Answers to Workers’ Compensation Questions From a Columbus Attorney
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General Workers' Compensation Claim FAQs
Columbus employees and workers throughout Ohio who suffer injuries on the job normally have many questions running through their mind. Here we have provided many answers to common questions we are asked regarding general claim information. We have also provided many questions and answers regarding medical treatment and receiving compensation.
- Who is responsible for filing an Ohio workers’ compensation claim?
- Do I qualify for workers’ compensation benefits?
- What kind of injuries are covered by workers’ compensation?
- Do I need an attorney for my workers’ compensation case?
- How do I claim workers' compensation?
- How long does it take to process a workers’ compensation claim?
- What types of benefits will I receive?
- What is a C84?
- What’s a MEDCO-14?
- What is permanent partial disability?
- If my injury happened at work, why is my employer denying treatment?
- What if my employer tells me not to file a workers' compensation claim?
- Can I appeal a denied workers' compensation claim?
Who files an Ohio workers’ compensation claim?
You do! When an injury occurs at work, immediately report the accident to your employer. They are supposed to help you file the claim with the company’s Managed Care Organization (MCO). Reporting the claim online at ohiobwc.com is the Bureau’s preferred way of filing a claim. When you file a claim online, you will immediately receive a claim number. Learn more about filing a claim if you have already seen a doctor.
Do I qualify for workers’ compensation benefits?
Unfortunately, the answer is not so simple. Workers' compensation laws are very complex and it is sensible to work with an experienced Columbus workers compensation attorney. It really does depend on your individual situation. Please call our office at (614) 334-4649.
What kind of injuries are covered by workers’ compensation?
In Ohio, workers’ compensation covers physical injuries sustained in the course of and arising out of employment. Pre-existing physical conditions substantially aggravated by a work injury/incident may also be covered. Psychiatric/psychological conditions that develop from or, if pre-existing, are substantially aggravated by physical injuries are also covered. Ohio is one of a minority of states that does NOT recognize as compensable psychiatric/psychological conditions that develop without a corresponding physical injury.
Do I need an attorney for my workers’ comp case in Columbus?
Not all claims involve serious injuries and not all claims need attorney involvement. If an injury is relatively minor, requiring maybe a trip to the emergency room and a stitch or two with no residual impairment, it may go through without a hitch. It’s likely you will want to talk with a Columbus attorney who specializes in workers’ compensation claims if your injury is serious, will likely involve lost-time from work, and/or is being contested by your employer and/or the BWC. Learn more
How do I claim workers' compensation in Columbus?
First, report the injury to your Columbus or Ohio employer in writing. While reporting in writing isn’t a legal requirement, doing so documents your actions and lessens the possibility that your claim will be contested. Second, seek medical attention from an urgent care facility, hospital emergency room, company nurse, or doctor soon. Provide a complete history of what you were doing, how you were injured, and where it hurts. Third, if you are claiming workers’ compensation, file your claim promptly. The time you have to file a claim is limited by the statute of limitations. Your hospital or employer may furnish necessary paperwork and even file the claim for you, but it is ultimately your responsibility to ensure that your claim is filed with the Ohio Bureau of Workers’ Compensation and a claim number is assigned.
How long does it take to process a workers’ compensation claim?
Within 28 days, the Bureau of Workers’ Compensation (BWC) will allow or deny your claim. By responding to any inquiries from them or from your managed care organization (MCO), you will speed up the decision process and receipt of benefits.
What types of benefits will I receive?
Injured workers in Ohio are eligible to receive medical treatment for their work-related injuries and compensation for their lost time from work. This compensation, known as Temporary Total Disability (TTD), is paid if the injury results in more than a week off work. If the lost time is less than a week, no compensation is payable. If it’s between one and two weeks, only the period during the second week is compensable. If over 2 weeks, it’s all paid.
Temporary Total Disability compensation is paid based on a percentage of the worker’s earnings for one week, 6 weeks or 52 weeks prior to the injury, depending on how long the period of disability lasts. Injuries resulting in some permanent impairment may permit an additional award of compensation known as permanent partial disability.
What is a C84?
