FAQ
What is the difference between BWC, an MCO, and a TPA in the claims management process?
BWC- The Ohio Bureau of Workers’ Compensation (BWC) is responsible for making initial claim and diagnoses determinations.
MCO- A Managed Care Organization (MCO) is a private company that an employer selects to medically manage the workers’ compensation claims for injured employees.
MCOs are responsible for filing a first report of injury with BWC, medically managing claims, and coordinating medical bill payment. MCOs help coordinate a safe and timely return to work for injured workers.
TPA- A Third Party Administrator is a private company that an employer contracts with to represent the employer’s interests on issues relating to matters regarding workers’ compensation and alternative rating programs.
How do I report a work-related injury?
When a work-related injury occurs, the injured worker should make his employer aware of the injury, and then contact the MCO to report the injury information. The injured worker, employer, or provider may report the claim to their MCO by phone, fax, mail, or on-line. Sheakley UniComp will gather the necessary information for claim filing through conferring with all parties of the claim (injured worker, employer, and provider), and report the information to the Ohio Bureau of Workers’ Compensation. For injury reporting, call Sheakley UniComp at 1-888-743-2559, or fax First Report of Injury form to 1-888-626-2667. Claims may also be reported on-line via the Ohio Bureau of Workers' Compensation web site at www.ohiobwc.com.
Where can the injured worker receive medical treatment?
In emergency situations, the injured worker may seek treatment from any medical treatment facility or medical provider. After the initial treatment, injured workers must seek treatment from a BWC certified medical provider. Sheakley UniComp can assist you with locating a medical provider by calling 1-888-743-2559.
What types of information are necessary to report a claim?
In order to create a claim, the following information is most critical to begin the process: employer name and address, injured worker name, address, date of birth, and social security number, date of injury, provider name and address (if treatment sought), detailed accident description, and nature of injury. Injured workers, employers, or providers reporting work related injuries are encouraged to use and/or refer to the Ohio Bureau of Workers Compensation First Report of Injury form which includes much of the necessary information to file a claim.
Who determines if my claim will be allowed?
BWC is responsible for making a determination as to whether a work related injury will be allowed as a claim. Prompt notification of injury and cooperation by all parties of the claim in information gathering by the MCO, including date of injury, accident description, and treating provider information, all assist the BWC in making appropriate and timely claim allowance decisions. BWC will contact the parties of the claim to inform of claim allowance decisions via letter.
What is a claim number, and why is it important?
All injured workers who have a claim filed with BWC will receive a claim number within five to ten days of filing a claim. This unique claim number is extremely important in the workers’ compensation process. Please have this number available when visiting a medical provider, or when speaking to a BWC or Sheakley UniComp representative.
How are injured workers reimbursed for lost wages?
BWC is responsible for wage compensation determination and mailing compensation checks. Please refer all questions relating to wage compensation payments to BWC at 1-800-OHIOBWC.
What is considered a Lost Time claim?
A lost time claim occurs when an injured worker is off work for eight days or longer due to an allowed injury or occupational disease.
Who is responsible for paying medical bills for work-related injuries?
Coordination for the payment of medical bills on allowed claims is the responsibility of Sheakley UniComp. Medical providers should send appropriate billing format directly to Sheakley UniComp for reimbursement of medical bills.
What can I do to help control my workers’ compensation costs?
The Ohio BWC premium rates are based upon an employer's payroll and claims experience and how this experience relates to other employers within the same industry type. There are many options available to Ohio BWC employers which can help them control and possibly even lower their worker compensation premiums. These discount programs include, but at not limited to: The 10 - Step Business plan, Premium Discount Program + (PDP+) and the Drug Free Workplace Program. More information can be found at the following website: www.ohiobwc.com.
We also suggest you contact Sheakley UniComp and ask for a Client Relations Manager to assist you.
Can I view my company claim information on line?
Yes. On the Ohio BWC's website (www.ohiobwc.com) employers, injured workers, and their representatives will be able to enter a social security number or a BWC claim number and view the claims associated with that number.
As a Sheakley UniComp client, with an assigned login and password, employers will have a similar access at www.sheakley.com. You will have the ability to view treatment plan requests, case management plans, medical billing info (including check number and amount) and activity notes. You will also have the ability to view reports relating to your claims.
