Agency : BWC
Confidential Description : This record contains the injured workers’ claim file with personal information, address, telephone number, medical records, psychological records, social security numbers, provider numbers, employment records, employer policy numbers, payments made, etc. Ohio Revised Code (ORC) 149.43A(1)(a) Availability of public records for inspection and copying. ORC 4123.88 (B) Disclosure of record Ohio Administrative Code 4121-3-22 (D) Inspection of Claim Files.
Revision : 4
Record Description : The Deceased Injured Worker (here after known as DIW) Claim Files contains documents related to a claim for workers’ compensation benefits due to a work-related injury resulting in the death of an employee. These Claim files may include (but are not limited to); Dependent death benefits, all correspondence, BWC Orders, IC Orders, Family Support Orders, Forms: FROI-1 the First Report of Injury, C-101 Authorization to Release Medical Information, C-86 Motion of Claimant, IC Hearing Documents, C-92 Percentage Applications and Awards, medical documents, Medical Peer Reviews, Medical and non-medical Alternative Dispute Resolution (ADR) packets, x-ray interpretations, psychological reports, C-84 Request for Temporary Total Compensation, Permanent Total Disability Compensation Application, Vocational Rehabilitation Reports, Wage Loss Application (working and non-working wage loss), Living Maintenance Compensation Application, Complete Settlement Packets and Settlement Agreement, Disability Relief and Disability Relief Award Orders. • Retain DIW Claims with date of injury on or after with DOI on or after 9/15/2020 on a Medical Only Claim, the claim expires five (5) years from the date of the last medical service rendered, compensation payment, or date of death. • Retain DIW Claims with date of injury on or after 08/25/2006 to 9/14/2020 on a Medical Only Claim: Retain for six (6) years from the last medical bill, compensation payment, date of death, or six (6) years from the date of injury if no medical payments. • Retain DIW Claims with date of injury on or after 12/11/1967 to 8/24/2006 on a Medical Only Claim: Retain for six (6) years from the last medical bill, compensation payment, date of death, or six (6) years from the date of injury if no medical payments. • Retain DIW Claims for Date of Injury Prior to 12/11/1967 on a Medical Only Claim: Retain ten (10) years from last medical bill, compensation payment, date of death, or ten (10) years from the date of injury if no medical payments. • Retain DIW Claims with date of injury on or after with DOI on or after 9/15/2020 on a Lost Time Claim, the claim expires five (5) years from the date of the last medical service rendered, compensation payment, or date of death. • Retain DIW Claims with date of injury on or after 08/25/2006 to 9/14/2020 on a Lost Time Claim: Retain for six (6) years from the last medical bill, compensation payment, or date of death, or six (6) years from the date of injury if no medical payments. • Retain DIW Claims with date of injury on or after 12/11/1967 to 8/24/2006 on a Lost Time Claim: Retain for six (6) years from the last medical bill, compensation payment, date of death, or six (6) years from the date of injury if no medical payments. • Retain DIW Claims for Date of Injury Prior to 12/11/1967 on a Lost Time Claim: Retain ten (10) years from last medical bill, compensation payment, date of death, or ten (10) years from the date of injury if no medical payments.