Form Focus: Ohio Motion (C-86)

Columbus, OH (WorkersCompensation.com) -- An injured worker in Ohio seeking workers' compensation benefits in the Buckeye State will need to file a motion to make the claim happen. The state requires from C-86 for such a motion, and we highlight what it requires here.

Request to Be Considered

A claimant must specifically state the requested action as noted below:

+ For an additional condition, the diagnosis of the medical condition you wish BWC or the
Industrial Commission of Ohio to consider.
+ If requesting a psychiatric or psychological condition, the claimant must include the following statement, which must be signed and dated by the injured worker --
I am aware this motion is requesting that this claim be additionally recognized for a psychiatric or psychological condition that is a result of the injury for which the claim is allowed.
+ For temporary total compensation, the claimant must state the period for which she is requesting TT.
+ For wage adjustment, the claimant must state the current wage amount and the amount the claimant wants adjusted.
+ For a self-insured claim dispute, the claimant must state the issue she disputes, such as payment of medical bills compensation, authorization of treatment, and allowance of medical condition.
+ For other issues, the claimant must state in detail the specific action she wishes BWC or the IC to consider.

Supporting Evidence

A claimant must submit or reference evidence to support the requested action as noted below:

+ For additional conditions, a claimant must indicate documentation on file that supports your request, or attach medical documentation such as medical reports, which includes a physician statement addressing the causal relationship between the requested diagnosis and the work-related injury, diagnostic test results, radiology exam results, operative reports, etc.
+ Claimants requesting the addition of a pre-existing condition that has been aggravated by the work-related injury must clearly identify it as an aggravation or substantial aggravation (depending on the date of injury) of the specific pre-existing condition.
+ If the date of injury is on or after Aug. 25, 2006, (substantial aggravation), the claimant must provide objective diagnostic findings, objective clinical findings, or objective test results that show the specific pre-existing condition has substantially worsened due to the work-related injury.
+ If the date of injury is before Aug. 25, 2006, the claimant must provide objective or subjective evidence or both that show aggravation, i.e., some real adverse effect on the specific pre-existing condition.
+ For TT, a claimant include a completed and signed Request for Temporary Total Compensation (C-84), Physician’s Report of Work Ability (MEDCO-14) or equivalent form, and any additional evidence to support the request.
+ For a wage adjustment, the claimant must indicate documentation on file that supports the request, or attach earning statements, pay stubs, a wage statement form, a payroll report, a W-2 or other tax forms, etc.
+For a self-insured claim dispute, indicate documentation on file that supports your request, or attach
copies of authorization requests, medical bills, or other evidence.
+ For any other request, the claimant must indicate documentation on file that supports the request or attach specific evidence that supports the action the claimant wishes to have taken.

Note: For a complete list of forms visit bwc.ohio.gov, or call BWC at 1-800-644-6292.

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