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 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.
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.
Can I see my own doctor for a work-related injury?
When you're injured in a fork-lift accident at your warehouse job or think you may have developed carpal-tunnel syndrome at your office job, your first move may be to go to the nearest emergency room or your doctor for diagnosis and treatment.
Fortunately, the Ohio workers’ compensation program allows this—but only for that initial visit.
After that, you must see a Bureau of Workers’ Compensation (BWC)-certified physician for your treatment to be covered by workers’ comp. If you work for a self-insured employer such as UPS or Ohio State, your employer will decide regarding your eligibility and who you can see for treatment.
Finding a Certified Doctor
It's possible that your doctor is already BWC-certified—in which case, you won’t have to look further for a doctor to treat your work injury. However, if she's not and you continue to see her, you'll be responsible for all medical costs related to your work injury.
While your employer may suggest a doctor, you're under no obligation to visit that doctor. Instead, you can find a certified physician in your area by checking the provider look-up tool on the BWC’s website. As long as you receive workers’ comp benefits for the injury for which you're seeking treatment, medical costs related to your claim will be covered.
However, even for BWC-certified doctors, treatment has to be approved by your employer’s managed care organization (MCO) with employers who obtain workers' compensation through Ohio's state insurance fund or by your self-insured employer.
Getting Approval From Your MCO
If you're not already familiar with managed care organizations, understand how they work.
All employers who purchase workers’ comp insurance through a state fund must choose one of 13 MCOs recognized by the BWC to manage their workers’ compensation claims. The MCO oversees claim filing, and supervises medical treatment and employer return-to-work programs. Your employer’s MCO manages the medical portion of the claim, so additional medical procedures, treatments, and referrals from the treating physician have to be approved by the MCO.
If medications are prescribed, you have to inform the pharmacist that it's a workers’ comp claim and provide your BWC claim number. Any treatment or services you received before your workers’ comp claim is approved should be reimbursed after that approval. Note that some large Ohio employers are self-insured—this means they administer workers’ compensation claims directly, and your employer may manage the medical portion of your application.
Having Trouble? Call an Experienced Workers’ Comp Attorney
If you're like most of our clients, you may feel frustrated and hopeless when coverage for a needed medical procedure or prescription is denied. However, you may appeal any medical decisions made by your MCO, and you may work with an experienced workers’ comp attorney on your appeal.
If you feel like the BWC is saying you and your doctors are wrong, or even fraudulent, call me for a free review of your claim. I help many workers just like you overcome the challenges of the Ohio workers’ comp system, and I may assist you, too. We're never too busy to take your call or answer questions. Fill out the form on this page to connect with me today.
Do I have to use sick time for my work-related injury?
The intent of workers' compensation in Ohio is to cover all costs related to an injury you sustain at work or an illness you develop because of your job.
The benefits you receive depend on the seriousness of the injury or illness and how much time you must take off work. If you only miss a few days after a workplace accident, charge that time against your paid time off (PTO).
However, if your injury or illness leads to eight or more days off work, you qualify for temporary total compensation benefits from workers’ comp to replace your lost income.
Understanding Ohio Temporary Total Compensation Benefits
The Ohio Bureau of Workers’ Compensation (BWC) defines temporary total disability as “the temporary inability of the injured worker to return to his former position of employment.” If your claim for workers’ comp benefits is approved, your injury-related medical bills will be paid no matter how long you must miss work.
However, temporary total compensation benefits—or reimbursement for PTO already taken—won't start until the eighth day you're off work. If you miss two weeks of work, you'll only be compensated for the second week. If you're away over 14 days, you'll be compensated for all the days you have missed, including the initial week.
If you're approved to return to work under modified conditions and your employer cannot accommodate you, you can remain on temporary total compensation benefits as you continue to improve. It's important to note that getting these benefits doesn't mean you'll receive 100 percent of your wages. Instead, you'll receive between 72 and 66 2/3 percent of your wages, depending on how long you're off. When you return to work, temporary total compensation benefits end. However, you may be eligible for wage loss benefits if your injury causes work restrictions that lead to a reduction in earnings.
Monast Law Can Help Maximize Your Benefits
When you're injured on the job and cannot work, you may be eligible for many benefits. Because every case is unique, call us for a strategy session. We can explain your rights and help you pursue the maximum compensation.
How long do I have to file a workers’ comp claim in Ohio?
As of September 29, 2017, House Bill 27 reduced the amount of time injured workers have to file a claim to one year from the date of the workplace injury or death in Ohio. For claims involving occupational disease, you have two years to file a claim. This is known as the statute of limitations.
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. If you do not file a claim before the statute of limitations deadline, you no longer have the right to file a 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 and risk hitting the statute of limitations 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.
Don't Delay, the Statute of Limitations Gives Strict Deadlines to File a Work Injury Claim in Ohio
A year can pass by quickly when recovering from a workplace accident, 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.
- 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.
What is vocational rehabilitation?
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?
If 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.
In 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.