The Ohio Bureau of Workers’ Compensation requires Form C84 as proof of ongoing temporary total disability. The injured worker must complete the form, verifying the period of disability and that she has not worked and has not received other wages during the period of temporary total disability. These forms must be periodically updated for compensation to continue. Your doctor must complete a separate form certifying temporary total disability. Both forms are required before compensation can be paid.
What’s a MEDCO-14?
A MEDCO-14 is a Physician’s Report of Work Ability. Your doctor completes this form to certify that you are temporarily and totally disabled due to your work injury or to identify any restrictions on your ability to perform your job duties due to the injury. A MEDCO-14 must be submitted every time you submit a C-84.
What is permanent partial disability?
Permanent partial disability (PPD) is a form of compensation that may be payable following a work injury. It is paid by the Ohio Bureau of Workers’ Compensation or a self-insured employer following an exam (or sometimes multiple exams) at which a physician is asked to provide an opinion regarding lost bodily function that has resulted from an injury or occupational disease. It is workers’ compensation’s version of a damages award for an industrial injury. Time limitations may apply in requesting an award of PPD. In addition, the percentage of disability resulting from an injury may be disputed by the injured worker, the employer, and/or the BWC. In such situations, the Industrial Commission conducts a hearing to determine a proper award. This is differs from a settlement of your claim.
If my injury happened at work, why is my employer denying treatment?
Treatment may be denied by your employer, your managed care organization (MCO), or the BWC if excessive, inappropriate, or not cost-effective. MCOs may deny treatment they consider too expensive, even if it is treatment your doctor believes is beneficial. You may appeal decisions denying treatment that your doctor believes appropriate.
What if my employer tells me not to file a workers' compensation claim?
Penalties may be assessed against employers who fail to provide workers’ compensation coverage. If an employer tells you not to file a claim for a work-related injury, maybe s/he tried to cut costs by not obtaining the mandatory workers’ compensation coverage. Reporting the injury would notify the BWC of the employer’s non-compliance. It could also be the employer has had so many claims filed against them they fear the BWC will increase their insurance premiums.
Injured employees are still covered by the workers’ compensation system even if their employer is non-complying, so it is still best to file a claim. Learn more
Can I appeal a denied workers' compensation claim?
The BWC has 28 days to allow or deny your claim. If you or your employer disagrees with BWC’s decision, either party can file an appeal with the Industrial Commission (IC) within 14 days.
There are three hearing levels for workers’ claims at the IC:
• District level hearings — These take place in locations throughout Ohio within 45 days of filing an appeal. The district hearing officer will decide within seven days. The IC sends both parties a written notice of the hearing officer’s decision. Each party has 14 days from receipt of the district hearing officer’s decision to file an appeal to the next level.
• Staff level hearings — These take place within 45 days after an appeal of the district hearing officer’s decision is filed. The staff hearing officer will decide within seven days. The IC will send each party a written notice of the staff hearing officer’s decision. Each party has 14 days from receiving the staff hearing officer’s decision to file an appeal to the next level.
• The commission level — After studying the staff hearing officer’s decision, the commission either agrees to hear the appeal or refuses to permit further appeal. If the commission accepts the appeal, a commission hearing will occur within 45 days. The commission will decide within seven days. If the commission refuses to hear the appeal, depending upon the issue, you may appeal the matter to the court within 60 days after receipt of the commission order. Learn more about your options if your workers' comp claim has been denied.
Medical Treatment FAQs
It only takes a split second for an accident at work to turn a person’s life upside-down as the medical bills roll in. We've aimed to answer all of your questions regarding receiving the medical treatment you need. If you still have questions about workers' compensation or receiving medical treatment, please contact our office at (614) 334-4649. We've also answered many FAQs regarding general claim info and receiving compensation.
- Who approves treatment?
- Can I go to my family doctor?
- I want to change doctors. How?
- I can’t get my prescriptions filled. What should I do?
- What is MMI?
- Why do I have to wait for treatment?
- What is Independent Medical Examination (IME)?
- How will I know if a doctor is certified by BWC?
- How do I get my medical bills paid for?
- What should I do if I get medical bills?
- Can I get reimbursed for prescriptions?
Who approves treatment?
