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Injured workers of self-insuring employers can notify us of specific concerns in the management of their claim

Injured workers of self-insuring employers can notify us of specific concerns in the management of their claim. Our goal is to investigate the issue and resolve it promptly and fairly. We will maintain a record of all findings which will be included in evaluating the employer’s fitness to maintain its self-insuring privilege. Ohio Administrative Code rule 4123-19-09 governs the complaint process pertaining to self-insuring employers.
An injured worker or representative may file a complaint as a party to the claim. The statement should clearly outline the issue(s) and provide supporting documentation. The injured worker or representative may use the Allegation Against a Self-Insuring Employer (SI-28) or a clear written statement.

Mail: Bureau of Workers’ Compensation 
Attn:  Self-Insured Department
          30 W. Spring St 
          Columbus, OH  43215-2256
Email: SIINQ@bwc.state.oh.us
Fax: 614-621-1081

Upon receipt of a complaint, our self-insured staff sends a notification letter to the employer’s designated administrator, assigned representatives, claimant and claimant’s representative. It requests that the employer provide a written response to the allegation within 14 days of receipt.

The employer may, with good cause, request an extension for providing a response by contacting the assigned BWC representative. We investigate the allegation(s) to determine the validity of the complaint and send notification to all parties to the claim. Within 14 days of receipt of the BWC decision, all parties to a complaint may file a written request for reconsideration. The reconsideration must include evidence of new or changed information not considered in the initial decision. BWC conducts a second-level administrative review to address the complaint reconsideration in light of the additional information and notifies all parties to the complaint of the outcome of this reconsideration investigation and evaluation.

Any unresolved issues and appeals to the administrator’s designee’s finding will go to Self-Insured Employers Evaluation Board (SIEEB).

View past SIEEB decisions.