Answers to Workers’ Compensation Questions From a Columbus Attorney

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.

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.

You opted into your employer’s long-term disability (LTD) insurance plan thinking it would protect your family if something happened to you that prevented you from working. Now that your fears have come true, you're shocked to discover that your claim for LTD benefits is denied. You’ve paid your premiums reliably for years—how could this happen? We look at common—and often petty—reasons LTD claims are denied.

Insurance Adjusters Are Paid to Deny Claims

The first thing to realize is that insurance companies only make money on the claims they deny, so their adjusters will look for any undotted "i" or uncrossed "t" to throw out your claim. You may not even be given a reason when your claim is rejected, but it's probably for one of these reasons:

• Small print in your policy. You must meet the terms of your specific LTD policy, including its definition of a disability. Most policies exclude pre-existing conditions, so if the claims adjuster believes your condition isn't new, you'll be denied.
• Lack of evidence. You must include evidence of your medical condition and your physical limitations. Medical evidence includes doctors’ reports, scans, and lab tests, which have to be dated within the period of eligibility. Statements and evaluations from doctors and occupational experts attesting to your inability to perform work must also be included.
• Application errors. Incomplete applications, or forms with even minor mistakes on them, will likely be rejected immediately.
• Missed deadlines. You must meet strict deadlines when applying for LTD benefits. If you miss a deadline, your application won't even be read.
• Evidence of duplicity. An approved LTD claim means a hefty payout by the insurance company, so it may go to great lengths to prove your claim is fake. Tactics such as monitoring your social media, spying on you in public, and speaking to friends and co-workers aren't beneath adjusters instructed to find any reason for fault. They won't hesitate to misconstrue perfectly innocent actions as being evidence of fraud.

If you're denied for any of these reasons, or have no idea why your claim was denied, you may be able to file an appeal helped by a long-term disability attorney.

But Not Just Any LTD Attorney

Employer-sponsored long-term disability insurance policies are regulated by the Employee Retirement Income Security Act (ERISA), a set of complicated federal laws originally intended to protect workers’ retirement savings. ERISA now also includes provisions that dictate how LTD claims and appeals should be handled.

Because these cases are complex and time-consuming, few attorneys take them, but I do. As an experienced Columbus workers’ comp attorney, I understand the frustration of a denied LTD benefits claim. Call the Monast Law Office to discuss the possibility of filing an appeal. We'll take a look at your claim and let you know if we can help you navigate the difficult ERISA process.

 

 

That’s a great question, and it’s one we encourage our clients to ask. The problem is that some workers’ comp doctors cave to pressure from employers to get people back on the job or to Managed Care Organizations (MCO) to cut costs.

This absolutely should not happen. Your workers’ comp doctor should only be concerned with your well-being. If this isn't the case, it may help to talk to an attorney.

The Physician’s Role in a Workers’ Comp Claim

While you can see any doctor—including your own—for your initial evaluation after a workplace injury, you must choose from a list of BWC-approved physicians after that. These doctors don't work for the BWC, but are approved by the BWC to handle workers’ comp claims.

Doctors who see workers’ comp patients are expected to provide the same medical care as they would to any other patients, such as:

• Recommending treatment, regardless of what the MCO or self-insured employer will voluntarily pay.
• Advising the patient of possible alternative diagnoses, treatment options, and associated risks.
• Evaluating all symptoms, even those that may seem unrelated to the workplace injury.
• Objectively assessing impairment or disability and the employee's readiness to return to work.
• Providing medically-appropriate restrictions when the worker returns to the job.

Potential Conflicts of Interest for Workers’ Comp Doctors

Along with helping the patient get better, the workers’ comp doctor may also be expected to make judgments about the cause of the individual’s injury and his readiness to return to work. This might create a conflict for some doctors when employers pressure them to support a claim denial or to release a patient to work before he's ready. Be especially careful when your employer refers you to a particular medical practice, in-house medical dispensary, or local "work health center" for treatment.

Again, your doctor’s primary job is to care for you, not to worry about your employer. If you feel like your care is compromised because your physician is trying to please your employer or MCO, it may be time to change doctors and talk to an attorney.

Monast Law Office Cares About Your Recovery

The BWC allows you to switch doctors, but you must submit a change form and can have only one physician of record at a time. If you go to a doctor who isn't BWC-certified, you must pay for this care yourself.

If you're having difficulty getting the treatment you need from your workers’ comp doctor, contact my office and talk to my team. To learn more about your right to workers’ compensation, request a free download of our book, The Worker’s Guide to Injury Compensation in Ohio.  

Related Links: Ohio Workers’ Compensation Miller Criteria Ohio Workers’ Comp Modified Work Offers Unfair Treatment After a Work Injury in Ohio

 

People often think of workers’ comp as an insurance program for work-related injuries—which it is—but it also covers illnesses that are contracted due to workplace exposure. Some examples of work-related illness include respiratory conditions, hearing loss, skin diseases, heatstroke, and heavy metal or gas poisoning.