Requests for treatment are submitted by your doctor to the MCO assigned to your case. If your employer is self-insured, requests are sent to your employer’s TPA (third-party administrator). The MCO or TPA may request additional information from your doctor or a medical review before approving the treatment. Denials of treatment may be appealed.
Can I go to my family doctor?
An injured Ohio worker may be treated by a doctor of his choice, as long as the doctor is a BWC-certified healthcare provider. Often, family doctors do not treat job-related injuries because they are concerned about the paperwork involved and/or the hassles associated with claims procedures. Your family doctor refer you to a BWC-certified provider. You can also ask for recommendations from co-workers, your union representative, your attorney, or other people who have received treatment for a work injury. The BWC and your MCO also maintain lists of physicians who treat industrial injuries.
I want to change doctors. How?
You may decide to change physicians for a variety of reasons, ranging from the retirement of the provider, travel distance, or a desire for a different treatment option. Injured workers who wants to change physicians should notify the MCO and submit BWC Form C23. If your employer is self-insured, this form should be sent directly to the employer or its TPA.
I can’t get my prescriptions filled. What should I do?
Your pharmacist can explain why payment for a prescription is denied. It may be a coding error or a concern that the medication is inappropriate. Your doctor can provide additional information regarding the need for and the propriety of the medication. If the bill was denied pending the allowance of the claim, you will be reimbursed once your claim is allowed. Keep all receipts for medications and treatment related to your injury if you need to request reimbursement.
What is MMI?
Temporary total disability (TTD) compensation is payable following an on-the-job injury until the injured worker is released to return to her former job, actually returns to that job, or is determined to have reached maximum medical improvement (MMI). MMI indicates that the injury has reached a treatment plateau under the current treatment regimen, meaning it has gotten about as good as it will get! Although temporary benefits are no longer payable if the condition is no longer improving, other forms of compensation may be available for injured workers whose TTD has been terminated after a finding that their condition has reached MMI.
Why do I have to wait for treatment? I just want to get back to work!
During the initial processing period (i.e., when the Ohio BWC or your employer is deciding whether to allow or contest the claim), physicians may be reluctant to provide treatment, as there is no guarantee they will be paid. Some doctors will provide treatment, pending the allowance of the claim, expectating the claim will be allowed or that you have other means of paying (for example, other insurance) should the claim be disallowed. While your claim is considered, avoid large unpaid medical bills you may have to pay should your claim be disallowed. Once the claim is allowed, providers (other than pharmacies) who have treated you for the job-related injury should submit their bills to your MCO.
What is an Independent Medical Examination (IME)?
An independent medical examination (IME) is a medical evaluation scheduled by the BWC or employer's representative to opine about various medical issues related to your claim, including, but not limited to, whether treatment or testing is necessary, the degree of your permanent impairment and whether you have reached MMI. When scheduled by an employer, I believe it more accurate to describe this as a DME: Defense Medical Exam. Employers hire the same doctors over and over to render medical opinions on their behalf--they are not "independent".
How will I know if a doctor is certified by BWC?
The simplest way is to ask your doctor when you make the initial appointment. You may also call the employer's MCO, the BWC at 1-800-644-6292, or research BWC certified providers (by name, location and/or specialty) at the BWC's website.
How do I get my medical bills paid?
Medical bills should be payable in an allowed claim. Give your claim number to all of your medical providers who treat you in your claim. They will then request authorization for the medical treatment they request from the MCO. There are advantages of using the workers' compensation system as opposed to using private health insurance for a work injury.
What should I do if I get medical bills?
You should forward the bills to your MCO or self-insured employer. Unpaid bills can be appealed to the BWC for further investigation.
Can I get reimbursed for prescriptions?
Like medical bills, prescriptions for allowed conditions in your claim should be payable in an allowed claim. Inform your pharmacist that the prescription is for a workers' compensation claim. You may need to pay for the initial prescription, but if the BWC determines the medicine was for the allowed conditions, you will be reimbursed.
Obviously, you are responsible for any bill or prescription that the BWC determines is not related to your claim.
Workers who suffer injuries on the job normally have many questions running through their mind. Here we have provided answers to the questions we are commonly asked. We have also provided many questions and answers regarding medical treatment and general questions.
- When will I get paid? How much will I be paid?
