Answers to Workers’ Compensation Questions From a Columbus Attorney

Could you be fired for filing for workers’ comp? Can an employer refuse to provide workplace injury compensation? Get fast answers to your injury questions by browsing our work injury FAQ page.

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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 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? 

    Ohio workers' compensation form

    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. 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

    Woman receiving medical treatment for work injury

    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?

    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.

    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.

     

  • Compensation FAQs

    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?

    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.

  • How long do I have to file a workers’ comp claim in Ohio?

    calendar

    As of September 29, 2017, you have one year from a workplace accident to file a workers’ comp claim for injury or death in Ohio. For claims involving occupational disease, you have two years to file a claim.

    That may seem like plenty of time. After all, why would you wait to apply for the benefits you need to pay for medical treatment and lost wages?


    While most people file within the first few weeks or months after an accident, others delay their filing and jeopardize their claim.

    Why Injured Workers Delay Filing

    When injured on the job, immediately report the accident to your employer and seek medical attention. Not doing so could hurt your claim before you've even filed. While those steps are essential, they're not the same as actually filing a claim for compensation.

    I've found that injured workers sometimes delay filing a workers’ compensation claim because:

    • Fear of employer retaliation. Some workers are worried they'll be fired, demoted, or moved to a bad shift if they pursue claims, especially for injuries they hope go away on their own. Retaliatory actions are illegal, and fear of them shouldn't discourage you from applying for needed benefits.
    • Fear of what people will think. If the injury seems minor, sometimes a worker doesn't want to be a whiner who complains about every little ache and pain. He or she may also worry about the stigma of being on “workmen’s comp” or that co-workers will treat him or her differently.
    • Fear of missing work. Some employees worry if they take the time needed to treat their injuries, they'll lose wages they won’t be able to get back. Ohio workers’ comp authorizes payments for lost wages during the period of recovery, so a successful claim will help you more than toughing it out and working while injured. Continuing to work while hurt may lengthen your recovery time or lead to increased problems later. Remember, most of us aren't eighteen anymore: injuries we used to "walk off" take longer to heal as we age.
    • Employer pressure. Some employers may encourage or even push injured workers to use their health insurance to pay for treatment. Some small business owners also tell injured employees not to file because their premiums will skyrocket, promising to “take care of them” through other means. Remember: you should have the benefits offered by Ohio workers’ compensation, and it's not up to your employer to decide how you take care of yourself.
    • Waiting to see how severe the injury is. It's not uncommon for individuals to push themselves to work through injuries to see if they get better without treatment. However, filing the claim permits a doctor to request diagnostic tests to confirm or rule out a diagnosis, setting you on the road to health much more quickly.

    Don’t let these reasons affect your filing. At Monast Law, we've helped hundreds--actually, thousands--of people just like you who have fears about filing claims, and we can help you, too.

    A Year Can Fly By

    When recovering from a workplace accident at Ohio State, Amazon or Grant Riverside Hospital, a year can pass by quickly, especially if you're hesitant to file. It's important to take action immediately when injured at work. If you were hurt, or your employer isn't cooperating fully, call me to schedule a free consultation. If I can help, I'll work quickly to make sure you meet the deadlines and present the most persuasive claim possible.

    Meanwhile, request a download of my free book to learn what you need to know about workers’ comp in Ohio.

     

  • What is vocational rehabilitation?

    vocational_training

    Vocational rehabilitation is a program offered to individuals unable to return to the work they did before being injured on the job.

    However, they may be able to work in another capacity, whether with the same employer or a different employer.

    Vocational rehab helps workers transition to jobs they're able to do despite the physical and sometimes emotional restrictions and limitations caused by workplace accidents. Failure to pursue opportunities for re-employment is required under Ohio Revised Code §4123.58 which prohibits an award of permanent total disability if "the employee has not engaged in educational or rehabilitation efforts to enhance the employee's employability, unless such efforts are determined to be in vain."

    During this transition, workers will be eligible for Living Maintenance or Living Maintenance Wage Loss benefits.

    What Happens in a Vocational Rehab Program?

    A vocational rehabilitation program tries to help injured workers get or keep a job. The rehab process may consist of:

    • Evaluation of the disability or limitation
    • Vocational counseling and training
    • Job search and placement assistance
    • Educational assistance
    • Transportation, occupational tools, and equipment
    • Personal attendant services

    These services are not always available through the Ohio Bureau of Workers’ Compensation (BWC), so it may be necessary to work with other agencies. The BWC, your managed care organization, and the Ohion Bureau of Vocational Rehabilitation (BVR) can work together to help find the right program for you.

