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.
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.
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:
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.
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:
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:
All employers with more than one employee are required to secure workers’ compensation, although coverage is elective for the following:
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:
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.
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.
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.
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.
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:
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.
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:
Contact the attorneys you are interested in and schedule a consultation. Consider asking the following during the consultation:
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.
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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