- How long can I get paid for missing work?
- What decides how much money I receive while out of work?
- Can I ask for a settlement?
- What happens if I go back to work after being deemed permanently and totally disabled?
- Do I still get any benefits when I return to work?
- Is any tax taken out of my benefits check?
- Why do my Worker's Comp checks come in for different amounts?
- How long does it take for me to receive my benefits check?
When will I get paid? How much will I be paid?
Filing a claim doesn’t guarantee payment of compensation or benefits. Your claim may be denied or disputed by the BWC or your employer. The Ohio Bureau of Workers’ Compensation has 28 days from claim filing to accept or deny a claim. Learn about your options if your claim has been denied. Compensation won’t be paid until a claim is allowed.
The amount you are paid depends in part on how long you cannot work. The Ohio BWC or a self-insured employer will calculate your earnings prior to your injury, and you will be paid a percentage of those wages. The wage calculation and rate of payment often change, depending upon how long you cannot work. Wages may be set too low, and in these cases we can request an adjustment to consider special circumstances, periods of unemployment, or additional wage information, including wages from a second job.
How long will I be paid for the work I miss?
Generally, you could be compensated until you are released to return to your former job, actually return to that job, or are determined to have reached maximum medical improvement (MMI).
How is the money I am paid determined?
Your benefits are based on the money you earned working for the year prior to injury. Your Full Weekly Wage (FWW) is determined by the greater of your gross wages (including overtime) earned over the 6 weeks prior to injury, divided by 6; or your gross wages (excluding overtime) for the 7 days before the injury. The first 12 weeks of temporary total disability (TTD) compensation will be paid at 72% of your FWW. Benefits after the first 12 weeks of TTD will be paid based on your Average Weekly Wage (AWW), which is generally calculated by taking your earnings from all employers for the year prior to the injury and dividing that amount by 52 weeks. Those benefits are paid at 66⅔% of your AWW.
Can I ask for a settlement?
This is an issue you should consult an attorney about. There may be factors you are not aware of, and an experienced attorney can help secure the maximum settlement amount. At a minimum, wait until you are sure you will have no further complications from your work injury. Most employers will not settle with an employee while they are still working there, as the risk of re-injury and a new claim is present.
What happens if I go back to work after being deemed permanently and totally disabled?
You will lose any permanent total disability (PTD) benefits and likely be charged with fraud if you collect PTD compensation while working (unless you are receiving statutory PTD). If you believe you have medically recovered to the point of returning to work, consult an attorney about options before you do.
Do I still get any benefits when I return to work?
There are other benefits that may be available after returning to work. For instance, you may be entitled to a Working Wage Loss if your injury prevents you from making the same salary as you did prior to the injury. This is something you should consult with an attorney about.
Is any tax taken out of my benefits check?
No. Workers' compensation benefits are tax-free.
Why do my Worker's Comp checks come in for different amounts?
The first 12 weeks of TTD compensation are paid at 72% of your FWW. After the first 12 weeks, it is paid at 66⅔% of your AWW. It is possible that, because of the day of the week a check is originally issued or other factors, a check may only cover a portion of the standard 2-week pay period. The period covered will be listed on the payment. You will receive the amount you are entitled to, and eventually, the checks will be for a consistent amount and released on a consistent basis.
How long does it take for me to receive my benefits check?
Unfortunately, there is no definitive answer to this question. It may take many weeks (and sometimes, months) before compensation is received after it is awarded.
What can I do if my employer claims I voluntarily abandoned my job?
If your employer raises a voluntary abandonment defense to deny your application for permanent total disability (PTD) or temporary total disability (TTD) under Ohio’s workers’ compensation program, he may have opened a can of worms that could turn into a long legal battle.
If you're facing this defense, run—don’t walk—to a workers’ comp attorney. As I've discussed in an earlier blog, the voluntary abandonment defense is based on court decisions, not a statute or rule, so it’s anyone’s guess on how a hearing officer will decide.
What Is Voluntary Abandonment?
Although voluntary abandonment defenses are never simple, the idea behind them is relatively straightforward. If you're collecting PTD or TTD or applying for these benefits, and you retire;
get fired for breaking a rule, or quit working altogether; your employer or the Bureau of Worker’s Compensation can claim you voluntarily abandoned your employment and are therefore ineligible for benefits.
