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.

We get this question frequently from people who collect workers’ comp benefits past the age of 65. Although most of your medical costs are covered by Medicare once you turn 65, if you're collecting workers’ comp for a work-related injury, Medicare won't pay for anything it thinks should be covered by the Bureau of Workers’ Compensation (BWC).

It can be very frustrating when claims are denied by both programs because one agency thinks the other should pay.

The workers’ comp team at the Monast Law Office can help you sort out these problems.

Workers’ Comp Is the Primary Benefit

The first thing to understand is that workers’ comp is your primary insurance, and Medicare— once you're eligible—will become your secondary insurance. This means that workplace-related medical bills should first go to workers’ comp and, if a claim is denied, then submitted to Medicare.

However, Medicare will only pay for healthcare costs unrelated to your work injury, so if you submit a bill that Medicare thinks should have been paid by workers’ comp, it will be denied.

What Can You Do If Both Insurers Deny Your Claim?

If you're already consulting with a workers’ compensation attorney, bring the issue to his/her attention immediately. If you have no attorney, this might be an excellent time to find one.

This back-and-forth between the BWC and Medicare can go on for a long time, leaving you to suffer in the meantime. An attorney can discover why the claim was denied by workers’ comp and, if the BWC denial is unjustified, s/he'll file an appeal to make sure they pay what you're owed. If Medicare should be paying the cost, your attorney will help you deal with that issue.

Managing Workers’ Comp and Medicare Together

Sometimes, if the BWC is taking a long time to approve a claim, Medicare may make a conditional payment—but once the BWC pays the claim, you must pay Medicare back.

Also, if you settle a workers’ comp claim for a lump sum, you must set up a Medicare Set-Aside (MSA) to pay back Medicare for any work-related costs it covers.

Call Our Team With Your Questions

We understand all this can be confusing--and, frankly, a royal pain. If you're collecting workers’ comp and have questions after a Medicare denial, please call our office in Upper Arlington. We'll give you the necessary information to help receive the benefits to which you're entitled—whether from workers’ comp or Medicare.

Please learn more about workers’ compensation in Ohio by requesting a free download of our book, The Worker’s Guide to Injury Compensation in Ohio. 

Related Links: Can I Still Collect Workers' Comp After a Job Injury If I'm Past Retirement Age? Drug Use and Obtaining Workers’ Compensation Benefits Employer Pressure to File Work Injury With Health Insurance

 

So much is still unknown about how coronavirus disease (COVID-19) will affect the workforce in Ohio, but one thing is certain—it will take a toll. The threat of infection and efforts to curb the spread are already having a major impact on workplaces throughout the state.

However, as the virus spreads, and more people get sick, what role will workers' compensation play?

Industrial Commission Hearings Canceled

From a procedural viewpoint, the effects of COVID-19 have been swift. To avoid potential exposure to the virus, the Ohio Industrial Commission (OIC) suspended all hearings scheduled for March 16–17, 2020 and announced that beginning March 18, 2020, hearings will be conducted over the phone for permanent total disability, temporary total disability or the termination of temporary total disability, wage loss, allowance, and additional allowance. OIC plans to evaluate the process and make changes as necessary.

Filing a Claim If You Get Infected at Work

On to the important question: if you believe you contracted coronavirus disease through workplace contact, can you file a claim for workers' compensation? Possibly—if you can answer yes to these questions:

• Is COVID-19 an occupational disease for you? Occupational diseases are covered by workers' comp, but what kinds of illnesses fall into this category? That depends on your occupation. For example, mesothelioma is an occupational disease for someone who worked with asbestos. Infectious diseases are generally only covered for employees required to come in contact with sick people. So, if you're a healthcare worker or emergency responder and you contract COVID-19, your illness may be covered.
• Will you miss over seven days of work? From what we know so far, the symptoms of coronavirus vary from person to person. For younger people, symptoms can be fairly mild. If you test positive for coronavirus, you cannot go to work, regardless of how sick you feel. At this time, doctors are ordering patients with the disease to be isolated for 14 days, so it's likely that you'll miss at least two weeks of work. Here, you could qualify for temporary total disability benefits.

