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Policy
and Procedure Name:
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Authorized
Representatives
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Policy
#:
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CP-01-01
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Code/Rule
Reference:
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RC
4123.06; 4123.88
O.A.C.
4121-2-01; 4123-3-22; 4123-3-24; 4123-3-29
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Ohio
Industrial Commission (IC) Resolution/Memo
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R07-1-01
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Effective
Date:
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01/22/2020
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Approved:
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Ann
M. Shannon, Chief of Claims Policy & Support
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Origin:
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Claims
Policy
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Supersedes:
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Policy
# CP-01-01, effective 07/17/18
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History:
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Previous
versions of this policy are available upon request.
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Table
of Contents
I.
POLICY PURPOSE
II.
APPLICABILITY
III.
DEFINITIONS
Authorized
Representative
Demographic
Information
Employer
Representative
IV.
POLICY
A. General Policy Statements
B. Representative Identification
Numbers (RIN)
C. Representative Assignment to
Claim
D. Employer Authorized
Representative
V. PROCEDURE
A. Standard
Claim File Documentation
B. Representative
Identification Numbers (RIN)
C. Claimant
Requests Assignment of Authorized Representative
D. Representative
Assignment to Claim
E. Employer
Authorized Representative
F. Claimant
Representative Demographic Changes
G. Structural
Business Changes for Claimant Representatives
H. Representative
Death or Attorney Disbarment
The
purpose of this policy is to ensure that BWC staff properly identify and enter
into the claims management system an authorized representative of a claimant
and employer.
This
policy applies to claims services and attorney representative desk staff.
Authorized
Representative:
An individual, company, union or firm designated by the claimant or employer to
represent his or her interests before BWC and the Industrial Commission.
Demographic
Information:
For purposes of this policy, demographic information refers to the
representative’s business address, contact information (e.g., phone and fax
numbers, and email address).
Employer
Representative:
A type of authorized representative designated by an employer to represent it
in policy or claim-related matters associated with the employer’s policy
number.
1.
It
is the policy of BWC to recognize representatives properly designated and
authorized by a claimant or an employer.
2.
BWC
shall ensure authorized representatives receive:
a.
Electronic
access to the claim; and
b. Notices of
claim actions.
3.
Representative
Demographic and Structural Business Changes
a.
It
is the policy of BWC to maintain up to date records pertaining to the demographics
and business structure (e.g., mergers and splits) of representatives; and
b. To make timely
updates to all affected customer records.
4.
Death
or Disbarment of a Representative: It is the policy of the BWC to update
customer records when BWC receives notification of a representative’s death or
disbarment.
1.
All
authorized representatives of claimants or employers must have a BWC-issued
RIN, obtained by filing an Application for
Representative Identification Number (RIN) (R-4) with
BWC.
2.
If
the representative anticipates payment from BWC, the representative must
provide a Request for Taxpayer Identification Number and Certification
(IRS form W-9) with the R-4. The name and taxpayer identification number
provided on the R-4 must match the name and number on the W-9. BWC will make
payment based on the taxpayer identification number provided on the R-4 and
W-9.
3.
If
the applicant is an out-of-state attorney, the attorney must also submit a
“Certificate of Pro Hac Vice Registration” from the Supreme Court of Ohio’s
Office of Attorney Services.
1.
A
claimant must file a Claimant
Authorized Representative (R-2) form or equivalent with BWC to
appoint an authorized representative.
a.
The
authorization must include the:
i.
Claim
number;
ii.
Date
of injury;
iii. Claimant’s
name, address, and phone number;
iv. Representative’s
name, address and phone number; and
v.
Representative’s
RIN
b. The
authorization must be signed by the claimant.
i.
Only
the claimant may authorize a representative except when the claimant has a
guardian.
ii.
See
the Custody,
Guardianship, Power of Attorney and Incapacitation
policy for
information.
2.
Upon
request, a claimant may have multiple authorized representatives.
a.
A
claimant may have only one legal representative, one attorney or law firm.
b. In addition to
a legal representative, a claimant may have a union representative at the same
time.
c.
This
request shall be documented in claim notes.
3.
A
claimant may change or dismiss an authorized representative at any time.
a.
The
submission of an authorization for a new legal or union representative will
replace any prior legal or union representative.
b. If a
representative withdraws or is removed by the claimant and the claimant hires a
new representative, the claimant must file a new authorization.
4.
It
is the responsibility of the claimant to notify new and former authorized
representatives of any changes.
5.
The
changing of an authorized representative does not automatically update any
previously filed Authorization
to Receive a Workers’ Compensation Check (C-230).
a.
If
the claimant desires the new authorized representative to also receive a
workers’ compensation payment on behalf of the claimant, the claimant must:
i.
Cancel,
in writing, any previously filed C-230; and
ii.
File
a new C-230 identifying the newly authorized representative as authorized to
receive a workers’ compensation payment.
b. See the Authorization
to Receive a Workers’ Compensation Check policy for further information.
6.
Having
representative authorization from BWC does not excuse the representative from
complying with all Industrial Commission (IC) requirements for representation.
