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OhioBWC - Worker: Claim status definitions
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Claim status definitions
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Claim status defines what stage your claim is in at a given time. The various
claim statuses are listed below.
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- New claim – BWC has received your claim and is investigating
to determine whether it meets our criteria and is valid.
At this time, the claims have no International Classification of Diseases
(ICD-9) codes for the injuries.
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Pending (a.k.a. alleged) – Claim is still under investigation and
has no ICD-9 codes for specific injuries.
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Allowed/appeal – BWC has issued an order allowing your claim;
however, the claim is still within the appeal period. Any party to the
claim can file an appeal during the appeal period.
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Allowed – BWC has issued an order allowing your claim. No one filed
an appeal or The Industrial Commission of Ohio (IC) has allowed your claim
in a hearing.
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Hearing – A party to the claim has filed an appeal to our order which
allowed/disallowed your claim. We have referred it to the IC for a formal
hearing.
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Hearing DHO – The IC has allowed the claim at the first hearing level,
but the claim is still within the appeal period. We can pay compensation;
however, the injured worker cannot receive medical benefits until the appeal
period has ended, or the claim goes to the next hearing.
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Disallowed/appeal - We have completed our investigation, and it appears
the injury does not meet our guidelines for allowance. A BWC order has been
issued denying the claim, but the claim is still within the appeal period.
At this time any party to the claim may file an appeal to the claim denial.
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Disallowed - We have issued an order denying your claim. No one filed
an appeal or the IC has denied your claim in a hearing.
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Dismissed - You or your authorized representative has voluntarily
withdrawn your claim before we made a decision. Withdrawing this claim
will not have a negative effect on any future claims you file.
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Hearing - The IC has allowed the claim at the first hearing level,
but the claim is still within the appeal period. We can pay compensation;
however, the injured worker cannot receive medical benefits until the
appeal period has ended, or the claim goes to the next hearing level.
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Pending settled - medical and indemnity - A settlement agreement
has been generated to settle your claim in its entirety. We will hold the
claim for 30 days before finalizing settlement. During the hold period any
party to the claim may withdraw from the settlement.
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Pending settled - indemnity - All parties have agreed to settle the
indemnity (compensation) portion of your claim. The medical portion of the
claim will remain open. BWC will hold the claim for 30 days before
finalizing the settlement. During the hold period any party to the claim
may withdraw from the settlement.
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Pending settled - medical - All parties have agreed to settle the
medical portion of your claim. The indemnity (compensation) portion of the
claim will remain open. We will hold the claim for 30 days before
finalizing settlement. During the hold period any party to the claim may
withdraw from the settlement.
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Settled - medical and indemnity - We will close the claim in its
entirety in exchange for an agreed upon sum of money. BWC will pay no additional
medical treatment or compensation. once it's settled;
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Settled medical - We will close the medical portion of your claim
in its entirety in exchange for an agreed upon sum of money. We and your
managed care organization will pay for no additional medical treatment
once it's settled.
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Settled indemnity - We will close the indemnity (compensation)
portion of your claim in its entirety in exchange for an agreed upon
sum of money. BWC will pay no additional compensation once it's settled.
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Claim status date - The date the status of the claim became effective.
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Active/Inactive status - This status indicates the claim has had
recent activity and we are providing ongoing services. A claim is classified
as active provided that no more than 13 months have passed since the last date
of medical service or compensation payment. Also, no outstanding
Application for Determination of Percentage of Permanent Partial Disability
or Increase of Permanent Partial Disability (C-92), Settlement Agreement and
Application for Approval of Settlement Agreement (C-240) or Application for
Permanent Total Disability (IC-2) applications exist for this claim.
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Active/Inactive status date - This is the date the claim became
active/inactive according to the criteria above.
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What is the status of my claim?
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