Injured in Toledo, Ohio? Contact Our Toledo Workers’ Compensation Attorneys
Each state sets workers’ compensation laws, so you must understand the workers’ compensation laws in your state as an employee or independent contractor. Workers’ compensation insurance can help protect you in the event you are injured while on the job. Workers’ compensation is meant to prevent workers from having to be in the awkward position of suing their boss to recover medical expenses and lost wages. Under workers’ compensation laws, your workplace injury is considered no-fault. This means your workers comp benefits are not dependent on proving who was at fault for causing the injury; rather, as long as the injury occurred due to workplace activity, the injury is considered a fully compensable claim. This “no-fault system” means even if the employee is partially responsible for the accident, they are still entitled to benefits. Our Toledo workers’ compensation attorneys at Schaffer & Associates, LPA are here to help you with this process.
The Ohio workers’ compensation system helps injured workers cope with workplace injuries by providing lost wages and medical benefits to those injured on the job or those who contract an occupational disease. When a workplace accident results in an employee’s death, weekly death benefits are also payable to the employee’s survivors. The benefits are paid by either the Bureau of Workers’ Compensation or the self-insured employer.
While workers’ compensation is no-fault, it typically will not cover injury if purposely self-inflicted, due to the employee being intoxicated in the workplace, an injury received in a fight started by the employee, or any emotional injuries not directly related to physical workplace trauma.
Workers’ Comp Insurance
In Ohio, any business that employs even one person must carry workers’ compensation insurance. The exception to that rule is domestic workers (nannies, babysitters, housekeepers, or gardeners) who earn less than $160 per calendar quarter. Volunteers are not required to be covered under Ohio workers’ compensation unless they work for a public employer. As far as part-time employees, they are covered under Ohio workers’ compensation. However, any benefits would be calculated according to a specific formula that considers the number of hours worked.
Sole proprietors or members of a partnership are required to carry workers’ compensation insurance for any employees; however, they have the option of carrying coverage for themselves.
Employers who fail to carry workers’ compensation insurance or have misclassified their workers as independent contractors rather than employees could face severe penalties. If a workplace accident occurs and the workers’ comp policy has lapsed or the employer does not have proper workers compensation coverage, the employer can be sued by the injured worker or workers for all damages and expenses, including an award for pain and suffering. Alternatively, the injured workers can file a workers’ compensation claim and if allowed the claim is fully compensable and the BWC would require reimbursement of the entire cost of the claim from the employer. Employers who have misclassified their employees as independent contractors are also liable for the full cost of the claim.
Is Ohio Workers’ Compensation Different Than in the Other States?
The system for workers’ compensation is a bit different in Ohio than in most other states. Ohio’s workers’ comp system uses a monopolistic state fund, meaning employers purchase workers’ compensation insurance through government-operated funds rather than through a private insurer. However, where an employer employs more than 50 employees, that employer can request to be self-insured. A self-insured employer pays workers’ compensation benefits directly, although they are required to follow the rules and regulations of the Bureau of Workers’ Compensation. If an employer is self-insured and refuses to pay benefits, the Industrial Commission of Ohio has the power to decide the issue and direct the self-insured employer to pay the benefits that are due.
Businesses with employees outside the state of Ohio will be required to add additional coverage to meet the other state’s workers’ compensation requirements. Alternatively, employers outside the state doing business in Ohio are required to carry Ohio coverage if their presence in Ohio exceeds 90 days.
What is the Ohio Workers’ Compensation Claim Process?
Workers injured on the job in Ohio must file a workers’ comp claim with BWC. A claim is classified as a medical-only claim when an employee has missed seven or fewer days of work due to a work-related injury. The worker can be treated for the injury yet still return to work. A claim is classified as a lost-time claim when the injured employee has missed more than eight days of work. The injured employee can file the BWC workers’ comp claim, the doctor who treats the injured employee, or any interested party, including a spouse of the injured worker, or the injured worker’s employer.
When does a claim need to be submitted?
No matter who files the injury claim, it must be submitted to the BWC within one year of the date of injury. If the claim is filed outside of one year, the claim will be denied as being outside the statute of limitations.