While these diseases result from dangerous conditions in the work environment, an employee may also contract an infectious disease in the course and scope of employment. In some cases, those individuals will also be covered by workers’ compensation.

No Coverage for the Common Cold

Catching an illness like a cold, the flu, chickenpox, or measles from a coworker doesn't qualify for workers’ compensation. You can take sick days and work with your private health insurance regarding payment of medical bills. Even if you catch these airborne diseases from a customer or patient as you're doing your job, you won't be covered by workers’ comp in Ohio.

So What Kinds of Infectious Disease Are Covered?

According to the Ohio Bureau of Workers’ Compensation, private employers are required under the Occupational Safety and Health Administration (OSHA) to pay for all costs related to worker exposure to infectious diseases through contact with blood or other bodily fluids. There doesn't have to be an unavoidable accident or physical injury for this coverage to apply, but it doesn't include airborne exposure.

Public employers aren't subject to OSHA rules, but under Ohio law, they must offer the same coverage for emergency workers, including peace officers, firefighters, and emergency medical personnel. If these workers, or any private employees, come in contact with the bodily fluid of a person infected with a communicable disease, they should be compensated for:

• Office visits
• Emergency room visits
• Tetanus, HIV, or hepatitis testing
• Suturing or dressing of wounds
• Physician evaluation/management, including counseling
• Prophylactic medication
• Follow-up testing/treatment required according to the current Centers for Disease Control protocol.

In order to have these costs covered, it's important that you report the exposure incident as soon as possible. If you were potentially exposed to an infectious disease by a splash or spatter in the eye or mouth, skin puncture, cut, open sore, wound, lesion, abrasion or ulcer, or in the course of performing mouth-to-mouth resuscitation, your medical costs should be compensated.

Call Monast Law Office If You Have Any Problems

These kinds of claims should be straightforward in Ohio, but if you're struggling to get medical testing or prophylactic treatment paid for by your employer, give us a call. To learn more about your right to workers’ compensation, request a free download of our book, The Worker’s Guide to Injury Compensation in Ohio.

 

Related Links: Heart Attack and Stroke May Be Covered by Ohio Workers' Comp Workers’ Compensation Benefits for Firefighters With Cancer Unfair Treatment After a Work Injury in Ohio

 

It was big news in 2018 when Amazon was named one of the most dangerous places to work in America. Everybody’s favorite click and ship retailer was slammed for pushing hourly workers too hard and creating dangerous work environments for year-round and seasonal employees.

I took a look at the story around Christmastime and reminded readers that even part-time and seasonal employees may have workers’ compensation if they're injured in a fulfillment center.

Unfortunately, little seems to have changed since then, and individuals continue to suffer serious injuries because of the high-pressure environment Amazon has created.

On-Site Clinics Don’t Help

A lot of employers provide on-site health clinics, and Amazon is no exception. The problem with these clinics is the healthcare providers work for the company—not for the patient—and their goal is to patch people up and get them back to work.

In Amazon’s AmCare clinics, they don’t employ doctors. Instead, they hire certified EMTs to provide first aid care, which isn't even legal in some states. Workers report being given ice packs when they visit an AmCare clinic for acute and chronic injuries, but not being given the opportunity to report their injuries. This routine of giving first-aid and returning warehouse employees to the floor is exactly the situation that leads to chronic injuries and ultimately a disability that keeps people off work.

Your Rights as an Amazon Employee

If you work at an Amazon fulfillment center in the Columbus area, you may not have been given information about workers’ compensation, but you're still entitled to it if you're injured on the job and cannot work.

With few exceptions, no matter where you're employed, your medical bills and lost wages are covered by Ohio workers’ compensation when you're hurt at work. Employers who think they are above the law—like Amazon—may violate your rights when you suffer a work-related injury.

Protect Your Rights With Reliable Information

If you want to learn more about Ohio worker’s comp, download a free copy of my book, The Worker’s Guide to Injury Compensation in Ohio. In less than 30 minutes, you'll know how to handle filing a claim, the steps to avoid contested claims, and what to expect if you have pre-existing conditions.

If you have specific questions for me about an injury in an Amazon warehouse—or any other workplace—call me. I’d be happy to help you get the benefits you deserve. 

Related Links: Ohio Workers’ Comp Modified Work Offers Unfair Treatment After a Work Injury in Ohio Workplace Accidents That Result in Traumatic Brain Injury

 

Probably. When you're collecting workers’ comp after a workplace injury, your employer’s goal is to get you back to work as soon as possible.

Depending on your injuries, your treating physician may release you for work with certain restrictions.

If your employer can provide you with work that accommodates those restrictions, you must probably take it. However, you want to make sure it's a valid offer.