    How Do You Qualify for a Program?

    To apply for vocational rehabilitation, your doctor should fill out a C-9 Request for Authorization form and submit it to the BWC. To qualify, you need an allowed claim with eight or more days of lost time from work and a “significant impediment” to returning to work. You'll also have to meet certain criteria related to the extent of your injuries and type of compensation you're awarded.

    How Monast Law Can Help

    If you were turned down for vocational rehabilitation and are struggling to get the workers’ comp benefits you need to make up for losses related to a work injury, request a free copy of my book, The Worker’s Guide to Injury Compensation in Ohio.

    And call our office today! We've helped hundreds of injured workers just like you get the benefits they deserve, and we can help you, too.

     

  • What should I consider before settling my workers’ comp case?

    legal_consultIf you were injured on the job and are collecting workers’ compensation benefits, you may be approached by your employer or the Ohio Bureau of Workers' Compensation (BWC) about settling your claim. Or, you yourself may decide you'd like to pursue a settlement so you no longer have to deal with the BWC or your self-insured employer.

    As with anything, there are pros and cons to settling a workers’ comp claim.

    What Is a Settlement?

    When you settle your workers’ comp claim, you agree to a lump sum payment from the BWC or your self-insured employer and give up coverage for injury-related medical care and wage replacement payments. You also release any further right to compensation related to the injury or illness that led to the claim.

    It's important to be aware of the following:

    • The date the BWC mails a settlement approval letter is your effective settlement date.
    • Payments for medical bills or wage replacement stop on the effective settlement date.
    • If you owe child support, it will be taken from the settlement before you receive any money.
    • Any overpayment of compensation you received is recouped from the settlement.

    Your attorney will explain the terms of a settlement to be sure you understand what you agree to.

    How Does a Settlement Proceed?

    A workers’ comp settlement can be initiated by either the injured worker or his employer, but all parties involved, including the BWC, must ultimately agree to the settlement. The BWC administers and approves the claim settlement, which must also be reviewed by the Industrial Commission of Ohio to make sure it's fair to all parties.

    While not a requirement, it's a good idea to get the advice of an experienced Ohio workers’ comp attorney to make sure the financial recovery offered is in your best interest. If you have an attorney, the BWC works directly with him or her to negotiate the settlement. 

    What to Think About When Considering a Settlement

    While the thought of a lump sum payment from the BWC or your self-insured employer may be appealing, you need to understand what you're giving up. Sometimes, it makes sense to initiate or agree to a settlement. There are also pivotal circumstances when it doesn’t make good financial sense.

    Some questions to consider include:

    • Are you receiving ongoing treatment? If you're seeing a doctor or physical therapist regularly to treat your injury, will you be able to continue to pay for visits if you need to? If you require surgery later—for example, for a back injury sustained while loading heavy packages for UPS—will you have the money for it? Workers' comp benefits will cover these costs for the duration of the injury, but if you agree to a settlement, you won't have this coverage. This may not be a concern if you have other health insurance to cover current and future treatment.
    • Need you keep working? Settlement agreements usually require your resignation from Kroger, Walmart, or another Ohio employer settling your claim. If you require continuing income, make sure you can get another job.
    • Are you moving out of state? If you're relocating from Ohio, it may make sense to settle, because it's difficult to pursue claims with the BWC for medical treatment received in another state.
    • Are you receiving other benefits? If you're receiving Social Security disability, Medicare, or VA benefits, you must work with an experienced attorney to properly structure a workers' comp settlement to your best advantage.

    While these questions can get you started, you should not consider a settlement until you talk to an Ohio workers’ comp attorney.

    You Need an Experienced Lawyer by Your Side

    You're faced with a big decision when thinking about settling a workers’ comp claim, and you shouldn't trust the decision to just any attorney--and certainly not to the BWC or self-insured employer's representative. Hiring the right legal counsel could pocket you thousands of additional dollars.

    I handle hundreds of Ohio workers’ comp claims each year, but you'll never be simply a number. At Monast Law, you get the personal time and attention your claim deserves as we help you reach a workers’ comp settlement you can be happy with. To learn more, request our free book, The Worker’s Guide to Injury Compensation in Ohio, or call us today.

