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 the common questions we are asked about 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 is responsible for filing an Ohio workers’ compensation claim?
You are! When an injury occurs at work, you should 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 advised 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 covered as well. 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 certainly, 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 if it 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 as soon as possible. Provide a complete history of what you were doing, how you were injured, and where it hurts. Third, if you are claiming workers’ compensation, file your claim promptly. Your hospital or employer may furnish necessary paperwork and even file the claim for you, but it is ultimately your responsibility to ensure that your claim is filed with the Ohio Bureau of Workers’ Compensation and a claim number is assigned.
How long does it take to process a workers’ compensation claim?
Within 28 days, the Bureau of Workers’ Compensation (BWC) will decide to 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 as well as compensation for their lost time from work. This compensation, known as Temporary Total Disability (TTD), is paid as long as 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 more than 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 degree of permanent impairment may result in 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 of your ability to perform your job duties due to the injury. A MEDCO-14 needs to 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 the loss of bodily function, if any, that has resulted from an injury or occupational disease. It is workers’ compensation’s version of a damages award for an industrial injury. There are time limitations that 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 not the same as 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 there is a question as to whether treatment is excessive, appropriate, or cost-effective. MCOs may deny treatment they consider too expensive, even if it is treatment your doctor believes is beneficial. You have the right to appeal decisions denying treatment that your doctor believes is 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. As such, if an employer tells you not to file a claim for a work-related injury, it may be that 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 decide to allow or deny your claim. If you or your employer disagrees with the 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 issue a decision within seven days of the hearing. 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 the filing of an appeal of the district hearing officer’s decision. The staff hearing officer will make a decision within seven days of the hearing. The IC will send each party a written notice of the staff hearing officer’s decision. Each party has 14 days from the receipt of 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 issue a decision within seven days of the hearing. If the commission refuses to hear the appeal, depending upon the issue, you may be able to 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 start to roll in. We've aimed to answer all of your questions regarding receiving the medical treatment you need. If you still have unanswered 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 start getting 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 Columbus worker has the right to be treated by a doctor of his choice, as long as the doctor is a BWC-certified healthcare provider. Many times, 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 may be able to 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 maintain lists of physicians who treat industrial injuries, as well.
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, if necessary, 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. Make sure to keep all receipts for medications and treatment related to your injury in case you need to request reimbursement.
What is MMI?
Temporary total disability (TTD) compensation is payable following an on-the-job injury until such time as 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. In other words, the condition has gotten about as good as it’s going to 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, with the expectation that 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 that you may be responsible for paying 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 determine various medical issues related to your claim, including, but not limited to, whether treatment or testing is necessary, the degree of your permanent impairment, if any, and whether you have reached MMI.
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 for?
In general, medical bills should be payable in an allowed claim. You should 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 start getting medical bills?
You should forward the bills to your MCO or self-insured employer. Bills that are not paid can be appealed to the BWC for further investigation.
Can I get reimbursed for prescriptions?
Like medical bills, in general, 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 many answers to the questions we are commonly asked about compensation information. 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 when 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 are unable to 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 are unable to 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 would be entitled to 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 amount of money I am paid determined?
Your benefits are based on the amount of money you earned working for the year prior to the date of injury. In general, your Full Weekly Wage (FWW) is determined by the greater of your gross wages (including overtime) earned over the 6 weeks prior to the date of 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, you should 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 reinjury 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 would likely be charged with fraud if you collect PTD compensation while working. If you believe you have medically recovered to the point of being able to return to work, consult an attorney about options before you do.
Do I still get any benefits when I return to work?
There are other types of 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 amount of 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, that a check may only cover a portion of the standard 2-week pay period. The period covered will be listed on the payment. Rest assured, you will receive the full 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 use my health insurance to obtain medical treatment after a work injury?
Ohio runs the largest state-funded workers’ compensation program in the country, covering 244,000 state employees. Last year, the system provided medical care and wage replacement benefits to injured workers with more than 88,000 claims. For some injured workers and their families, these can be daunting figures. Worry about successfully navigating a large system or confusion about the workers’ compensation process can make employees want to find other ways to address their on-the-job illnesses and injuries. Sometimes, employers may even discourage an injured worker from filing a workers’ compensation claim. Often, workers wonder if it is possible to use their health insurance benefits to treat their injuries. While this seems like a simple option, there are specific rules concerning work injuries, and failing to follow those rules can make it difficult for injured employees to obtain the benefits they need to heal and move forward.
The Benefits of Using the Ohio Workers’ Compensation System
For those workers who fear workers’ compensation or have concerns about the effectiveness of the system, it has some key advantages over private health insurance after a work injury. While both workers’ compensation and private health insurance provide medical care to those under their programs, workers’ compensation offers additional benefits, including:
- Wage replacement – Often, workers are forced to miss work as they are treated and recover from their injuries. This means lost wages and potentially significant financial strain. Wage replacement benefits compensate workers to minimize this stress and help them remain financially afloat.