This situation is evolving by the hour. Still, generally, if your work does not put you at greater risk of contracting coronavirus disease than the general public, you won't qualify for workers' compensation under current Ohio law. For additional information, you can read the frequently asked questions about coronavirus disease on the​ Ohio BWC website. 

Contact the Monast Law Office With Questions

If you're a client concerned about an upcoming hearing, or you're a healthcare worker who tested positive for COVID-19, please contact my office by telephone or through the contact form on this page, and I'll do my best to answer your question.

Related Links: Workers' Compensation for Occupational Disease in Ohio Workers' Comp for Respiratory Diseases in Ohio Do I Qualify For Ohio's Workers' Compensation Benefits?

 

Yes—and don't let your employer tell you otherwise. If you're injured in a workplace accident, you're entitled to collect workers’ compensation for your medical bills and lost wages—regardless of your age.

However, if you choose to retire while collecting workers’ comp, the benefits you receive could be affected.
 

Why Are More Seniors Working?

Across Ohio and the rest of the country, people are putting off retirement and staying in the workforce longer than ever. According to the National Institute for Occupational Safety and Health, one in four workers is over 55, and one in five workers is over 65. Since 1997, the employment of people over 75 has grown 172 percent. If you're a part of this growing demographic, it’s essential to understand your right to workers’ compensation if you're injured on the job.

Older people are continuing to work for various reasons. As people live longer and healthier lives, they often keep working only because they want to do something meaningful. Some skilled tradespeople—such as truck drivers, carpenters, and electricians—simply don’t have younger qualified workers coming up to replace them. And for a large number of older Americans, it’s merely a financial necessity to keep working.

While this growth in workers over 65 hasn’t led to a significant increase in the number of on-the-job injuries that occur, when older workers have an accident, they often sustain more severe injuries. What these workers may not understand is that they're just as entitled to workers’ comp benefits as their younger counterparts. 

You’re Never Too Old to Talk to a Workers’ Comp Attorney

Sometimes, when an older person is injured in the workplace, he decides—or is encouraged by his employer—just to hang up his hat and collect Social Security. However, employees who do this may be leaving valuable benefits on the table.

If you're over 65 and unable to work after an accident on the job, contact the Monast Law Office. Maximizing the benefits you can collect is sometimes a matter of timing, so before you do anything, talk to us! We're happy to outline all options and support you in asserting your right to the benefits you deserve. 

Related Links: Employer Pressure to File Work Injury With Health Insurance Understanding Statutory Permanent Total Disability in Ohio Ohio Workers’ Comp Modified Work Offers

 

If your employer is among the growing number of companies across the country that provides access to medical care in the workplace, you may be grateful for the convenience. But if you're injured at work, you may wonder if you have to see the company doctor.

Depending on your employer’s policies, you may have to report your injury to the on-site medical clinic.

However, if your injury is severe enough to warrant a workers’ compensation claim, understand that you have the right to choose the doctor you want to treat your illness or injury, as long as the doctor is certified by the Ohio Bureau of Workers’ Compensation (BWC).

Potential Problems With Company Doctors

Workplace medical clinics, such as Amazon’s Amcare clinics, may be offered as a perk for employees, but workers should recognize the potential for a conflict of interest. Because company doctors and nurses are paid by your employer, their loyalty may be to it, rather than to you as their patient.

When an insurance or workers’ compensation claim is a possibility, the onsite doctor may feel pressured to save the company money by downplaying your injury, so you don’t file a claim. While the onsite clinic may be an excellent option for easy and convenient first aid for a minor injury, see an outside doctor for anything more serious.