     

  • Can I collect workers’ comp benefits if my work-related vision loss is correctable?

    A traumatic workplace accident, chemical exposure, or eye strain could lead to permanently losing vision that limits your ability to continue working.

    man_with_glassesIn certain industries, these injuries happen regularly. The Centers for Disease Control and Prevention report that over 700,000 eye injuries requiring medical treatment occur in workplaces each year across the country.

    Vision loss, even loss caused by a traumatic accident, is often treatable with surgery or corrective lenses. But a workers’ comp loss of vision award is based on your condition before you receive any treatment.

    Qualifying for Vision Loss Benefits

    To qualify for an Ohio Bureau of Workers’ Compensation loss of vision award, you must have lost at least 25 percent of sight in one eye due to a workplace accident or exposure.

    The percentage of loss is based on your vision after the injury but before receiving treatment or corrective lenses. This assessment is compared to your sight ability before the accident to confirm the vision loss was caused by the accident or other workplace conditions.

    If your vision is expected to improve without medical intervention, your scheduled loss award won't be determined until the healing process is complete. Even if your vision is 100 percent correctable with surgery, glasses, or contact lenses, you'll still qualify for benefits based on your pre-treatment vision. If a workplace injury results in a removal of the eye or a traumatic cataract, you may also qualify for a facial disfigurement award.

    Causes of Workplace Vision Loss

    The most common cause of traumatic vision loss is a workplace injury caused by debris in the eye. Flying metal shards, broken glass, dirt, dust, sand, and other particulates lodge in the cornea, causing permanent damage. Other causes of on-the-job vision loss include:

    • Tools. Nail guns, staplers, saws, wire cutters, and other tools send dangerous projectiles into the eyes of the user or bystanders. Line workers at Honda, Whirlpool, and Worthington Industries are at high risk.
    • Chemicals. Splashes from industrial chemicals and cleaning products cause burns that damage the eyes. Workers at local companies such as GFS Chemical, Hexion, and Capital Resin handle chemicals daily that pose risks of permanent vision damage.
    • Thermal burns. Welders at companies like Honda, Cardington Yutaka Technologies, and Battelle may experience thermal burns to the retina, causing significant loss of vision.

    Most injuries can be prevented by using protective eyewear, but because workers’ comp is a no-fault insurance, it shouldn't matter whether your eye injury was preventable. If your vision is damaged while performing a task related to employment, you're entitled to workers’ comp benefits. The amount of your award depends on the percentage of impairment and increases if vision loss is complete and permanent in one or both eyes.

    Contact Me If You Have Been Denied

    If you suffered vision loss due to a workplace injury and your benefits were denied, or you're unhappy with the way your claim is being handled, contact me for a personalized assessment of your claim. I also encourage you to request a free copy of my book, The Worker’s Guide to Injury Compensation in Ohio.

     

  • What Is The Difference Between MCOs and TPAs

    Managed Care Organizations

    MCOs are the principal connection between injured workers, employers, medical providers and the Bureau of Workers’ Compensation. Created by the Ohio legislature and then-Governor Voinovich after voters overturned their efforts to privatize Ohio’s workers’ compensation system in 1997, MCOs are medical cost containment companies. They oversee claim filing and supervise medical treatment and employer return-to-work programs. MCOs add additional levels of bureaucracy to claims processing previously managed by BWC Claims examiners (now known as CSS or Claims Service Specialists) as its decisions may be appealed through two levels before reaching the BWC. This can delay treatment by months.

    MCOs direct the medical management of workplace injuries and occupational diseases. They assemble initial injury data and medical documentation, approve or deny treatment and testing, pay bills related to the claim and focus on returning injured employees to work soon.

    All employers must choose one of 13 MCOs recognized by the BWC to manage their workers’ compensation claims. MCOs are paid by the BWC through premiums paid by employers into the State Insurance Fund. Employers can select or change their MCO every two years.

    Third Party Administrator

    Unlike MCOs, required for all Ohio employers to direct medical management of workers’ compensation claims, TPAs are neither required nor regulated by the BWC. They can be hired by employers at any time or not.

    TPAs are private businesses hired by employers to help with the financial and administrative details of workers’ compensation claims. Slightly less than half of Ohio employers have a TPA representative.

