• Statute of limitations – this is the date in which the injured worker can no longer receive benefits because according to Ohio Revised Code 4123.52, the claim is closed. The date of injury, disability or death and the claim type determine the statute of limitations for a claim.
  • Medical-only claims with dates of injury prior to Oct. 20, 1993, are statutorily closed six years from the date of injury.
  • Medical-only claims with dates of injury on or after Oct. 20, 1993, are statutorily closed six years from date of last payment of medical benefits.
  • Lost-time claims are statutorily closed 10 years from date of last payment of compensation or medical benefits, from the date of death, or whichever is later.

• Benefit type - indicates whether the claim is medical only or lost time
  • Medical-only claims are those where an injured worker misses less than seven days of work due to the work-related injury.
  • Lost-time claims are those where an injured worker misses more than eight days due to the work-related injury.

• Accident type – refers to the type of injury the injured worker sustained in the course of employment. The three options include:
  • Accident (ACC) – a sudden, unusual, unexpected occurrence happening at a particular time and place, not in the usual or expected course of events;
  • Occupational disease (OD) – a disease peculiar to a particular industrial process to which an employee is not generally subjected or exposed and contracted in the course of employment. This process usually occurs over a course of time;
  • Death (DTH) – death has occurred as a result of an industrial accident. A date of death is included.

• Coverage type - indicates the status of the employer’s policy at the time the claim was filed and should not affect compensability of the claim. Abbreviations for coverage type are as follows:
  • COV – policy which had coverage at the time of injury as a result of timely payment of premiums;
  • NO COV – period of time where an employer did not have coverage as a result of failure to pay premiums timely;
  • NO REC – BWC shows there was no record of coverage for this employer;
  • BKRP – an account status that shows the employer’s business is bankrupt.

• Fund type - indicates the fund from which payments are issued. Abbreviations for fund type are as follows:
  • OSIF - State Fund;
  • PE - Public Employer;
  • SI - Self-Insured;
  • BL - Black Lung;
  • MF - Marine Fund;
  • APP – Apprentice;
  • CD - Civil Defense;
  • CDF - Contract Coverage;
  • ONG - Ohio National Guard;
  • PWRE - Public Worker Relief Employee.

• 15K Program - This program allows state-fund employers with active coverage to choose to pay the first $15,000 of a medical-only claim (a claim with seven or fewer lost days from work). Once employers have enrolled, all of their medical-only claims with a date of injury past the date of enrollment will be automatically included in the program.
  
  BWC processes a 15K Program claim the same way we do any other medical-only claim.
  
  Employers can have an individual claim removed from the program at any time. They must notify BWC, the injured worker, provider and the MCO that they no longer want to be responsible for the bills and provide the last date of service they will pay. BWC will enter this as the 15K end date. However, you should submit any bills not paid by the employer, regardless of date of service, to the MCO.

• 15K start date – The date the employer enrolled in the program.

• 15K end date – The date the claim was removed from the program making the MCO responsible for medical management of the claim.

If you have additional questions, contact your claims service specialist.

If you know your claim number, click here to access the above information for your claim.