- Compensation for permanent disability – Sometimes, employees suffer injuries which result in a permanent impairment that will affect their ability to work and earn income. Depending on the severity of the disability, different benefits are available to address this future loss of earning power and income.
Private Insurance Is Not Required to Cover Work-Related Injuries
The workers’ compensation system exists specifically to address the unique needs and challenges associated with work-related injuries. The existence of these benefits effectively relieves private health insurance companies from their responsibility to those they insure when the injury or illness occurs on the job. Insurance companies do not have to cover costs that fall under the umbrella of workers’ compensation. If they pay for care related to a work injury, they may seek reimbursement from the appropriate party, known as subrogation.
Both providers and insurance company representatives will inquire on how an injury occurred, and workers should know that lying about the cause—either to avoid the workers’ compensation system or protect an employer—could be considered fraud, which is a criminal offense.
How an Ohio Workers’ Compensation Attorney Can Help
It is natural for workers and their families to have concerns about paying bills after a work injury. These concerns, however, should not keep you from seeking care. Emergency care is covered by workers’ compensation. The Ohio BWC requires injured workers to choose from a list of approved providers for treatment, though some flexibility depends on the situation. Workers’ compensation can provide the medical care and financial support injured workers need to recover and move forward, and workers have a right to these benefits. If you have been injured at work, especially if you feel unsure of your rights or your employers has discouraged you from filing a claim, an experienced attorney can help you:
- Understand your rights
- Prepare and file a claim
- Negotiate with the BWC
- State your case at a hearing if necessary
Care and compensation in Ohio typically must be secured through the state’s workers’ compensation system, and while it can feel overwhelming, it is possible to succeed. At Monast Law Office, our experienced legal team has helped many injured workers obtain the benefits they deserved. Call our Upper Arlington office today or fill out the contact form on this page to speak with a member of our team and schedule a free, no-obligation consultation to learn more about how we may help.
Can I be denied workers’ compensation benefits if I fail a drug test?
One of the main tenets of the workers’ compensation system across the U.S. is an injured employee’s ability to obtain benefits regardless of fault. In exchange for reduced liability, employers agree to provide care and compensation even if an employee played a role in the accident or situation that resulted in the illness or injury. There are, however, some key exceptions to this rule. In addition to injuries suffered in fights or that occur when an employee is in violation of company policy, drug use can disqualify workers from benefits. Consequently, many workers wonder both if their employers are allowed to perform drug tests and if it is possible to lose workers’ compensation benefits as a result of a failed test. Here, we take a look at drug testing and drug policy relevant to Ohio’s workers.
Employers’ Rights to Use Drug Testing in Ohio
Ohio employers are within their rights to perform drug tests on employees. In fact, the Ohio Bureau of Workers’ Compensation (BWC) even encourages employers to do so, offering incentives for employers to enroll in a state drug-free workplace initiative. The Drug Free Safety Program (DFSP) calls for employers to drug test employees after an accident and upon return to work as two of a number of requirements of the program. Employers are also permitted to test an employee when reasonable suspicion of intoxication or drug use arises. While this program is voluntary and not every Ohio employer will participate, it is important to know that drug testing is a common practice and may occur at your place of employment regardless of whether your employer is involved with DFSP or not.
What to Expect From a Drug Test and What They Test For
There are a number of ways to test a person for drug use, and different employers may elect to use different methods. The most common forms of drug testing include examining samples of urine, hair, blood, breath, or even sweat.
Employers most commonly follow the guidelines set by the national Substance Abuse and Mental Health Services Administration. Under these guidelines, employers will test for the presence of:
- Amphetamines (meth, speed, ecstasy)
- THC (marijuana)
- Cocaine and crack
- Opiates (heroin, morphine, oxycodone)
- Phencyclidine (PCP)
Failing a Drug Test Does Not Automatically Disqualify Workers From Benefits
So, you were involved in an accident at work and failed a subsequent drug test. What now? You may still be entitled to workers’ compensation benefits. State law mandates that an employee can only be denied benefits if:
- He or she was under the influence at the time of the accident or injury. It must be shown that the employee was, in fact, under the influence at the time the injury occurred. This means a drug test days or weeks later may not matter. Only timely tests that can scientifically and reliably indicate impairment at a specific time are relevant.
- The drug or alcohol use was the proximate cause of the injury. Proving an employee was impaired at the time of an injury is not enough. In addition, an employer must show that the impairment directly led to the accident or injury. If any other circumstances contributed to the injury other than the employee’s drug use, it can still be possible to obtain benefits.
Additionally, there are a number of other defenses against benefits denial after a failed drug test. Workers taking medication prescribed by a doctor for a legitimate medical reason, those singled out unfairly among other employees, and anyone subject to inappropriate testing methods could successfully dispute the drug test results.
If you or someone you love has suffered an injury at work, and you are worried about drug testing by your employer, contact the experienced workers’ compensation attorney at Monast Law Office. Attorney Jim Monast and his staff can share information about your rights to care and compensation, and they may be able to help you protect those rights. Call our Upper Arlington office today, or take a moment to fill out our online contact form for a prompt response from our team.