Fill a Valid Ohio Bwc 3907 Form
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Preview - Ohio Bwc 3907 Form
Waiver of Examination
Statewide Disability Evaluation System
•The employer should sign and date the form.
Injured worker name
Claim number
The employer or BWC has waived the medical examination, which Section 4123.53 (B) of the Ohio Revised
Code requires after 90 consecutive days of temporary total disability compensation. The employer or BWC
has waived the exam Temporarily or
Permanently |
for the following reason: |
Injured worker remains hospitalized; Injured worker is scheduled for surgery; Injured worker is scheduled to return to work on;
Other
.
Waiver authorized by:
Employer name
Date
Employer representative
Title
Requested
The BWC nurse has recommended to waive the examination.
Signature of
Signature
Date
BWC use only
BWC has approved the request for waiver.
BWC has denied the request for waiver for the following reasons:
Signature
Date
Document Properties
| Fact Name | Description |
|---|---|
| Form Purpose | The BWC 3907 form is used to waive the medical examination required for injured workers under certain circumstances. |
| Governing Law | This form is governed by Section 4123.53 (B) of the Ohio Revised Code, which outlines the requirements for medical examinations after temporary total disability compensation. |
| Employer's Role | The employer must sign and date the form to validate the waiver of the medical examination. |
| Injured Worker Information | The form requires the injured worker's name and claim number for proper identification and processing. |
| Reasons for Waiver | The waiver can be granted temporarily or permanently for reasons such as hospitalization, scheduled surgery, or imminent return to work. |
| Follow-Up Examination | The form includes a section to request a follow-up examination date, as recommended by the BWC nurse. |
| BWC Approval | The BWC will either approve or deny the waiver request, and this decision must be documented on the form. |
Documents used along the form
The Ohio BWC 3907 form is an important document in the workers' compensation process, specifically related to waiving the medical examination requirement for injured workers. Alongside this form, several other documents may be necessary to ensure a smooth and compliant claims process. Below are a few key forms that are often used in conjunction with the Ohio BWC 3907 form.
- MEDCO-6 Form: This form is used to report the details of an injured worker's medical treatment. It includes information about the diagnosis, treatment plan, and any medical expenses incurred. The MEDCO-6 is essential for tracking the progress of the worker's recovery and for determining ongoing eligibility for benefits.
- California Motorcycle Bill of Sale: A California Motorcycle Bill of Sale form is essential for transferring ownership of a motorcycle. For a detailed template and guidance on completing this form, visit documentonline.org/blank-california-motorcycle-bill-of-sale.
- BWC-1 Form: The BWC-1 form is the initial claim application for workers' compensation benefits. This document must be completed by the injured worker and submitted to the Bureau of Workers' Compensation (BWC) to initiate the claims process. It includes details about the injury, employment, and any witnesses.
- First Report of Injury (FROI): This report is filed by the employer to notify the BWC of an employee's work-related injury. It includes information about the incident, the injured worker, and any medical treatment provided. Timely submission of the FROI is crucial for ensuring that the claim is processed efficiently.
- Return to Work (RTW) Form: This form is completed when an injured worker is ready to return to their job. It provides documentation of the worker's ability to perform their duties and may include any restrictions or accommodations needed. The RTW form helps facilitate a smooth transition back to work.
Understanding these additional forms can greatly assist in navigating the workers' compensation process in Ohio. Each document plays a vital role in ensuring that injured workers receive the benefits and support they need during their recovery.
Guidelines on Filling in Ohio Bwc 3907
Filling out the Ohio BWC 3907 form is an important step in the process of managing temporary total disability compensation. After completing this form, it will be submitted to the Bureau of Workers' Compensation (BWC) for review. Below are the steps to accurately fill out the form.
- Begin by entering the name of the injured worker in the designated field.
- Fill in the claim number associated with the injured worker.
- Indicate whether the medical examination has been waived temporarily or permanently by checking the appropriate box.
- Provide the reason for the waiver by selecting one of the options:
- Injured worker remains hospitalized
- Injured worker is scheduled for surgery
- Injured worker is scheduled to return to work on (insert date)
- Other (specify)
- Enter the name of the employer or BWC representative authorizing the waiver.
- Date the form is being completed.
- Include the title of the employer representative or BWC nurse completing the form.
- Fill in the requested follow-up examination date if applicable.
- Have the self-insured employer or BWC nurse sign the form.
- Include the date of the signature.
- Leave the BWC use only section blank, as this will be completed by the BWC.
Common mistakes
Completing the Ohio BWC 3907 form is a crucial step in ensuring that injured workers receive the benefits they deserve. However, several common mistakes can hinder this process. Awareness of these pitfalls can help streamline the submission and approval of waivers.
One frequent error occurs when the employer fails to sign and date the form. This signature is essential, as it verifies that the employer acknowledges the waiver of the medical examination. Without this crucial step, the form may be deemed incomplete, resulting in delays or denials.
Another mistake involves not providing a clear reason for the waiver. The form allows for several options, such as hospitalization or a scheduled return to work. If the employer or BWC does not specify the reason, it may lead to confusion and potential rejection of the waiver request.
Additionally, some individuals neglect to include the requested follow-up examination date. This date is important as it helps the BWC track the injured worker's progress and ensures timely evaluations. Omitting this information can create complications in the review process.
Moreover, failing to include the name and title of the employer representative can result in complications. The BWC needs to know who authorized the waiver, and without this information, the request may not be processed correctly.
Another common oversight is when the BWC nurse's signature is missing. The form requires the nurse's signature to confirm that the examination waiver is recommended. Without this signature, the request may not carry the necessary weight for approval.
Finally, individuals sometimes overlook the importance of reviewing the form before submission. Errors in any section can lead to delays or denials. Taking the time to double-check the information ensures that the form is complete and accurate.
FAQ
-
What is the Ohio BWC 3907 form?
The Ohio BWC 3907 form is a Waiver of Examination used in the Statewide Disability Evaluation System. It is primarily utilized when an injured worker is receiving temporary total disability compensation and a medical examination is required after 90 consecutive days. This form allows the employer or the Bureau of Workers' Compensation (BWC) to waive that examination under certain circumstances.
-
Who needs to sign the BWC 3907 form?
The employer must sign and date the form. Additionally, the BWC nurse may also sign if they are completing the form on behalf of a self-insured employer. This ensures that all parties involved acknowledge the waiver of the examination.
-
What are the reasons for waiving the medical examination?
The form allows for several reasons to waive the examination, including:
- The injured worker remains hospitalized.
- The injured worker is scheduled for surgery.
- The injured worker is scheduled to return to work on a specific date.
- Other reasons can also be specified.
-
What happens if the waiver is approved?
If the BWC approves the waiver request, the injured worker will not be required to undergo the medical examination. This can provide relief and allow the worker to focus on recovery without the added stress of a medical exam.
-
What if the waiver request is denied?
If the BWC denies the waiver request, they will provide reasons for the denial. The injured worker and employer should be prepared to follow up on the next steps, which may include scheduling the required medical examination.
-
How does the employer fill out the form?
The employer must provide the injured worker's name, claim number, and the date. They should also indicate whether the waiver is temporary or permanent and select the appropriate reason for the waiver. Finally, the employer representative must sign and date the form.
-
What is the role of the BWC nurse in this process?
The BWC nurse can recommend waiving the examination based on the injured worker's condition. Their signature on the form indicates that they have assessed the situation and support the waiver request.
-
When should the follow-up examination be scheduled?
The form allows for a requested follow-up examination date to be specified. It’s important to coordinate this date based on the injured worker's recovery timeline and any upcoming medical appointments.