Your Guide To Ohio Workers' Compensation Benefits
Our law firm will help you understand this complex process
Most workers know that if they're hurt on the job, they are likely entitled to benefits through workers' compensation. But in our experience, few understand just how complex this process can be. At Hochman & Plunkett Co., L.P.A., we've helped thousands of workers throughout Ohio navigate the claims process, and we're happy to share what we know.
- How workers' compensation claims are paid in Ohio
- Steps to take immediately after a work injury
- Filing a workers' compensation claim
- Compensation you can receive
- Appealing a denied claim
- Negotiating a settlement
Unfortunately, the workers' compensations system is rarely on your side. That's why it's critical that you contact an experienced attorney from our firm as soon as possible. We can help you through every step in the process, from filing the initial claim through appeals and settlement negotiations. Call (877) 623-6863 for your free consultation.
Under Ohio law, all employers are required to offer workers' compensation benefits to their employees. In some states, employers with only a small number of employees are not required to provide workers' compensation, but in Ohio, even a business with only one employee is required to provide workers' compensation for that employee. There are two ways for an employer to satisfy this legal requirement:
- About two thirds of Ohio employers provide workers' compensation funded by the Bureau of Workers' Compensation (BWC), a state government agency that administers and pays workers' compensation claims. The employer pays a premium into the state workers' compensation fund. Each employer chooses or is assigned a managed care organization (MCO), a private company contracted to coordinate medical care and make treatment decisions for each claim.
- About one third of Ohio employers are self-insuring (SI), which means the employer pays workers' compensation benefits directly to the employee. Self-insuring employers are required to follow regulations set by the BWC and the Industrial Commission of Ohio (IC). There are certain legal and financial criteria that an employer must meet in order to self-insure - most such employers are very large corporations.
While the process of claiming workers' compensation benefits is fairly similar regardless of whether your employer is insured through the BWC or self-insured, there are a few important differences to note, which we will discuss in the sections below.
If you're hurt on the job - or become aware that an ongoing injury such as a repetitive strain injury is work-related - you need to take two immediate steps:
- Notify your employer. While you can make this notification verbally, we recommend doing so in writing so that you have a record - otherwise, your employer may later try to claim that you did not make appropriate notification. Follow your employer's protocol for reporting on-the-job injuries, and remember that you need to notify your manager or supervisor, not a coworker.
- Seek medical help. This is the most important step to protect your health, and your health needs to be your top priority. Even if you feel fine, you could have an internal injury with delayed-onset symptoms. Moreover, seeking medical attention allows you to document your injury and will help with your potential claim. Make sure you tell the physician who treats you that you sustained an on-the-job injury.
More often than not, your employer's MCO will file a workers' compensation claim on your behalf after being notified of your injury by your employer. However, you never want to assume that your claim has been filed. You can contact your employer, the MCO, or the BWC directly to confirm whether a claim has actually been filed.
You have the right to file a claim yourself by completing a First Report of Injury (FROI) on paper and mailing it to a BWC service office, or by completing it online on the BWC website. Once a First Report of Injury is received, the BWC will begin to investigate your claim, and will decide whether to allow or deny the claim within 28 days.
Under Ohio law, if your workers' compensation is allowed, you are entitled to full payment for medical bills for treatment related to the injury or occupational disease. Here are a few things to keep in mind regarding your medical benefits:
- Bills for any treatment you receive related to your on-the-job injury should be submitted to your employer's MCO for payment. If a provider sends you a bill, you should advise them that you are being treated for a work injury and that they should bill the MCO. Likewise, if your employer is self-insured, your providers should bill your employer, not you.
- If you need prescription medication to treat your work-related injury, inform the pharmacist that the prescription is covered by workers' compensation. Again, they should be billing your MCO or your employer, not you. However, if a prescription is filled before your claim is approved by the BWC, you may need to pay the pharmacy out of pocket, in which case the BWC will reimburse you based on its approved fee schedule. Do not go through your health insurance, as any co-payments you make for medication are not reimbursable through workers' compensation.
In addition, if you miss time from work while recovering from your on-the-job injury, you may be entitled to wage loss benefits. Lost-time wage benefits kick in once you have missed 8 consecutive days of work due to an allowed injury or occupational disease. The first 7 days of missed work are initially not compensable. However, if you are ultimately out of work for at least 14 consecutive days, workers' compensation will reimburse you for the full period of disability, including those initial 7 days.
If you are disabled and unable or less able to work as a result of your on-the-job injury, Ohio law allows you to claim several types of disability benefits through workers' compensation:
- Temporary Total Disability: If you are completely unable to work for a temporary time, this benefit will pay total compensation for that time.
- Permanent Partial Disability: This benefit pays out if your injury results in permanent impairment, but does not leave you totally disabled. The amount of compensation you receive is based on your percentage of impairment, based on an examination overseen by the BWC.
- Permanent Total Disability: This benefit provides compensation if you are found to be permanently and totally unable to return to your former position or engage in any other sustained, remunerative work.
If you receive notice from the Bureau of Worker's Compensation that your claim has been denied, that doesn't necessarily mean you cannot receive benefits - but it does mean you have to move quickly. In most cases, you only have 14 days to appeal the BWC's decision. Likewise, if your claim is denied by a self-insured employer, you have a limited window of time to appeal.
After you or your counsel - and at this stage, we highly recommend retaining counsel if you have not done so already - appeal the decision in writing, the matter will go before the Industrial Commission of Ohio (IC). There are three levels of appeals before the IC:
- District Hearing Officer
- Staff Hearing Officer
- Ohio Industrial Commission
After the final decision from the Industrial Commission, you may be able to appeal to the Court of Common Pleas. For example, issues such as whether to allow a claim or whether to allow a specific medical condition are within the Court of Common Pleas' jurisdiction. If you are appealing a more specific issue such as the extent of your disability, you may still have the option to appeal, but finding legal grounds to do so is more difficult.
Throughout the workers' compensation appeals process, the BWC and your employer will be represented by attorneys, and the hearing officers themselves are also attorneys. It's absolutely critical that you have your own attorney fighting for your legal rights. Moreover, there are very tight deadlines throughout the appeals process - as little as 10 days in many instances - and a single missed deadline will likely mean the end of your claim. That's why you need an experienced attorney who understands those deadlines and will keep moving your case forward.
Many workers' compensation claims are resolved through a lump sum settlement between the employer and the injured worker. For example, in situations involving long-term disability and other serious injuries, it is often in both parties' best interest to come to a settlement agreement. Many smaller claims settle as well, depending on the needs of the worker and the employer.
Settling a workers' compensation claim is a complex process that requires a thorough understanding of the law as well as the long-term implications of your injury. That's why it's incredibly important that you approach negotiations with an experienced attorney on your side. We can help you understand your legal options, determine whether a settlement may be in your interests, and represent your interests in settlement negotiations to fight for all of the compensation you need.