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This version of the form is not currently in use and is provided for reference only. Download this version of
Form C-11 (BWC-1115)
for the current year.
Form C-11 (BWC-1115) Adr Appeal to the Mco Medical Treatment / Service Decision - Ohio
What Is Form C-11 (BWC-1115)?
This is a legal form that was released by the Ohio Bureau of Workers' Compensation - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form C-11 (BWC-1115)?
A: Form C-11 (BWC-1115) is an appeal form in Ohio to challenge a medical treatment or service decision made by the Managed Care Organization (MCO).
Q: What is an MCO?
A: MCO stands for Managed Care Organization, which is responsible for managing and coordinating healthcare services for injured workers in Ohio.
Q: Who can use Form C-11 (BWC-1115)?
A: Injured workers in Ohio who disagree with a medical treatment or service decision made by their MCO can use Form C-11 (BWC-1115) to file an appeal.
Q: What is the purpose of filing an appeal using Form C-11 (BWC-1115)?
A: The purpose of filing an appeal using Form C-11 (BWC-1115) is to challenge the MCO's decision regarding medical treatment or services and seek a different outcome.
Q: What information do I need to provide on Form C-11 (BWC-1115)?
A: On Form C-11 (BWC-1115), you will need to provide your personal information, claim details, reasons for the appeal, and any supporting documents.
Q: What happens after I submit Form C-11 (BWC-1115)?
A: After you submit Form C-11 (BWC-1115), the BWC will review your appeal and make a decision based on the information provided.
Q: Is there a deadline for filing Form C-11 (BWC-1115)?
A: Yes, there is a deadline for filing Form C-11 (BWC-1115). It is typically within 14 days of receiving the MCO's decision, but it is best to check the specific deadline mentioned in the decision letter.
Q: Can I seek legal assistance for my appeal?
A: Yes, you have the right to seek legal assistance for your appeal. You may consult with an attorney who specializes in workers' compensation law to guide you through the process.
Q: What if my appeal is denied?
A: If your appeal is denied, you have the option to further appeal the decision through the Ohio Industrial Commission and, if necessary, the court system.
Form Details:
- Released on September 4, 2009;
- The latest edition provided by the Ohio Bureau of Workers' Compensation;
- Easy to use and ready to print;
- Available in Spanish;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of Form C-11 (BWC-1115) by clicking the link below or browse more documents and templates provided by the Ohio Bureau of Workers' Compensation.
