About Your Claim
Your agency will forward the completed Accident or Illness Report (ADM 4303) to your Managed Care Organization and the state’s third-party administrator.
The Managed Care Organization will file the initial claim information and medical documentation with the Ohio Bureau of Workers’ Compensation.
Your health care provider will forward all medical information regarding your claim to the managed care organization who will contact you to gather additional information regarding your treatment, recovery and claim.
The Bureau of Workers' Compensation will send you a letter informing you of your claim number. This number is to be retained and referenced when contacting your agency, Bureau of Workers' Compensation, the third-party administrator, the managed care organization and your health care provider regarding your claim.
Shortly after you receive your claim number, the Bureau of Workers' Compensation will make an initial decision to allow/approve or disallow/deny your claim and will notify you in writing.
Medical-Only Claims
You may be eligible for a medical-only claim if you are unable to work for seven calendar days or less.
If your medical-only claim is approved, your managed care organization will pay your health care provider for authorized treatments that are directly related to your claim.
Lost Time Claims
If your attending physician determines that your injury or illness will prevent you from working for eight or more calendar days, you may be eligible to receive lost time benefits through the Ohio Bureau of Workers’ Compensation.
If your claim is approved for lost time benefits, the Bureau of Workers' Compensation will begin paying benefits accordingly:
- On the eighth day, if you are off work from eight to 14 days; or
- From the first day, if you are off work for 14 or more consecutive days.
Bureau of Workers' Compensation will pay you directly by electronic deposit to your bank account. If you do not have an account, you will receive a debit card that will permit access to benefits.
You cannot receive payment from the Bureau of Workers' Compensation for the same period you receive payment from your agency for disability, salary continuation or occupational injury leave benefits. If this occurs, you will be responsible for reimbursing your agency for the benefits you received.
Temporary Total Compensation
If your claim is approved for lost time, you may receive temporary total compensation at 72 percent of your full weekly wages for up to 12 weeks.
If your injury or illness prevents you from working for more than 12 weeks, your temporary total compensation will be reduced to 66 2/3 percent of your average weekly wage.
These lost time payments are subject to a weekly maximum amount established by the Ohio Bureau of Workers' Compensation and are not taxable.
You and your attending physician will need to file a Bureau of Workers' Compensation
Request for Temporary Total Compensation (Form C-84).
Should you require prescription medications relative to your work injury, the Ohio Bureau of Workers' Compensation contracts with a prescription drug benefit manager to process prescription drug benefits.
- You must provide your Bureau of Workers' Compensation claim number, your Social Security number and your date of injury so that your pharmacist can bill the prescription drug benefit manager for the cost of your prescriptions.
If you require a prescription but have not received your claim number from the Ohio Bureau of Workers' Compensation, you may be required to pay your pharmacy for the cost of the prescription. Once you receive your claim number, give it to your pharmacy, which will then ask the prescription drug benefit manager to reimburse you for your out-of-pocket expenses.
Claim Denial
If any party (you or your agency) disagrees with the decision of the Ohio Bureau of Workers' Compensation your workers’ compensation claim, an appeal may be filed with the Industrial Commission.
All appeals must be made in writing and must be filed within 14 calendar days of the date of receipt of the order issued by the Ohio Bureau of Workers' Compensation. The order will inform you of your appeal rights. If you have questions regarding appeal rights, you can contact the Ohio Bureau of Workers' Compensation at 800-OHIO-BWC.
Hearing Process
There are three levels in the appeal process, which include the district level, the staff level and the commission level.
If you disagree with a decision during the hearing process, you may appeal your claim to the next level, in the following order:
- District Hearing Officer.
- Staff Hearing Officer.
- Industrial Commission.
- Common Pleas Court.
You may represent yourself, or you may be represented by an attorney. For more detailed information, visit:
Ohio Industrial Commission's Appeals Process
Ohio Bureau of Workers' Compensation
