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What to do in the event of a claim

In order to maximize claims & disability management efforts, the following suggestions are being made.  The desired result is to reduce your chargeable claim costs by reducing the amount of compensation paid in claims and, therefore, reducing the number and amount of the BWC established MIRA reserves.

Procedure to follow when a claim occurs...

  1. Arrange for prompt medical treatment. 
  2. Always carefully investigate circumstances surrounding the injury.  Document all details in writing.  Obtain witness statements if applicable.  Have injured worker complete the First Report of Injury (FROI) form in addition to any internal incident report and sign a medical release form.
  3. Determine if employee had similar disability previously, either industrial or non-industrial. Obtain an accurate diagnosis and be sure the diagnosis is compatible with the incident.  Obtain estimated period of lost time from the attending physician.  (ProComp can assist)
  4. Send a copy of all claim applications to your claims manager.  If a claim was filed directly with the BWC by your employee or medical provider, send a copy of the claim to your claims manager.                                                                                

Claim form to be used  (FROI)

The Bureau created a universal claim form which covers all initial filing situations.  It is the “First Report of an Injury, Occupational Disease, or Death” (FROI) application.  If lost time is seven calendar days or less (last day worked and return date not included), the claim is considered to be “medical only”.  If lost time is more than seven calendar days or the injury results in amputation, the claim is considered to be “lost time”.  Wage information will be requested by the Bureau and should be obtained from your Payroll Department as soon as possible.

Be sure to have your employee fill out a medical release form and an accident report for any injury that results in a workers’ compensation claim.  Send the original to your claims manger and keep a copy for your records.

A question of Compensability...

Is it a valid claim?  You should contact your claims manager to discuss certification/rejection and alternative claims management options.  You should also contact your claims manager on all lost time claims to:

               a.   Determine an estimated return to work date

               b.   Determine if an independent medical exam (IME) is necessary

               c.   Determine if claim needs to be contested

               d.   Determine future loss liability

If the disability in any lost time claim seems to be headed for 90 days or more

               a.   Contact your claims manager immediately

               b.   Discuss the need to schedule a 90 day exam with the BWC

               c.   Determine if an employer’s exam is needed

Report to your claims manager immediately

                a.   Any adverse developments on a return to work date

               b.   An actual return to work date

               c.   Any difficulty getting information from an attending physician

               d.   If the employer is able to accommodate modified duty to meet any restrictions

 Other factors to consider:

  1. Was the employee acting in the course of his/her employment?
  2. Was there an injury as a result of employment and not just coincidental with employment?
  3. Consider implementing a salary continuation policy.  This program can reduce the amount of compensation paid by the Bureau and therefore, greatly reduce your reserve calculations (contact your claims manager for more information).
  4. Consider a Transitional Work Program (TWP) on all lost time claims.  Having a program in place to meet an injured worker’s restrictions could significantly reduce lost time days (contact your claims manager for more information).

Hearing Notices

Copies of all hearing notices should be forwarded to ProComp upon receipt.  If a hearing is scheduled within five (5) working days of receipt, you should call and fax notice to our office.  All Record of Proceedings (hearing results) should also be forwarded to your claims manager.

Ohio Group Rating

Group rating allows Ohio employers of similar industry groups to pool together and achieve discounts off their workers' compensation premiums.