. Mark your received date on the envelope and keep the envelope and order as proof of when you actually received the order.
If you have an attorney, call your lawyer and tell him/her to file an appeal on your behalf.
If you don’t have a lawyer, find one fast! Don’t give up on your Ohio Workers’ Compensation claim.