Once the company makes a claim, it's up to the hearing officer to determine if you have voluntarily abandoned your job. Past rulings have been inconsistent, with some judges interpreting the defense much more strictly than others.
Ohio Industrial Commission Amends Its Information
- In April 2019, the Ohio Industrial Commission (BWC) amended the section on voluntary abandonment in its manual on adjudications—apparently to clarify past rulings. While not introducing any new guidelines, the memo defines three types of actions that could be considered voluntary abandonment:
- Voluntary retirement. When a worker retires for reasons unrelated to the injury or illness he or she suffered at work, this can give rise to a finding of voluntary abandonment.
- Termination. If someone is fired for breaking a written rule or condition of employment he or she should know, there could be cause for voluntary abandonment.
- Abandonment of the workforce. If a worker is capable of performing light-duty or modified work but fails to return to the workforce, it may be considered abandonment.
Cases are decided individually. Evidence can be presented on your behalf to counter the affirmative defense, but you'll need help to build a persuasive argument.
Consult an Ohio Worker’s Comp Attorney
A voluntary abandonment defense might create a difficult battle for you. If your employer or the BWC raise this as a defense in your claim, you must consult an attorney to protect yourself. To learn more, request a free download of my book, The Worker’s Guide to Injury Compensation in Ohio, and call me to discuss your situation.
Free Consultation—What’s it mean?
Lawyers are just like anyone else – we have only so much time in a day. Some lawyers charge by the hour while others charge a flat fee for a service. Other lawyers charge a contingent fee, which means they get paid only if they win your case. When the case is won, they take a percentage of the money they earn on your behalf.
When a lawyer says that he or she will provide a free consultation, it means they will sit down with you, hear about your problem, and give you initial thoughts about it, at no charge or obligation to you. This meeting gives you a chance to "interview" the lawyer and the lawyer to interview you. After the meeting, you may decide that you do not want to hire the lawyer and, likewise, the lawyer may decide that he or she cannot help you with your problem.
During our visit, you can ask about our experience with matters similar to yours, our thoughts on the best course of action for your situation, and the timeline for a case like yours. You will also get to meet the people assigned to your case if we represent you.
The discussion should help you discover your rights and whether you need an attorney to represent you. Sometimes, the consultation itself may provide you with enough information to solve your workers’ compensation issue.
The meeting usually lasts somewhere between 15 and 30 minutes and can be done in person or over the phone—sometimes both. We will discuss the facts of your case, review the legal and practical issues you may expect to face and outline how we might pursue your case if we work together. If your claim is more complicated, the consultation can take a little longer. We want to take the time to understand your situation.
Preparing for Your Free Consultation
The more prepared you are, the less time it will take for us to understand and discuss your legal issue with some level of intelligence. Look through my website for answers to lots of questions you may have and download a copy of my book The Worker’s Guide to Injury Compensation in Ohio. It’s free, jam-packed with thrilling information about Ohio workers’ compensation and more fun to read than just about anything you can imagine! (OK, even I have to give that statement a few Pinocchios). Also, if we meet in person,
- Bring all documents. Make copies of all the materials you have collected regarding your case. Give these copies to the lawyer.
- Get organized and take notes. Write down notes outlining your legal problem, or questions you may have. We need details to decide what is essential and how to move forward in your best interests.
- Be honest. You should give an accurate account of your legal problem. This includes issues that may be sensitive to you or your family. Remember that the conversation with us is private, and cannot be discussed with others without your permission.
- Talk about how much this will cost you. We strictly work on a contingency fee basis for our workers’ compensation clients.
- Ask questions. For us to serve you better, I want you to understand your case and the legal procedure. My job is to guide you through this process that can be lengthy and frustrating. It's no help to either of us if we don’t have clear communication. I’d prefer you ask questions than not.
- Read all documents carefully before signing. Before you sign a document, we will explain to you what exactly it is that you are signing. If you do not understand the material you are being asked to sign, ask us to go over it again.
- Keep your own files. We’ll do our best to copy you on all letters and documents prepared on your case. Also, keep the written fee agreement between you and your lawyer for your records.
