If you have been injured at work, it is common to ask the people closest to you for their advice, especially if they have experienced a similar situation. While the intentions may be well meaning, it can also be extremely harmful if the advice is not truly sound. One constant in life is that workers' compensation laws and procedures change like Ohio weather: stick around a few minutes and it'll be different. Even if you yourself have had claims before, don't presume things aren't different now than even last year.
What Should I Know About Workers’ Compensation Cases and Claims?
There are many misconceptions about how to recover from a debilitating on-the-job injury and how to go through the workers’ compensation claims process. Any one of these common misunderstandings could result in missed compensation and appropriate treatment for your injury. Here are five important things you should know if you find yourself managing a workers’ compensation claim:
- Workers’ Compensation laws vary considerably from state to state - From determining whether and how employee fault is considered to the time you have to file a claim, laws regarding work accidents depend on the state where you live. Ohio is truly unique among the states in terms of how it handles workers compensation claims. In nearly every other state in the union, companies purchase workers’ compensation insurance much as they would fire or health insurance. In such states, workers’ compensation claims are handled much more like personal injury claims and settlements along with return to work at the same employer are the norm. This is not at all how it works in Ohio where we have a constitutionally-established state insurance fund known as the Bureau of Workers’ Compensation (BWC). Except for very large employers such as Navistar, Children’s Hospital, Staffmark, Worthington Industries and others, employers pay premiums to the BWC for workers’ compensation coverage--much like we ourselves pay for life insurance or homeowners coverage. This state agency, not private insurance companies, is responsible for administering workers compensation claims in Ohio for such state-funded employers. Settlement of claims may occur or not; some claims go on for 40 years or more ( I have one client whose injury dates back to 1965!!). And while settlement may be an option, it requires resignation from work at the employer of record in all but the rarest of circumstances. Similar to many other states, Ohio has a “no-fault” system for workers’ compensation coverage, meaning that a claim may be pursued even if the result of the injured worker’s negligence. However, it seems that every few years Ohio legislators, courts and self-insured employers try to whittle away at this and make employee “fault” or “contributory negligence” a bar to recovery. Not long ago, for example, a 17 year-old worker sustained significant burns when adding water to a fryer at a fast-food chicken restaurant. The Ohio Supreme Court initially accepted the employer’s argument that this young employee, who had been instructed not to clean the fryer with water, essentially had caused his own injuries by his own stupidity or inattention. This case caused such a widespread reaction from we attorneys who represent injured workers that the Court agreed to reconsider its decision and affirm that Ohio is a no-fault system when it comes to workers’ compensation claims—for now.
- Don’t just let BWC, Industrial Commission of Ohio, or your self-insured employer “work it out” - Since the BWC and self-insured (SI) employers provide much-needed payments in times of need, many people forget the BWC is, in fact, the state INSURANCE fund and that SI employers are businesses driven only by profit. In the workers’ compensation setting, the BWC is the equivalent of the insurance company in a car accident case: they are they ones paying the bills and determining whether they even should be paid. Add to this mix the Managed Care Organizations (MCOs) which do the initial processing of treatment requests and the Industrial Commission (IC) which schedules hearings on disputed matters; MCO and BWC reviewing physicians looking to “manage” the medical costs of claims; employer attorneys and/or Third Party Administrators (TPAs) whose business is to limit an employer’s exposure to claim costs and the possible increase in insurance premiums that can result when a claim is allowed. In short, an injured worker in Ohio has a lot of people and institutions potentially fighting against a valid claim. In our day-to-day lives, we all hope others, including our employers, will “do the right thing” by us given our loyalty to the company, etc.—but don’t bet the farm on it. Money has a way of shifting loyalties in the blink of an eye (if you've ever had to deal with family members over an inheritance, you sadly may know exactly what I mean). Injured workers often treat their claims representatives (aka “Claims Service Specialist” or CSS) like someone who is there to help them, when in reality these adjusters are trained to find ways to deny claims or pay out as little as possible. As SI employers, MCOs and sometimes the BWC itself will work hard to avoid liability, you may need an attorney to guide you through the frustrating and time-consuming process.
- Choosing the right attorney can have a significant impact on the outcome of your case! - Many attorneys claim to have experience with workers’ compensation cases. In fact, some firms with YUGE marketing budgets and bad hairpieces advertise that they handle such cases even when what they really do is farm them out to someone else looking to build a workers’ comp practice or who does it part-time. Not all experience is created equal. A lawyer who primarily deals with slip and fall personal injury cases may not be a good fit for a dockworker who injures his shoulder at Fedex or UPS. An attorney who has won car accident cases may not have experience with administrative hearings before the IC representing a Honda employee who developed carpal tunnel syndrome shooting bolts on the production line or an STNA who injures her back lifting a patient at Dublin Methodist Hospital. The right attorney for you is the one who has experience in your type of industrial injury, your type of employer and your type of claim problems and delays. S/he should also have success in administrative hearings as well as negotiating settlements. Ohio recognizes as workers’ compensation specialists attorneys (such as yours truly) who devote most or all of their practice to workers’ compensation cases, who have the endorsements of their peers, who take additional continuing legal education classes in workers’ compensation and who have passed a rigorous and lengthy examination regarding Ohio workers’ compensation law and procedure. I have been certified as a workers’ compensation specialist since 2003 and currently sit on the Ohio State Bar Association’s Workers’ Compensation Specialty Board. Would you let a foot doctor do your heart surgery? Probably not…heck, I wouldn't even trust myself to do my own Will as it's not my area of expertise and there's too much potential hassle at stake for my family if I screw it up!!
- The time you have to file a WC claim is limited - While it is true that people have a limited window of time to file a claim and get compensation for an injury, that time limit is determined by the state. The Ohio statute of limitations in workers’ compensation cases was, until very recently, two years, meaning the case had to be filed within two years of the date of the injury (or date of death resulting from an on-the-job injury) or you lost your right to payment. In fact, this is still the time frame in most states. Effective September 29, 2017, Ohio’s statute of limitations was reduced from two years to one year for injury claims (there are different statutes of limitations for death claims and for occupational disease claims as well as certain extensions that may be available in situations where SI employers play dirty). Many people suffer injuries that seem minor at first, only to worsen over the next few weeks—and some of these can cause arthritis, complex regional pain syndrome or other permanent effects. If your doctor says your injuries are work-related and the one-year time limit has not passed, you are still eligible to pursue a case. Note also: many employers stress that on-the-job injuries must be reported with 24-48 hours. This is NOT a requirement of Ohio law but failure to comply with employer policies may raise questions whether your injury happened on the job. Be prepared for questions if you don’t report your injury to your employer in compliance with company policy.
- Hiring an attorney is not “too expensive” - If your work accident involved only minor injuries, no time lost from work, and is accepted by your employer and the BWC for all the injuries you sustained, you may not need to hire an attorney. However, workers involved in any accident that causes significant injuries, expensive and/or ongoing medical treatment and prolonged time off work are usually best served by getting an attorney’s advice. As an attorney who handles workers’ compensation claims exclusively on behalf of injured Ohioans, I work on a contingency fee basis, meaning there is no upfront fee for legal representation and no hourly billing. I am paid only if and when I obtain money for you in your claim.
This website is dedicated to educating injured workers in Ohio and their families. Our clients are often going through the claims process for the first time and not exactly sure on how to best handle their claim. We want to help you avoid some of these common pitfalls we often see. Contact our workers’ compensation law office in Upper Arlington at (614) 334-4649 for a free consultation if you have any questions after experiencing a work-related injury in Ohio.