What is the Ohio Workers’ Compensation claim process?
If you are involved in an accident and injured in the workplace, you must follow several basic steps. First, if you are physically able, you should report the injuries or illness to your employer. Next, seek medical attention for your injuries. (If your injuries are severe, seek medical attention first, then report your injuries to your employer). Next, you will file a claim for Ohio Workers’ Compensation.
For each of these steps, you must make careful notes of everything you can remember about the accident, as well as saving all records of your medical treatments, medical expenses, and other expenses related to your workplace accident. Most workplaces have specific policies and procedures in place for reporting an accident that results in injury. OSHA also requires employers to keep a comprehensive record of injuries and illnesses as a means of helping employers identify potential hazards and prevent future injuries and illnesses.
If your company has an HR department, you should determine the policies and procedures for reporting a workplace accident. Your HR department could also ask you to complete forms or answer questions. It is crucial you provide the most accurate information possible when you describe how your workplace accident occurred. In some instances, your employer may recommend a specific doctor, although you are allowed to see any BWC certified medical provider. You do not have to be treated by the doctor your employer recommends.
After your initial visit to your doctor, you must seek ongoing care from a Bureau of Workers’ Compensation certified medical provider. While you can see the BWC-certified provider of your choice, he or she must have that certification. You must always follow any orders from your doctor, including showing up for all appointments and undergoing any recommended treatment. If you disagree with your BWC-certified provider as far as your treatment goes, you have the right to see a different provider.
How To File a Workers’ Compensation Claim
Filing a workers’ compensation claim can be time-consuming and difficult, requiring workers to closely follow the rules and regulations of Ohio law. Any mistakes or errors during the process can have disastrous consequences, including significant delays or outright denial of the claim. For an injured worker who is burdened by large medical expenses and lost wages, such pitfalls can quickly become overwhelming.
Before filing a workers’ compensation claim, it is necessary to report the injury to your employer. Failing to report the injury can impact the success of your claim down the line. Moreover, it is important to seek medical attention for the injury as soon as possible. Seeking medical attention is essential to beginning your recovery and adding to the credibility of your claim.
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. Keep records related to your injury and any treatment received, including any relevant information regarding the prognosis of the injury. This information will become necessary as you begin the workers’ comp claims process.
Make sure you gather relevant claim documentation related to your injury, such as medical records, witness statements, accident reports, or any other evidence that supports your claim. These documents will be essential when filing your claim and throughout the claims process.
To formally begin the workers’ compensation claims process, the First Report of an Injury, Occupational Disease, or Death (FROI) must be completed and filed with the Ohio Bureau of Workers’ Compensation (BWC). The FROI can be filed either online, by phone or fax, or via mail to your local BWC customer service office. You will be required to include a range of information in this form, including your rate of pay and the number of hours worked per week. You must also detail the nature and extent of your injury as well as the date on which you first reported the injury to your employer.
Once the Ohio Bureau of Workers’ Compensation has received your application, you will receive a notification letter that includes your claim number as well as the information of the service specialist assigned to your case. It is at this point that the Ohio BWC will begin its investigation into your claim to determine whether or not you are eligible for workers’ compensation due to your injury. The BWC has 28 days to issue a decision regarding your case. They can either approve or deny the claim. If the BWC denies the claim, you have 14 days from receipt of the denial to appeal and request a hearing before the Industrial Commission of Ohio. In a self-insured claim, the employer has 28 days to advise the BWC whether they are accepting or rejecting the claim. If the self-insured employer rejects the claim, the matter will be referred to the Industrial Commission of Ohio for a hearing.
Whether your claim is denied by the BWC or a self-insured employer, an appeal must be filed within 14 calendar days of the decision, making it imperative to act quickly in these situations. An experienced attorney at Schaffer & Associates LPA can help you navigate the appeals process and ensure that you receive full and fair compensation for your injuries.
Who Can File a Claim in Ohio?
We often field questions regarding who is legally permitted to file a claim in the state of Ohio. Several parties can file a workers’ compensation claim in Ohio, not just the injured worker. Aside from the injured employee, a claim can be filed by any of the following:
- The employer
- A medical provider
- The employer’s managed care organization
- Your legal representative
Many injured workers seek legal assistance from experienced attorneys when filing a workers’ compensation case to avoid costly mistakes and missteps during the process. An attorney who is familiar with the workers’ compensation process in Ohio will be able to compile necessary evidence and complete relevant paperwork according to state law. Moreover, they have the experience necessary to navigate the appeals process and negotiate the greatest possible settlement for your case.
How Long Can a Workers’ Compensation Claim Stay Open?
A workers’ comp claim officially opens when the FROI is filed and the injured employee applies for benefits. There are time limitations set on how long after an injury an employee can apply for benefits, which are detailed by the Ohio Bureau of Workers’ Compensation. In Ohio, injured workers have only one year to file for workers’ compensation benefits.
According to Section 4123.52 of the Ohio Revised Code, while a claim is considered open, the Ohio Bureau of Workers’ Compensation and Industrial Commission of Ohio has “continuing jurisdiction” over the case. This means that an injured worker may continue seeking different types of compensation from these governing agencies based on the conditions of their claim.
The length of time that a workers’ compensation claim can stay open depends on the unique circumstances of the case. Some claims will remain open far longer than others. Claims formally close in one of three different ways, namely:
- The claim has been rejected or withdrawn. The simplest way to close a claim is through withdrawal or rejection. In both situations, the claim has been deemed unable to go any further in the process and compensation is not available to the injured worker. Many first-time applicants experience rejection of their claim, due to mistakes in the application process or other disputes. In such cases, it is possible to appeal the rejection and pursue compensation.