Once the BWC receives the workers’ compensation claim, the injured employee will receive a notification letter, along with a BWC ID card, generally within a few days of the filing. The First Report of Injury, Occupational Disease, or Death (FROI) can be filed online as well. During the initial investigation of a work-related injury, a claims service specialist (CSS), medical claims specialist (MCS), or a representative of a self-insured employer will request some or all of the following information:
- Documentation from medical providers regarding the injury
- If an injured worker has work restrictions, a Physician’s Report of Work Ability will be required from the doctor.
- An Injured Worker Earnings Statement
- A Request for Temporary Total Compensation
- An Employer Report of Employee Earnings
Within 28 days from when the workers’ compensation claim was filed, the BWC or self-insured employer will complete the initial investigation, deciding whether the claim will be allowed or denied. In a state-funded claim, the BWC will issue an Administrative Order either allowing or denying the claim. The employer or the injured worker can appeal this order within 14 days of receipt of the decision. If there is no appeal filed within 14 days, the decision is final and binding on all the parties. In a self-insured claim, the employer has 28 days to decide whether to accept or reject the claim. If the employer rejects the claim, the BWC refers the matter to the Industrial Commission of Ohio for determination on whether the claim should be allowed.
What are Some Common Missteps Associated with Ohio Workers’ Compensation?
Unfortunately, there are plenty of missteps or mistakes that can be made that can inadvertently affect your workers’ compensation claim. Some of the most common errors include waiting too long to report your work injury, failing to see a doctor immediately, being dishonest in any way regarding your injury, or failing to follow your doctor’s orders. Other common missteps include:
- Discrepancies in your medical records
- Discussing your case on social media
- Failing to request a second opinion on medical treatment
- Failing to return to work on light duty
- Accepting a workers compensation settlement without counsel
- Signing documents without a workers’ compensation attorney present
- Failing to consult a Toledo workers’ compensation attorneys
What Is Workers’ Compensation?
Workers’ compensation refers to a type of employer insurance coverage that provides benefits to workers who are injured, or become ill or disabled, as a direct result of their job. This type of insurance is designed to protect workers, provide income security, and facilitate healthcare assistance for injured employees. In nearly all states, Ohio included, workers’ compensation is required by law. Employers typically obtain workers’ compensation through the state-certified insurance fund or by becoming an employer that self-insures its claims. Workers’ compensation is not equivalent to disability insurance or unemployment benefits, which are different systems entirely.
In Ohio, where an employer is state-funded, the Bureau of Workers’ Compensation provides medical and compensation benefits for work-related injuries, disabilities, or deaths in the state. In a self-insured case, the employer pays the medical and compensation benefits for work-related injuries. The differences between a state-funded and self-insured employer can be characterized as follows:
- State-funded: here, employees pay a premium to the Bureau of Workers’ Compensation (BWC) in exchange for an insurance policy. If an employee becomes injured or ill on the job, the BWC is responsible for paying benefits directly to the worker.
- Self-insured: these employers assume the financial risk to pay for the claims cost for their employee’s injury. Claims cost is the amount paid out by the insurer to cover any losses or damages. In turn, self-insuring employers are required to pay compensation benefits directly to any injured or ill workers.
All employers with more than one employee are required to secure workers’ compensation, although coverage is elective for the following:
- Sole proprietors, partnerships, or limited liability companies acting as either of those entities for tax purposes
- Family farm corporate officers
- An individual who has an established corporation but no employees
- Ordained or associate ministers of a religious organization
This type of insurance is designed to benefit both the employee and the employer. Employers are able to mitigate the real costs of workplace injuries and illnesses. Workers’ compensation also reduces the employer’s risk of being sued by the employee. On the other hand, employees are also guaranteed protections, which include the following:
- Payment for medical treatment and ongoing care
- Reimbursement of lost wages
- Disability benefits
- Death benefits
It is important to note that workers’ compensation benefits are not available to employees who experience an injury outside of work. Similarly, employees who were intoxicated or who acted recklessly to cause intentional harm may not be protected through workers’ compensation insurance.
How Does Workers’ Compensation Work?
As Toledo workers’ compensation attorneys, we often receive questions about the claims process in Ohio. Workers’ compensation systems vary depending on the specific rules and regulations of the state. In Ohio, the claims process follows a specific procedure, regardless of whether the employer is state-funded or self-insured. The steps of the workers’ compensation claims process can be categorized as follows.