What Is Modified or Light Duty Work?

If the doctor says you're able to perform work after a workplace injury, an employer may modify your previous duties or create a new position to accommodate you. The Ohio Bureau of Worker’s Compensation (BWC) encourages employers to offer options such as:

• Transitional work. Some employers offer a program that brings workers with physical restrictions into the workplace to contribute productively under the direction of rehabilitation professionals.
• Job modification. If an employer can remove or alter the physical barriers preventing an injured worker from performing the essential functions of the job, he or she may be brought back to the job before recovering.
• Gradual return. A recovering worker could be asked to return to work on a graduated basis, slowly building up to full-time work over a 13-week period.

It costs companies to have employees off for long periods, so they're motivated to get you back to work, even if you're limited in what you can do. Not every job situation lends itself well to modification, but employers may try anyway and in their rush, cross a line.

What to Watch Out for When Offered Modified Duties

When an employer is worried about the bottom line, they can easily violate your rights as an injured worker. While you have to accept a valid offer of modified work if your treating physician approves, also be aware that:

• You're entitled to wage loss compensation if the modified work you're offered pays less than what you earned before the injury.
• A supervisor may not have the authority to offer modified work. Be sure to understand who's making the offer and confirm that it's a valid offer. 
• Workplace health centers, such as OhioHealth’s WorkHealth clinics, have mixed loyalty. They work for your employer, not for you, so they may push you back to the job when you’re not ready.
• Employers can be sneaky. They may promise you modified tasks and then not follow through by honoring your doctor’s restrictions.

When you're injured at work, your employer should treat you with respect and give you the time and space you need to heal completely before returning to full duty.

How an Attorney May Be Able to Help

An Ohio worker’s comp attorney can make sure your rights are protected when you're offered modified or light duty work. It's difficult to advocate for yourself in these situations, but I can make sure you're not being taken advantage of by your employer.

Get more information about workers’ comp in Ohio by requesting a free download of my book, The Worker’s Guide to Injury Compensation in Ohio and then call me to talk about your modified work offer.

Related Links: Voluntary Abandonment Defense in Ohio Unfair Treatment After a Work Injury in Ohio Workplace Accidents That Result in Traumatic Brain Injury

 

Some people—and, unfortunately, many employers—believe that workers’ comp recipients are gaming the system and not doing the things they need to do to get better and return to work.

However, I've found over many years of practicing workers’ comp law that my clients want nothing more than to recover and get back to the work that made them feel like contributing members of society. My clients often push for newer, better, or alternative treatments to help them heal more quickly.

The problem isn't about getting better. The problem is often gaining approval for the treatment that will help them do just that.

MCOs Must Apply the Miller Criteria to Requested Treatments

As with everything related to Ohio workers' comp, getting approval for a medical procedure, service, or treatment is a process. When you or your doctor request approval from your Managed Care Organization (MCO) for a new treatment, the state Bureau of Workers’ Compensation (BWC) requires that a three-pronged test, referred to as the Miller Criteria, be applied.

The medical service you're requesting has to meet all three of these criteria:

• It must be reasonably related to the industrial injury.
• It must be reasonably necessary and appropriate to treat the industrial injury or allowed condition.
• The costs of the services must be medically reasonable.

The MCO may consult the Official Disability Guidelines when deciding, but ultimately, the choice is up to its judgment.

Miller v. Industrial Commission Ruling

The Miller Criteria arose from a 1994 Ohio Supreme Court ruling on a case involving an injured woman who was obese. Even though her weight wasn't a factor in her workplace injury, her doctor believed it was preventing her from recovering, so he recommended that she enter a supervised weight-loss program.

Her employer’s MCO denied coverage of the program, and she appealed to the Supreme Court. The Supreme Court drafted these criteria and ruled that they must be applied to her request for medical service. Her weight loss treatment was approved, with the requirement that the weight loss would help her overcome her injury and not just ease her discomfort—standards now routinely applied to weight-loss programs paid for by workers’ comp.

The Miller Criteria were later embedded in Ohio workers’ comp law and are now applied to every treatment request, not just weight loss.

Do the Miller Criteria Sound Vague and Subjective to You?

That’s because they are. If you're facing a denial of treatment, an experienced workers’ comp attorney might have to argue for the validity of the treatment your doctor says you need.

Learn more by requesting my free guide, Worker’s Guide to Injury Compensation in Ohio. Then call my office to schedule a meeting to discuss your specific situation.  

Related Links: Unfair Treatment After a Work Injury in Ohio Releasing Medical Records to the Ohio BWC Workplace Accidents That Result in Traumatic Brain Injury

 

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. 

Related Links: Workers’ Comp Additional Allowance Without an Attorney Danger of Injuries in Beer Brewing Industry Unfair Treatment After a Work Injury in Ohio