Getting the Best Care for Your Workplace Injury

If you're injured at work, you're free to go to the emergency room or your personal doctor for the initial medical evaluation. However, after that, you're required to choose a BWC-certified doctor for treatment. The company doctor may be BWC-certified, but your employer can't require you to get your treatment there—and you would be smart to look for a healthcare professional who doesn't work for your employer.

Under Ohio workers’ comp law, you're entitled to do the following to get the best possible care for your illness or injury:

• Get a second opinion. To confirm the diagnosis and treatment plan provided by the first doctor, you can always seek a second opinion from another BWC-certified doctor.
• Switch doctors. If you don’t connect with the first doctor you choose or are unhappy with the level of care you are receiving, you can change to another BWC-certified physician—but you have to notify your Managed Care Organization of the switch.
• Talk to a workers’ comp attorney. If, at any point in the workers’ comp process, you feel you're being mistreated or denied certain rights by the employer, contact an attorney immediately.

Monast Law Office Wants to Help You Get the Best Care Possible

If you're being pressured to use a company doctor or are struggling to find the right outside doctor, contact my office and talk to my team. You can also learn more about your right to workers’ compensation by requesting a free download of our book, The Worker’s Guide to Injury Compensation in Ohio.  

Related Links: Ohio Workers’ Comp for Back Injuries Unfair Treatment After a Work Injury in Ohio Tips for Your Ohio Workers’ Compensation Doctor Visit

 

People use the word “disability” to refer to many kinds of insurance programs. If someone says they’re “on disability,” they may mean they're collecting veteran’s disability, supplemental security income, Social Security Disability Insurance (SSDI), or private long-term disability (LTD) insurance.

These are vastly different programs that all do the same thing—provide financial assistance when the claimant cannot work due to a disabling condition. You should know which programs apply to you and how they work together.

SSDI Is a Government Program, While LTD Insurance Is Optional

If you worked and earned a paycheck in the United States, you have most likely paid into the Social Security system. The Old-Age, Survivors, and Disability Insurance tax is deducted from your paycheck each month. If you become disabled, you can apply to receive these benefits, regardless of your assets and income. You'll have to meet fairly stringent criteria, including having enough work credits and meeting the Social Security Administration's (SSA) medical standards of disability.

If you purchased long-term disability insurance through your employer, you could also claim benefits on this policy. These employee benefits are governed by the Employee Retirement Income Security Act (ERISA). An attorney who handles ERISA cases can help you understand this coverage or if your application is denied. Generally, it's easier—and faster—to get approved for private LTD benefits than it is for SSDI. 

How the Two Programs Work Together

This is the tricky part. Some LTD policies require that you also apply for SSDI within a specific timeframe and, if approved, will lower their payments to you. This is a way LTD policies shift their disability payment burden to Social Security.

Likewise, when the SSA notices that you're collecting on an LTD policy, it will consider that income and reduce payments to you. If your LTD claim is approved before your SSDI claim, but you're eventually awarded SSDI benefits, your LTD insurer may require you to reimburse them some of what you've collected so far.

Confused? Contact ERISA Attorney Jim Monast Today!

If you have long-term disability insurance through your employer and were denied—or your insurer is demanding that you pay it back after an SSDI approval—contact Monast Law Office. We handle ERISA cases and can help get the benefits to which you are entitled. To learn more about the long-term disability application process, request a free copy of our book, How Insurance Companies Sabotage Disability Claims. 

Related Links: Do ERISA Rules Apply to Government Benefits? Filing a Successful Claim for Long-Term Disability in Ohio Denied Long-Term Disability Benefits? ERISA Attorney Jim Monast Can Help!

 

Your Ohio employer is required by state law to carry workers’ compensation insurance. This coverage kicks in if you're injured in a workplace accident or develop an occupational disease.

However, workers’ comp isn't an optional benefit. If you're seeking medical treatment because of a job-related injury, you must go through the workers’ comp system, not your health insurance.

