About The Injured Workers Process in Ohio
Each state sets workers’ compensation laws, so you must understand the workers’ compensation laws in your state as an employee. 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 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 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 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
- Signing documents without a workers’ compensation attorney present
- Failing to consult workers’ compensation attorneys
How Our Toledo Workers’ Compensation Attorneys Can Help
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 Schaffer & Associates 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.