    TPAs can assist employers in reducing their workers’ compensation premiums through discount plans such as group rating, retrospective rating, self-insurance and others. They also represent employers at Industrial Commission hearings, process appeals, schedule defense medical examinations, file motions to terminate treatment and compensation payments and negotiate claim settlements.

    To summarize, MCOs direct the medical aspects of a workers’ compensation claim while TPAs represent employers in processing claims and minimizing their workers’ comp expenditures and claim costs.

  • Do I have to be injured in my office, on my job site, or at my usual place of employment to qualify for workers' compensation benefits?

    No. There is no requirement you be hurt at your usual place of employment to qualify for workers’ compensation benefits in Ohio. However, your injury must be work-related regardless of where it occurred.

    Was Your Injury Work Related?

    A work-related injury is one that happened while you were fulfilling the duties of your job or while on company property. This includes not only work accidents that happen in your office or on your jobsite, but also injuries that occur while you are:

    • Traveling for your job. This does not include your regular commute, which is excluded under Ohio’s “going and coming” rule, but it could include running a work-related errand or traveling to another site as part of your work day.
    • Attending an off-site meeting or appointment. If you are hurt while attending a meeting or working at a site other than your usual place of business, your injury may be considered work related.
    • Attending a job-related social event. If you are hurt at the company holiday party, a company picnic, or a dinner with clients, your claim may be covered by workers’ compensation if your attendance was logically related to your employment.
    • Parking lot accidents. If you are in a car accident or fall in the parking lot, and the parking lot is owned by the employer, your injuries are compensable. If the parking lot is not owned by your employer, your injuries may still be covered by workers' compensation.
    • Injuries while on a lunch break. If you are injured while “off-duty” but still on work property, your injuries will be covered. If you are having lunch somewhere off property—or are on your way to or from lunch—your injuries will not be covered.

    Make Sure Your Rights Are Protected

    If you are hurt somewhere other than your usual work location or while you are on a break, a dispute may arise about whether you were hurt in a work-related event. This could affect your recovery of workers’ compensation benefits in Ohio. Accordingly, contact an experienced workers’ compensation lawyer who can make sure that you get the benefits to which you are legally entitled. To learn more, contact our legal team and download a complimentary copy of our book, The Worker’s Guide to Injury Compensation in Ohio.

  • Are all Ohio businesses required to carry workers’ compensation insurance?

    Yes. Ohio companies with any employees—even if they just have one person working for them—must purchase workers’ compensation insurance to protect their employees when they suffer work-related injuries. Employees must be covered as soon as they begin their first day of work. Most employers fulfill this requirement by obtaining insurance through the Ohio Bureau of Workers’ Compensation (BWC), but a few of the state’s larger employers are self-insured.

    There are no exceptions to this rule if a business has employees, but coverage is optional for Ohio businesses or religious organizations with no employees.

    Types of Businesses That Do Not Have to Carry Workers’ Comp

    These types of businesses do not have to carry workers compensation coverage:

    • Sole proprietors with no employees
    • Partnerships with no employees
    • Family farm corporate officers with no employees
    • Individuals incorporated as a business with no employees
    • Limited liability companies acting as sole proprietors with no employees
    • Limited liability companies acting as partnerships with no employees
    • Ordained or associate ministers of religious organizations exercising of their ministries (but any paid employees of the church must be covered).

    These businesses may carry workers’ comp in case the owner or minister is injured on the job. If they carry the insurance, they can report a work injury against their policy and, if approved by the BWC, medical bills and lost time wages can be paid.

    Coverage for Volunteer Workers

    Workers’ compensation is not available to cover volunteers who work for non-profit organizations or private companies. However, public employers who use volunteers to provide emergency services—such as volunteer firefighters—must provide workers’ compensation for them.

    Employees Should Not Have to Worry About Coverage

    You may wish to discover what kind of workers’ compensation insurance your employer has even before you are hurt. The workers’ comp process is different if your employer is self-insured rather than carrying BWC insurance, so knowing this information can be helpful. If you have been hurt, get accurate information right away so you can protect your recovery. Talk to your employer about your company’s coverage, or you can contact the Bureau of Workers’ Compensation to get this information.

    If you are not satisfied with the treatment you are receiving because of your injury, or if you feel that it's not being taken seriously or handled properly, see how we can help. To learn more, please download a free copy of our book, The Worker’s Guide to Injury Compensation in Ohio, and call us directly to schedule an initial meeting.