Step 1: Report the Injury or Illness
It is essential that employees report their work-related injuries as soon as possible to begin the process. There are time limits to filing a claim in Ohio, so it is important to avoid delays. When reporting the injury or illness, it is essential to document the issue thoroughly and explain how the injuries were sustained.
Step 2: Seek Medical Treatment
After reporting the injury, seeking medical treatment is critical. Delaying treatment can result in further health problems that exasperate the injury. When speaking with a medical professional, ensure that they understand how to properly document the injuries for a workers’ compensation case. An accurate and detailed description of the injuries will be necessary later in the claims process.
Step 3: Complete the First Report of Injury (FROI)
The First Report of Injury form is used to formally initiate the workers’ compensation claims process. The FROI can be filed by the worker, the employer, a physician or medical care provider, or an authorized representative such as a union representative or attorney. It is important to note that the FROI must be filed within one year of the injury or the date when the employee was no longer able to work. Typically, approval or denial will be issued within a month of filing the FROI.
The following elements will be considered when evaluating a workers’ compensation claim in Ohio:
- The description of the illness or injury
- Medical diagnosis
- Documentation detailing any treatment received in relation to the injury or illness
- Information about disability and/or other long-term health consequences
Both state-funded and self-insured employers have an incentive to mitigate costs as much as possible. For this reason, it can be helpful to seek assistance from an experienced Toledo workers’ compensation attorney to ensure that you receive a full and fair benefits package.
How Do I Choose the Right Workers’ Compensation Attorney For Me?
Choosing the right workers’ compensation attorney for you is one of the most important decisions you can make. An experienced attorney can help you file a claim successfully or appeal a workers’ compensation denial to ensure that you receive the benefits you deserve. This area of the law is quite complex, making it important to select a well-qualified attorney who has the skill and knowledge necessary to advocate for you.
To choose the right workers’ compensation attorney, consider investigating firms by doing the following:
- Research attorneys who specialize in workers’ compensation law in Ohio. You can use online resources like legal directories, law firm websites, or search engines to find potential attorneys. Look for attorneys with relevant experience and positive reviews.
- Seek the advice of friends, family members, or colleagues. Personal referrals can provide valuable insights and help you find a trusted attorney that is looking out for your best interests.
- Verify the credentials of any interest you are interested in. You can check to ensure they are licensed to practice law in Ohio and whether they have any disciplinary actions or complaints against them by visiting the Ohio Supreme Court website or the Ohio State Bar Association.
Contact the attorneys you are interested in and schedule a consultation. Consider asking the following during the consultation:
- How many years have you been practicing workers’ compensation law?
- What is your overall success rate?
- How effectively will your team communicate with me regarding my case?
- Do you anticipate any complications in my case? What are the strengths and weaknesses of my case?
- What are the fees involved if you are handling my case?
- Have you handled cases similar to mine?
After considering all the factors, including experience, credentials, fees, and personal rapport, make an informed decision and select the attorney you believe is best suited to handle your workers’ compensation claim. Once you have chosen an attorney, review and signed a written agreement that outlines the terms of representation, fees, and other relevant details. Ensure you fully understand the agreement before signing and make sure you are provided a copy of the agreement.
Ultimately, it is paramount to hire a Toledo workers’ compensation attorney who you trust. You will be working closely with your attorney and it is important that you feel comfortable and confident in their capabilities. A quality attorney will take the time to answer your questions with compassion and consideration. They will address your concerns with transparency. You are not required to hire the first attorney you consult with. Take the time to properly vet potential lawyers and ensure that their law firm is the right fit for you.
How Our Toledo Workers’ Compensation Attorneys Can Help
Contact Our Experienced Toledo Workers’ Compensation Team
If you have suffered an accident while on the job, you must speak to our experienced Schaffer & Associates workers’ compensation attorneys as quickly as possible. We will ensure you do not accidentally make a mistake that puts your workers’ compensation benefits in jeopardy. Our Toledo workers’ compensation attorneys will guide you through the process, ensuring you receive the medical treatments and compensation you need and deserve. Contact Schaffer & Associates today for a comprehensive evaluation of your Ohio workers’ compensation claim.
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