To help you better understand the process and terms involved in Bureau of Workers' Compensation (BWC) claims, here are some answers to commonly asked questions.
Every company has a MCO or TPA. What is a MCO/TPA?
MCO (managed care organization) – If your company is state-funded, a MCO will help manage your claim.
TPA (third party administrator) – If your company is self-insured, a TPA will help manage your claim.
How do I obtain a claim number?
If you work for a state-funded company, BWC will assign a claim number to you pertaining to your accident date.
If you work for a self-insured company, the TPA may or may not assign a claim number to you pertaining to your accident date.
Your claim number will be used as an identifier and tracking number. Use it whenever you contact BWC, your MCO or your self-insured employer. And give it to all of your doctors who are treating the work-related injury.
You may receive a claim identification card in the mail. Keep this identification card with you as it is very important for completing paperwork at your doctor appointments.
What is a Physician of Record (POR)?
OSU Occupational Medicine will be your POR which means we will guide or direct your claim. If at any time you are unhappy with your care, you have the right to seek or find another POR. The POR must be BWC certified.
Types of BWC Forms:
FROI (first report of injury) – This form, which is filled out by the IW (injured worker) and the POR, initiates your claim.
C9 – This form is used to request treatment, such as physical therapy or MRI, or a referral to specialist. Your POR must submit this form. The MCO has three business days to make a decision and respond, while the TPA has 10 business days to make a decision and respond. They can deny, approve or pend the request.
C84 – This form is used to pay compensation for being off work seven consecutive days or more. The BWC requires the IW to complete his/her portion of this form every time it is submitted.
C140 – This form is used for wage continuation. For example, if you usually work eight hours a day and now can only work four hours due to restrictions, this form will cover the other four lost hours.
What if I work for a company sponsored by Federal Workers’ Compensation?
You need to report your injury to your employer. Once this injury is processed, you will receive a case file number in the mail. It is important that you provide us with the case file number because it is required in order for OSU Occupational Medicine to submit requests for treatment(s) e.g., MRI, Physical Therapy, for the progression of your medical care.
How do I obtain more information related to Federal Workers’ Compensation?
If you have specific questions related to federal claims, you may call ACS Care Assistant at 1-850-558-1818.
Related Links:
www.ohiobwc.com
https://owcp.dol.acs-inc.com