So what should you do if your employer is pressuring you to submit your work injury to health insurance? First, don’t do it. And second, call an Ohio workers’ comp attorney.

Why Would an Employer Want You to Avoid Workers’ Comp?

When you file an injury report at work, your company—or someone working for it—may try to dissuade you from applying for workers’ comp. You might be told that workers’ comp approval takes too long or that you’ll probably be denied. Someone in the company or with the insurance carrier may try to convince you that you’d be better off just going through your health insurance. This is because when you use health insurance for a claim, it doesn’t cost your employer anything.

A workers’ comp claim costs your employer because it's paying the premiums—not you. And the more claims made by workers, the higher company premiums may become.

Why You Should Ignore Your Employer

While your employer may be right that a workers’ comp claim could take a while to be approved and your application could be denied, this doesn’t mean you should turn to your health insurance. Here are a few good reasons for that:

• You could be breaking the law. Your primary care provider should ask if your injury happened at work. If you lie and tell them no, you would be committing insurance fraud, which could land you in jail.
• Health insurance doesn't provide wage loss benefits. If you're forced to take time off from work to recover from your injury or illness, workers’ compensation will pay your lost wages. Without workers’ comp, you must use sick and vacation time, which isn't right.
• You could lose coverage altogether. If your health insurance company discovers that you're using your coverage for a work injury, your benefits may cease. It may be too late to file the workers’ comp claim, so you'll be paying out of pocket for all costs related to the injury.

These potential consequences aren't worth the risk. You should have workers’ comp benefits and shouldn't be coerced out of using them.

You May Need a Workers’ Comp Attorney on Your Side

If you're feeling pressured by your employer after a workplace accident, contact Monast Law Office soon. Not only can I file a successful claim quickly, but I can also help you stand up to your employer. Fill out the contact form on this page or call my office today to discuss your situation. You may also want to request a free copy of my book, The Worker’s Guide to Injury Compensation in Ohio.

 

Related Links: Using Your Private Health Insurance After a Work Injury Unfair Treatment After a Work Injury in Ohio Losing a Job After a Work Injury in Ohio

 

You suffered an on-the-job injury that required medical treatment but hasn't forced you to stop working. If you filed a medical-only workers’ comp claim and missed seven or fewer days of work, you may take advantage of remain-at-work programs to help manage the limitations caused by your injury without missing more workdays.

Supporting You on the Job

If you're having difficulty doing your job after a work-related injury, you can contact your Managed Care Organization (MCO) to ask for specialized services to help you continue to do your job. If the MCO determines you're eligible for these services, it will develop a plan, coordinate the services, and pay for them.

Some of the vocational programs that may be available to you include:

• Ergonomic study. An ergonomic study tries to examine the work environment and identify factors that prevent you from performing tasks comfortably. The next step would be to alter the environment to suit you better.
• Tools and equipment. The MCO might pay for specialized devices, furniture, or other material that allow you to do your job during injury recovery.
• Limited work hours. Returning to the job gradually by only working a few hours a day or a few days a week may make it possible for you to do tasks comfortably.
• On-the-job training. Injury limitations might require you to learn an entirely new position. Your employer may offer on-the-job training to transition into a new role.
• Physical or occupational therapy at work. You may perform specific tasks successfully if you have easy access to a physical therapist. Treatment may be offered through specific remain-at-work programs.

As long as you have received no workers’ comp wage-loss benefits yet, you should be eligible for workers’ comp remain-at-work services.

How Monast Law Can Help

If you're struggling to do your job after a medical-only workers’ comp claim and can’t get assistance from your MCO or your employer, contact my office to see if I can help. Meanwhile, request a free copy of my book, The Worker’s Guide to Injury Compensation in Ohio, for additional information. We've helped hundreds of injured workers just like you get the benefits they deserve, and we can help you, too. 

Related Links: What Is Vocational Rehabilitation? Unfair Treatment After a Work Injury in Ohio Do I Have to Use Sick Time for My Work-Related Injury?