- Listen! My evaluation of your situation is based on legal training and experience. Remember that I cannot work magic. No lawyer wins every case, and sometimes the best legal advice may not be what you want to hear. I will advise with your best interests in mind.
A free consultation with us is easy to set up by calling 614-334-4649.
- Bring all documents. Make copies of all the materials you have collected regarding your case. Give these copies to the lawyer.
If I'm injured while driving for Uber, can I collect workers’ comp benefits?
Unfortunately, the answer to that question in Ohio right now is no. This is because rideshare drivers are considered independent contractors and aren't eligible for workers’ comp or other employee benefits.
However, if you drive for Uber or Lyft to supplement your earnings from another company where you're a regular employee, you may get wage replacement benefits for the Uber job if you're collecting workers’ comp from your primary employer.
In this age of gig employment, it’s critical for workers to understand what they're entitled to if injured on the job.
Independent Contractors Aren't Covered
Whether you drive for Uber, write articles on a freelance basis, pick up day jobs in construction, or shop for and deliver groceries for Shipt, you're an independent contractor. This means you're self-employed and not eligible for the benefits and protections given to regular employees, such as minimum wage, unemployment, and workers’ comp.
Companies like Uber and Lyft save a lot of money hiring independent contractors, and these workers have the advantage of flexibility. But if you are injured while driving for Uber, you're on your own.
Pay Attention—This Could Change
For companies like Uber, the key to denying benefits like workers’ comp is classifying their drivers as independent contractors. This is changing in a few states. New York, Pennsylvania, and California have ruled for drivers, forcing Uber and Lyft to classify their drivers as employees.
However, a ruling in May 2019 by the National Labor Relations Board concluded that drivers are contractors, not employees, striking a significant blow to millions of workers. This debate will undoubtedly continue—not only for rideshare drivers but for other workers classified as independent contractors.
Meanwhile, if you're injured in Ohio as an Uber or Lyft driver, you cannot collect workers’ comp.
Wage Replacement and Private Insurance
Many Uber drivers have regular jobs and take passengers to earn extra income after hours. This will be important to note if you're injured at your primary place of employment and granted workers comp benefits through that employer. That’s because you may collect wage replacement benefits for all the money you earned before your injury—including as an Uber driver.
If driving for Uber is your only or primary source of income, consider purchasing private driver injury insurance through Uber to pay medical bills and replace earnings if you're injured while driving and unable to work. This isn't Ohio workers’ compensation, but it’s a way to protect yourself—if you can afford it.
Consult a Workers’ Comp Attorney
Unfortunately, there’s nothing an Ohio workers’ comp attorney can do if you're injured while driving for Uber.
However, if you're eligible for workers’ comp through your primary company because of an on-the-job injury there, and want to make sure you receive all the wage replacement benefits allowed to you, I may help. Call my office in Upper Arlington to discuss your situation.
To learn more about Ohio’s workers’ comp system, request a free download of my book, The Worker’s Guide to Injury Compensation in Ohio.
What is a medical treatment hearing, and why do I have to go?
Your Ohio workers’ comp claim was approved, and you're ready to start medical treatment to overcome your workplace injury.
Unfortunately, like almost everything with the Bureau of Worker’s Compensation (BWC), it’s not that easy.
As we’ve discussed in other articles on this website, you have to go to a BWC-certified doctor who assesses your condition and decides on a course of treatment.
He or she will then have to fill out a C-9 form to request the treatment be approved by your employer’s Managed Care Organization (MCO). If the procedure is authorized, you’re all set. However, if it’s not, things become more complicated.
Next Steps After Denial of Treatment by Your MCO
If you don’t already have a workers’ comp attorney, now would be a good time to get one. Your attorney will guide you through the appeals process and make sure you're providing complete information at each step.
If the MCO denies treatment, you or your attorney has 14 days to appeal the decision to the BWC. If the BWC also issues a denial, your next step will be to request a medical treatment hearing with the Ohio Industrial Commission (IC). This hearing is your chance to explain why the treatment is necessary and demonstrate how it will help you.