1.
An
employer may appoint an authorized representative for an individual claim by
filing an Authorization
of Representative of Employer (R-1) with BWC.
2.
The
R-1 must be signed by an individual within the business with the authority to
make such authorizations (e.g., Human Resource Manager, Safety Director, Chief
of Operations).
1.
BWC
staff shall refer to the Standard Claim
File Documentation and Altered Documents policy and procedure for claim
note requirements; and
2.
Shall
follow any other specific instructions for claim notes included in this procedure.
1.
When
a representative submits a completed Application for
Representative Identification Number (RIN) (R-4) and
other required documentation requesting a RIN, the BWC attorney representative
desk staff shall verify that no current record exists for the requestor, and if
not, issue an RIN and enter the representative as a business customer into the
claims management system.
2.
If
a W-9 is submitted with the R-4, BWC attorney representative desk staff shall
ensure that the name and taxpayer identification number on the R-4 matches the
name and taxpayer identification number on the W-9.
a.
The
BWC attorney representative desk staff shall notify the representative if there
is a discrepancy between a submitted W-9 and the information provided on the
R-4, or if the necessary W-9 has not been provided.
b. BWC will not
issue an RIN until all the needed taxpayer information and documentation is
complete.
3.
If
the representative is an out of state attorney not admitted to the Bar in Ohio,
BWC attorney representative desk staff shall ensure that a “Certificate of Pro
Hac Vice Registration” from the Supreme Court of Ohio’s Office of Attorney
Services is included with the R-4.
4.
If
the attorney registration number or a registration certificate is not provided
and has not been supplied upon request, or if there is any other reason to
question the attorney’s credentials, BWC attorney representative desk staff
shall consult with a BWC attorney to determine appropriate action.
1.
Claimant
may use an R-2 or signed equivalent form to request an authorized
representative be attached to a claim.
2.
This
request may be completed via fax, letter, or email attachment.
1.
Attorney
representative desk staff shall:
a.
Add
or update an authorized representative as a “Claimant Representative” or
“Dependent Representative” participant (as appropriate) to a claim when the
claimant has filed an R-2 form or equivalent to BWC that meets the requirements
in section V.C.
b. Update the
participant record to indicate the participant type as Legal Representative or
Union Representative.
c.
If
the claimant is changing legal representatives, attorney representative desk
staff shall ensure the previous legal representative is expired in the claims
management system as a participant on the claim.
2.
When
a claimant dies, claims services staff shall set a task for thirty (30) days
from the date BWC received notice of the death to expire the dependent’s
authorized representative in the claim.
a.
When
a new request is filed (typically for death benefits or accrued compensation)
during the 30-day period, attorney representative desk staff shall:
i.
Review
the file to determine if the decedent’s authorized representative has been
chosen to represent the filing party. For the decedent’s authorized
representative to represent the new claimant, the new claimant must sign and
submit a new R-2 (the representative will then be identified in the claims
management system as the representative of the spouse or other dependent);
ii.
Review
the file to determine if another authorized representative has been selected
with a new R-2, or whether the new claimant does not have an authorized
representative;
iii. In either
event, attorney representative desk staff shall immediately expire the
decedent’s previously authorized representative. An authorization made by the
decedent does not carry over to apply to the new claimant (i.e., surviving
spouse or dependent child) unless the new claimant chooses to designate and
authorize the same representative to represent them.
b. In the event
the 30-day period expires and no new R2 is filed, claims services staff shall
make the authorized representative inactive in the claims management system
within the identified claim.
1.
Upon
receipt of an R-1 form, attorney representative desk staff shall enter or
update the employer’s representative authorized for a specific claim in the
claims management system.
2.
For
more information, BWC staff may refer to the Employer
Authorized Representative policy.
1.
Upon
written notice from a claimant representative of a demographic change request,
the attorney representative desk staff shall update the customer record for the
representative in the claims management system.
2.
A
representative may request an update to their demographics by attaching and
sending the request via fax, letter, or email correspondence.
3.
Attorney
representative desk staff shall reference the Authorized Representative job aid
and follow the steps outlined to complete the necessary changes.
1.
Upon
written notice to change information related to a RIN due to a structural
business change (e.g., a law firm splitting up into two or more entities) the attorney
representative desk staff shall review the notice to determine if the following
information has been submitted:
a.
Name
of original business entity;
b. Name of new
business entity;
c.
Any
changes to demographic information for the new business entity;
d. Claims that are
affected by this change;
e.
Any
other information that may be necessary to address the structural business
change.
2.
If
there are any questions regarding the representative’s request, the attorney
representative desk shall attempt to contact the representative in order to
address.
3.
Attorney
representative desk staff shall reference the Authorized Representative job aid
and follow the steps outlined to complete the necessary changes.
1.
When
BWC is notified of an authorized representative’s death or disbarment the
attorney representative desk staff shall review the notice to determine if all
the necessary information has been submitted.
2.
Attorney
representative desk staff shall reference the Authorized Representative job aid
and follow the steps outlined to remove the representative from the claims
management system.