- A final settlement has been negotiated and finalized. A claim can be closed through the negotiation and acceptance of a final settlement. In these cases, the injured worker has received compensation for all outstanding claims and has agreed to file no further claims related to that injury. If a new injury arises, a new claim can be opened.
- Statutory time limits have been reached. In Ohio, if a worker does not submit any additional claims for medical expenses or lost income due to an injury, their claim will be closed after five years. This statutory limitation is applicable to all work-related injuries and deaths occurring after August 2006. Different time limitations are placed on injuries and deaths occurring before this date. A knowledgeable attorney can provide further information regarding these statutory time limits.
To keep a claim open, the injured worker must continue submitting claims related to their injury. Each claim must be directly related to their workplace injury or illness to be successfully approved by the court and ensure that their claim remains open. Obtaining proper paperwork from doctors and other medical professionals is necessary in these situations.
What is the Process for Filing an Ohio Workers’ Compensation Claim?
You may have questions about the process used to file your Ohio workers’ compensation claim. The following steps are the usual order of events when you have been injured at work and need to file a workers’ compensation claim:
- Complete and submit the First Report of Injury, Occupational Disease or Death (a single page form with several pages of instructions). This form will require you to detail your accident and resulting injuries, as well as stating your medical diagnosis. You will need to obtain a signature from your health care provider for this form and information regarding your medical diagnosis, and the International Classification of Diseases coding number.
- You will submit a signed authorization form that allows the BWC or the self-insured employer to obtain and review your medical records related to the injury.
- You will sign an authorization to allow your BWC claims service specialist to obtain and review records about what your employer paid you over the past 52 weeks.
Do You Need a Workers’ Compensation Attorney Following Your Workplace Injury?
One of your first steps following a workplace accident should be to speak to an experienced Ohio workplace injury lawyer before filing your FROI and seeking benefits from workers’ compensation. Your attorney will review your FROI—as well as other claims package documents—ensuring they are filled out correctly and completely. Your attorney will also check the documents to ensure they reflect what the BWC generally expects to see in a workers’ compensation claim.
Your Ohio workers’ compensation attorney will thoroughly investigate your workplace accident to determine whether a third party can potentially be held liable for your accident. If so, you will file a third-party liability claim in addition to your workers’ compensation claim. Your work injury attorney will help determine the amount of lost wages, as well as the extent of your injuries, and what it will take to get you back to the level of health you enjoyed before the accident.
What Should You Avoid During Your Workers’ Compensation Claim?
Since many people injured in the workplace are unfamiliar with the Ohio workers’ compensation system, it is easy to make mistakes—mistakes that can hurt the claim down the line. The most common mistakes made during the workers’ compensation process include the following:
- Failing to report your injury immediately. Under Ohio law, you have up to a year to file your claim for workers’ compensation benefits for an injury or for an occupational disease. That being said, as time passes, it becomes more difficult to obtain workers’ compensation benefits, so the sooner you report a workplace injury to your manager or HR, the better. In many cases, workers who wait too long to report their injuries may face disbelief on the part of the employer and the BWC regarding how severe the injuries really are or whether they even received the injuries at work. Once you report the accident, your employer may ask you to complete an incident report or provide additional information regarding the accident. Even if your employer does not require this additional information, it is a good idea for you to write down every detail you can remember regarding your workplace accident and the aftermath.
- Failing to seek immediate medical care or failing to follow doctor’s orders. If you do not seek medical attention immediately, you may have difficulty convincing others that your injury is real. If you ignore your doctor’s recommendations, workers’ compensation may be reluctant to pay your claim.
- Speaking to a Third-party Administrator. It is essential to know that a Third-party Administrator has your employer’s interests in mind rather than your own. Most employers want to reduce financial responsibility whenever possible. A TPA representative may seem kind and friendly but be aware he or she will use anything you might inadvertently say against you to deny benefits.
- Signing a settlement for your workers’ compensation claim without letting your attorney take a look at the documents. You should never, ever, sign your name to a document until your attorney has given you the go-ahead. Once you agree to something in writing, it will be virtually impossible to change the results, even if you did not fully understand what you were signing.
- Failing to hire an experienced Ohio workers’ compensation attorney. Many people injured at work may feel they don’t need a workers’ compensation attorney or cannot afford one. Having a knowledgeable attorney in your corner ensures you will receive maximum workers’ compensation benefits.
As soon as the BWC receives the First Report of Injury, they will begin gathering information and investigating your claim. A decision will be made regarding whether your claim is allowed or denied within 28 days. You have the right to appeal that decision. If your employer is self-insured, they will make the initial decision on the allowance of the claim. If they deny the claim or any compensation or medical benefits you have the right to a hearing before the Industrial Commission of Ohio.
The Importance of Having a Schaffer & Associates Toledo Team Member On Your Side
If you have been injured at work, an attorney from Schaffer & Associates can help! We can walk you through the process, answering any questions you may have, and ensuring you receive the maximum level of workers’ compensation benefits. At Schaffer & Associates, we genuinely care about your recovery and want to make the system work for you. Our attorneys have more than 50 years of combined experience and will use that experience on your behalf. We fully understand what you are going through regarding your recovery from a serious work injury and will help you through this difficult time. Contact Schaffer & Associates today for a comprehensive review of your Ohio workers’ compensation claim.