Preparing for Your Medical Treatment Hearing
While not as formal as a trial, this is an official proceeding you should take seriously. Dress appropriately, be on time, and have a positive attitude. The hearing is held in a state building, so you'll need an ID and will pass through security to get in. If you have an attorney, he or she will be with you, but you're answering the questions yourself. And, for heaven's sake, make sure to be there. Clients occasionally ask me whether they need to attend treatment hearings and the answer is a resounding "yes!". It's my belief, based on experience, that hearing officers will conclude you don't care one way or another about treatment if you don't even bother to show up to argue for it.
I encourage my clients to be honest and tell the Hearing Officer about:
- Limitations you have because of the injury
- Treatments tried in the past and how they did or didn't help
- Why a doctor is recommending this treatment now
- How this treatment will help you get better and return to work more quickly
- If you’ve had this treatment before, how it helped, and how long it lasted
- Your commitment to following this treatment
The job of the Hearing Officer who's deciding your appeal is to determine if the therapy is advantageous and if it's cost-effective. The clarity you use to explain how the treatment will help improves your chances of success.
If the District Hearing Officer denies your request, you can appeal again. You'll be referred to a Staff Hearing Officer at the IC.
I Can Help You Tell Your Story
As your workers’ compensation attorney, I'll guide you in how to explain the importance of your requested treatment. You need not be a medical expert to succeed in a medical treatment hearing—just tell the story in your words.
If you're struggling with a work-related illness or injury, I invite you to download my free book, The Workers' Guide to Injury Compensation in Ohio and contact my office for a personalized assessment of your claim.
How does the Ohio BWC catch people committing workers’ comp fraud?
Let’s be clear: workers' comp fraud hurts everybody. When a worker collects compensation illegally, the cost of the scam eventually trickles down to employers, workers still on the job, and, ultimately, consumers.
It's estimated that over $7 billion—that’s billion with a “b”—is paid out annually on fraudulent grounds nationwide.
With such losses, the Ohio Bureau of Workers' Compensation (BWC) will make every effort to catch these fraudsters.
However, sometimes the methods of the Special Investigations Department (SID) are a little too far-reaching, and innocent people are accused.
Special Investigations Department Methods
Workers’ comp fraud can involve employers, healthcare providers, and workers. The BWC assigns investigators to each area but relies heavily on reports from employers, co-workers, neighbors, and even family members to catch employees committing fraud. Often, these reports are anonymous tips called to the SID or submitted on its website.
When the SID receives a report about a suspicious worker, it may investigate by:
- Following the worker to catch him on another job, hitting the gym, or engaging in some activity that “proves” he’s not disabled. This may even involve taking video or photos of the target.
- Talking to neighbors, employers, or other people familiar with the accused to locate eyewitnesses to the alleged fraud.
- Interviewing the employee to get him or her to admit to something illegal. The investigators’ line of questioning can be extremely manipulative and confusing.
Don’t get me wrong. If people are collecting workers’ comp on fraudulent grounds, they should be stopped. However, the reliance on anonymous tips and the sometimes enthusiastic efforts of the SID can mean innocent people get accused.
Don’t Talk to a BWC Investigator
If you were accused of defrauding the BWC and are innocent, contact me before talking to an investigator. It’s far too easy to fall victim to the SID’s aggressive tactics and not only lose the benefits you need and deserve—but also face a criminal conviction.
To learn more about workers’ comp in Ohio, request a free digital copy of my book, The Worker’s Guide to Injury Compensation in Ohio, and call me for a consultation about your case.
What are the Official Disability Guidelines, and how do they affect my workers’ comp?
If you're collecting workers’ compensation in Ohio for an ongoing work injury or illness and seeking continued care or new treatment options, you must get approval from your managed care organization (MCO).
The Ohio Bureau of Workers’ Compensation (BWC) requires MCOs to use approved treatment and return-to-work guidelines to evaluate the necessity and effectiveness of the requested medical care.
Since 2004, the BWC follows the Work Loss Data Institute’s (WLDI) Official Disability Guidelines (ODG) to "assist" in decision making.
What Is the ODG?
It's an online database created by the WLDI on behalf of the insurance industry. When reviewing a claimant’s request, BWC or MCO staff members enter the particular illness or injury into the database, then receive the ODG’s treatment recommendations.
