Workers' Compensation
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Forms
Below are Workers' Compensation forms specific to ABX Air.
Additional forms are available at the Ohio Bureau of Workers' Compensation
web site (ohiobwc.com).
-
Employee Quality Improvement Survey
[9kb PDF] -
Employee Work Status Report
[30kb PDF] - To be completed by
your physician.
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Qualified Health Plan list request form
[13kb PDF]
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Sick Time Reimbursement
[8kb PDF]
Provider
Directory
Ohio
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| IMPORTANT NOTE: In case of an emergency, seek treatment immediately from the most convenient medical facility. Emergency treatment is not limited to the network providers by the QHP program. Always report injuries to your supervisor as soon as possible and follow ABX Air company policy for on-the-job injuries/illnesses. |
Ohio Provider Directory
This directory contains the names, addresses and telephone numbers of the
doctors, hospitals, and alternative providers who have contracted with the
Ohio Comp Network (OCN) to provide care for ABX Air employees in the event
of a work-related injury or illness.
Any provider who has been certified by the Ohio Bureau of Workers Compensation is eligible to treat injured workers. While we have taken great care to make this directory complete and accurate, oversights can occur. Provider contracts also might become effective or end after the printing of this directory. If you need to locate an Ohio provider in a county not listed below, or if the provider you are looking for is not listed, please contact the Workers Compensation Department at ABX Air, Inc.
Click on the county below for the provider list you wish to see.
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If you are uncertain about the county, the physicians' specialty, the physicians within a specialty, or the county the physicians are in, please check out the following:
Specialty to Provider Cross reference
Provider to Specialty Cross reference
If you don't have Microsoft Excel on your PC, click here if you need to Download the MS Excel Viewer.
Non-Ohio Provider Directory
Click on the link to your state below to:
- Connect to your state's workers compensation web site for further information,
- Read the Right to Direct Laws for treatment and care, and
- Select a Panel Provider, for treatment, if applicable.
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For any state not listed, or for areas outside the United States, please contact the Workers Compensation Department at ABX Air, Inc.
What is my claim number?
ABX Air is a self-insured company. We use your date
of injury as an internal claim number; however, if you miss over seven
days of work due to the on the job injury a number will be issued by the
Bureau of Workers' Compensation.
Will I get paid for my time off?
If an injured worker loses eight or more
calendar days as a result of an approved work-related injury, ABX Air will
pay compensation for lost wages from that point forward.
If an injured worker loses 14 or more consecutive calendar days from ABX Air due to an approved claim, ABX Air will pay from the first day missed.
Are there any programs available to assist me back
to full duty?
The following programs are available to assist
you in a safe return to work:
- Alternate Duty: If you become temporarily unable to perform the essential functions of your job because of an illness or injury (on or off-the-job), functional restriction or disability, you may be placed by the Company into a temporary alternate duty assignment which is within the capabilities (as medically documented) that you are able to perform safely to promote a safe and expedient return to your original job.
- Functional Capacity Evaluation: This is an assessment designed to measure your potential to return to work in your previous position. The assessment includes a musculoskeletal evaluation to determine your physical deficits as well as functional testing of work related activities (lifting, pushing, pulling, carrying, etc.) to determine your individual current functional capability in relation to the physical demands of your job. The information is then used to establish a treatment plan for a successful return to work.
- On-site Work Reconditioning: An innovative approach to rehabilitation that takes the successful concepts of work reconditioning to the work site. The program allows you to progressively build your tolerance to work activities in a controlled and supervised fashion using work simulation and actual structured work tasks. You will also perform individual exercises to improve your strength and flexibility. Body mechanics, joint protection principles, and safety awareness are additional program components. Adaptive equipment recommendations (anti-vibration gloves, etc.) can be made as needed. You are placed on a discharge exercise program to promote your ongoing wellness.
- Physical Therapy: An industrially trained therapist will handle your acute injury in a timely and efficient manner allowing you to return to work in the most expedient manner possible. Most employees will usually return to work following their physical therapy; however, you may need to transition into the on-site work reconditioning to build work tolerances prior to returning to your original job.
What is a Qualified Health Plan?
The Ohio Bureau of Workers Compensation has certified ABX Air, Inc. to
participate in the Qualified Health Plan System (QHP) as part of its
self-insured workers compensation program. ABX Air, Inc. is permitted to
develop a QHP based on legislation that became effective October 20, 1993
which created a comprehensive managed care program tailored specifically
for Ohio s system of workers compensation.
