Authorization Number : 855-1179
Agency Series No. : C-36
Status : Active
Agency Web Link :
Agency : BWC
Confidential Description : Records will contain injured worker name, claim number and may also contain contact information, dates of injury and/or disability.
This record is deemed confidential pursuant to O.R.C. 4123.88(B), and is specifically exempted from public records law.
Division : BWCCLMS
Vital Description :
Section :
Record Title : Wage Referral Form
Revision : 0
Record Description : The Wage Referral Form contains claim information such as injured worker name, claim number, reasons for wage calculation. This form is used as a tool for the Lost Time Claim Specialist (claim owner) and/or Injury Management Supervisor(IMS) to refer a claim to a wage specialist for wage calculation. The Wage Specialist and/or IMS will use this to assign wage calculation requests and be used as a worklist. Once the wage specialist completes the requested calculation will then “Complete” the assigned Wage Referral Form. A completed Wage Referral Form is indicated after a Wage Calculation Workbook is completed and/or a claim is noted as such. The Wage Specialist IMS will continue to utilize the completed Wage Referral Form for pertinent information such as date referred, reason for referral, date pulled, date started and date completed as well as who the Wage Referral Form was assigned to so that management can ensure that performance measures are being met on a daily, weekly, monthly and yearly reporting standard.