While the WLDI claims it provides evidence-based and data-driven treatment guidelines, the organization's ultimate goal is to “reduce excessive utilization of medical services and corresponding medical cost” and get workers back on the job "as efficiently as possible".
In other words, it's on the side of the insurance company—in our case, the BWC—and the employer. Far too often, the ODG is used merely to deny requests rather than as just another piece of information to consider. If you're requesting treatment that isn't explicitly listed in the ODG, you're likely to be denied, first by the MCO and then by the rubber-stamp of the BWC. Because, hey, medical treatment costs money and the MCOs and BWC are all about saving money!
What Can You Do About it?
Appeal the MCO’s decisions and the BWC’s order to the Industrial Commission to get a hearing. The Industrial Commission is not bound to follow the ODG guidelines. The ODG should be used as it was intended—as a guideline for decision-making, not as the sole piece of evidence being considered. Make sure you get a letter from your doctor supporting her request for treatment: i.e., why it's reasonable, beneficial and necessary in your case. This needs to be submitted to your claim file before or at the hearing.
Your treating physician’s opinion, diagnostic testing, results of past treatment attempts, and many other factors should be considered when making a treatment decision. Also, I suggest you never go into a treatment request hearing alone. A qualified Ohio workers’ comp attorney will make sure all evidence is reviewed and that your request is given fair consideration.
When You Need Help in Ohio, Call Monast Law Office
Don't go through this process alone. I've helped hundreds of injured workers get the respect they deserve as they go through the workers’ comp process. Contact my office to discover if I can help you.
For more information meanwhile, request a free copy of our book, The Worker’s Guide to Injury Compensation in Ohio.
What should I do if my employer is treating me differently after reporting an injury?
Uh oh. That's not good. As an employee in Ohio, you may file a claim for compensation with the Bureau of Workers’ Compensation (BWC) if injured on the job, or if you developed an illness due to unsafe conditions in the workplace.
It doesn't matter if you lost focus for a minute on the Honda assembly line and your leg got crushed, or if your employer failed to make sure ice was cleared from the UPS loading dock and you fell and hit your head.
Either way, your medical treatment and lost wages should be covered by workers’ comp.
Ohio workers’ compensation is a no-fault insurance system designed to take blame out of the equation. Your employer can’t blame you, and you can’t sue your employer.
Then Why Are You Being Treating Differently at Work?
Unfortunately, despite the no-fault nature of workers’ comp, we often hear from employees who feel they're treated poorly after reporting an injury or filing a claim. If this treatment reaches the level of retaliation, legal action may be taken against the employer.
Usually, tactics are more subtle, such as:
- Asking you not to file a claim. If an employer isn't in compliance with Ohio workers’ comp law, he won't want you to file so he doesn’t get caught. If he has a lot of claims and fears his premiums will go up, he may also try to keep you from filing. Either way, you may file a claim with the BWC and shouldn't be dissuaded.
- Disparaging remarks from co-workers. Sadly, workers who file claims are sometimes made to feel like liars and criminals, often by co-workers. This treatment creates a hostile workplace, and supervisors and managers should stop it.
- Withholding information. You may be excluded from meetings, left off email distribution lists, and kept out of the loop purposely when you're out recovering from a workplace injury. If these actions impede your employment, you may take legal action to stop it.
- Generally making your life harder. Increased supervision, cold shoulders, and a challenging environment can make your job a miserable place to be. This shouldn't happen just because you were injured.
When my clients have these experiences, I want to hear about them. While your employer may not be breaking the law, it's inappropriate to continue treating you this way.
When poor treatment escalates to the point that your employer is breaking an agreement, you may take legal action. Examples of this include:
- Not honoring restrictions. If you return to work with certain restrictions ordered by a doctor, they must be upheld by your employer.
- Not accommodating your schedule. Shorter workdays, medical appointments, follow-up treatment, and other accommodations must be allowed if required for your return to work.
Monast Law Office Is Here for You
No one hopes to be injured on the job so they can collect workers’ comp and take time off—that’s just not how it works. To be mistreated because of something out of your control is a terrible thing to face. Regardless of whether you're a client or not, please contact us if you're experiencing unfair treatment at work, and we'll discuss your options.