In the event of a work-related injury, please follow ABX Air company policy for reporting injuries. You should receive a Qualified Health Plan Identification Card from your supervisor when you are injured. This card is to be shown to the healthcare provider or facility each time you receive treatment related to your injury. This card also allows you to receive prescription medication related to your injury. You are to show this card to your pharmacist when filling a prescription.
You must first seek medical treatment from a provider
(doctor, therapist or other health care professional) that is on the panel
of ABX Air, Inc. QHP. These providers will expedite the best treatment
possible. A list of providers is available on this web site (see below).
Hard copies of the provider list may be requested by returning a
request
form
[13kb PDF] to the Workers'
Compensation Department. Please keep this information for future reference
in the event of injury. If you are dissatisfied with the health care
services of a provider in the QHP, you must notify the QHP in writing of
your selections of another provider within the QHP and the reasons for the
change. If you choose a Bureau-certified provider outside the QHP, you
must also notify the QHP in writing with the reasons for the change and
the QHP will provide notice to the Bureau of Workers compensation as
required. If a provider is chosen for medical care that is not BWC-certified,
you may be required to pay this provider out of pocket rather than the
company as part of the workers compensation claim. Medical management of
all injured workers; claims covered under the QHP will be provided by the
QHP, whether medical services are provided within or out of the QHP
network of providers.
How do you appeal a denial of a C-9 treatment
request?
As required by the self-insured medical management process, ABX Air
provides for up to two levels of dispute resolution, both of which must be
concluded within a 30-day period. The provider, employee or their
representative, or employer or their representative for the first and
second level of review may file a dispute. [read the
full
Medical Dispute Resolution Process
9kb PDF]
How do I keep my injury private?
As required by Occupational Safety & Health Administration (OSHA)
regulations, ABX Air will maintain a separate log for privacy cases. If
you do not wish your name to be listed on the standard OSHA log, check the
Confidentiality box under the description section on the ABX AIR, Inc.
Supervisor's Accident Investigation form.
There are certain instances where your name will automatically be removed from the log, they are:
- An injury or illness to an intimate body part or the reproductive system
- An injury or illness resulting from a sexual assault
- A mental illness
- A case of HIV infection, hepatitis, or tuberculosis
- A needlestick injury or cut from a sharp object that is contaminated with blood or other potentially infectious material
- Other illnesses, if the employee independently and voluntarily requests that his or her name not be entered on the log
If you have any further questions, please visit the OSHA website at osha.gov.
Definitions and Terminology
- Allowed condition: A Medical condition recognized by BWC as a direct result of an industrial injury or occupational disease.
- BWC: Bureau of Workers' Compensation.
- C-23: A request for change of physician; to be completed if you wish to change your attending physician in your claim.
- C-84: A request for temporary total compensation.
- C-86 Motion: The form to be used by the injured worker or employer and/or their authorized representatives to request a decision by the Bureau of Workers' Compensation or the Industrial Commission that cannot be accomplished through any other form or application.
- C-9: A physician's request for medical service or recommendation for additional conditions for industrial injury or occupational disease.
- C-92: An application for determination of percentage of permanent partial disability or increase of permanent partial disability.
- FROI: First report of an injury, occupational disease, or death.
- Industrial Commission of Ohio (IC): The adjudicative branch of the Ohio workers' compensation system.
- Lost Time Claim: A claim filed when an employee loses eight or more calendar days from his or her job as a result of an industrial injury or occupational disease.
- Maximum Medical Improvement (MMI): A treatment plateau (static or well-stabilized) at which no fundamental functional or physiological change can be expected within reasonable medical probability in spite of continuing medical or rehabilitative procedure. An injured worker may need supportive treatment to maintain this level of function.
- Medical-only claim: A claim filed when an employee loses seven or fewer calendar days from his or her job as a result of an industrial or occupational disease.
- Ohio Bureau of Workers' Compensation (BWC): The administrative branch of the Ohio workers' compensation system. Their web site is available at ohiobwc.com.
- QHP: Qualified Health Plan.
Contact Us
Ohio claims and first report of injury:
Judy Branham, (800) 736-3973 ext. 62388
or (937) 366-2388 Judy.Branham@abxair.com
Workers' Compensation Fax: (937) 366-3116
ABX Qualified Health Plan: (800) 736-3973 Ext. 62157
Prescription Processing Questions: Progressive Medical, (800) 996-5936
Billing Inquiries: Hunter Consulting, (800) 486-6652 Ext. 109
Copyright 2018, ABX Air, Inc. All rights reserved. ABX Air, 145 Hunter Drive, Wilmington OH 45177.