Answers to Workers’ Compensation Questions From a Columbus Attorney
Could you be fired for filing for workers’ comp? Can an employer refuse to provide workplace injury compensation? Get fast answers to your injury questions by browsing our work injury FAQ page.
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General Workers' Compensation Claim FAQs
Columbus employees and workers throughout Ohio who suffer injuries on the job normally have many questions running through their mind. Here we have provided many answers to common questions we are asked regarding general claim information. We have also provided many questions and answers regarding medical treatment and receiving compensation.
- Who is responsible for filing an Ohio workers’ compensation claim?
- Do I qualify for workers’ compensation benefits?
- What kind of injuries are covered by workers’ compensation?
- Do I need an attorney for my workers’ compensation case?
- How do I claim workers' compensation?
- How long does it take to process a workers’ compensation claim?
- What types of benefits will I receive?
- What is a C84?
- What’s a MEDCO-14?
- What is permanent partial disability?
- If my injury happened at work, why is my employer denying treatment?
- What if my employer tells me not to file a workers' compensation claim?
- Can I appeal a denied workers' compensation claim?
Who files an Ohio workers’ compensation claim?
You do! When an injury occurs at work, immediately report the accident to your employer. They are supposed to help you file the claim with the company’s Managed Care Organization (MCO). Reporting the claim on the BWC website is the Bureau’s preferred way of filing a claim. When you file a claim online, you will immediately receive a claim number. Learn more about filing a claim if you have already seen a doctor.
Do I qualify for workers’ compensation benefits?
Unfortunately, the answer is not so simple. Workers' compensation laws are very complex and it is sensible to work with an experienced Columbus workers compensation attorney. It really does depend on your individual situation. Please call our office at (614) 334-4649.
What kind of injuries are covered by workers’ compensation?
In Ohio, workers’ compensation covers physical injuries sustained in the course of and arising out of employment. Pre-existing physical conditions substantially aggravated by a work injury/incident may also be covered. Psychiatric/psychological conditions that develop from or, if pre-existing, are substantially aggravated by physical injuries are also covered. Ohio is one of a minority of states that does NOT recognize as compensable psychiatric/psychological conditions that develop without a corresponding physical injury.
Do I need an attorney for my workers’ comp case in Columbus?
Not all claims involve serious injuries and not all claims need attorney involvement. If an injury is relatively minor, requiring maybe a trip to the emergency room and a stitch or two with no residual impairment, it may go through without a hitch. It’s likely you will want to talk with a Columbus attorney who specializes in workers’ compensation claims if your injury is serious, will likely involve lost-time from work, and/or is being contested by your employer and/or the BWC. Learn more
How do I claim workers' compensation in Columbus?
First, report the injury to your Columbus or Ohio employer in writing. While reporting in writing isn’t a legal requirement, doing so documents your actions and lessens the possibility that your claim will be contested. Second, seek medical attention from an urgent care facility, hospital emergency room, company nurse, or doctor soon. Provide a complete history of what you were doing, how you were injured, and where it hurts. Third, if you are claiming workers’ compensation, file your claim promptly. The time you have to file a claim is limited by the statute of limitations. Your hospital or employer may furnish necessary paperwork and even file the claim for you, but it is ultimately your responsibility to ensure that your claim is filed with the Ohio Bureau of Workers’ Compensation and a claim number is assigned.
How long does it take to process a workers’ compensation claim?
Within 28 days, the Bureau of Workers’ Compensation (BWC) will allow or deny your claim. By responding to any inquiries from them or from your managed care organization (MCO), you will speed up the decision process and receipt of benefits.
What types of benefits will I receive?
Injured workers in Ohio are eligible to receive medical treatment for their work-related injuries and compensation for their lost time from work. This compensation, known as Temporary Total Disability (TTD), is paid if the injury results in more than a week off work. If the lost time is less than a week, no compensation is payable. If it’s between one and two weeks, only the period during the second week is compensable. If over 2 weeks, it’s all paid.
Temporary Total Disability compensation is paid based on a percentage of the worker’s earnings for one week, 6 weeks or 52 weeks prior to the injury, depending on how long the period of disability lasts. Injuries resulting in some permanent impairment may permit an additional award of compensation known as permanent partial disability.
What is a C84?
The Ohio Bureau of Workers’ Compensation requires Form C84 as proof of ongoing temporary total disability. The injured worker must complete the form, verifying the period of disability and that she has not worked and has not received other wages during the period of temporary total disability. These forms must be periodically updated for compensation to continue. Your doctor must complete a separate form certifying temporary total disability. Both forms are required before compensation can be paid.
What’s a MEDCO-14?
A MEDCO-14 is a Physician’s Report of Work Ability. Your doctor completes this form to certify that you are temporarily and totally disabled due to your work injury or to identify any restrictions on your ability to perform your job duties due to the injury. A MEDCO-14 must be submitted every time you submit a C-84.
What is permanent partial disability?
Permanent partial disability (PPD) is a form of compensation that may be payable following a work injury. It is paid by the Ohio Bureau of Workers’ Compensation or a self-insured employer following an exam (or sometimes multiple exams) at which a physician is asked to provide an opinion regarding lost bodily function that has resulted from an injury or occupational disease. It is workers’ compensation’s version of a damages award for an industrial injury. Time limitations may apply in requesting an award of PPD. In addition, the percentage of disability resulting from an injury may be disputed by the injured worker, the employer, and/or the BWC. In such situations, the Industrial Commission conducts a hearing to determine a proper award. This is differs from a settlement of your claim.
If my injury happened at work, why is my employer denying treatment?
Treatment may be denied by your employer, your managed care organization (MCO), or the BWC if excessive, inappropriate, or not cost-effective. MCOs may deny treatment they consider too expensive, even if it is treatment your doctor believes is beneficial. You may appeal decisions denying treatment that your doctor believes appropriate.
What if my employer tells me not to file a workers' compensation claim?
Penalties may be assessed against employers who fail to provide workers’ compensation coverage. If an employer tells you not to file a claim for a work-related injury, maybe s/he tried to cut costs by not obtaining the mandatory workers’ compensation coverage. Reporting the injury would notify the BWC of the employer’s non-compliance. It could also be the employer has had so many claims filed against them they fear the BWC will increase their insurance premiums.
Injured employees are still covered by the workers’ compensation system even if their employer is non-complying, so it is still best to file a claim. Learn more
Can I appeal a denied workers' compensation claim?
The BWC has 28 days to allow or deny your claim. If you or your employer disagrees with BWC’s decision, either party can file an appeal with the Industrial Commission (IC) within 14 days.
There are three hearing levels for workers’ claims at the IC:
• District level hearings — These take place in locations throughout Ohio within 45 days of filing an appeal. The district hearing officer will decide within seven days. The IC sends both parties a written notice of the hearing officer’s decision. Each party has 14 days from receipt of the district hearing officer’s decision to file an appeal to the next level.
• Staff level hearings — These take place within 45 days after an appeal of the district hearing officer’s decision is filed. The staff hearing officer will decide within seven days. The IC will send each party a written notice of the staff hearing officer’s decision. Each party has 14 days from receiving the staff hearing officer’s decision to file an appeal to the next level.
• The commission level — After studying the staff hearing officer’s decision, the commission either agrees to hear the appeal or refuses to permit further appeal. If the commission accepts the appeal, a commission hearing will occur within 45 days. The commission will decide within seven days. If the commission refuses to hear the appeal, depending upon the issue, you may appeal the matter to the court within 60 days after receipt of the commission order. Learn more about your options if your workers' comp claim has been denied.
Medical Treatment FAQs
It only takes a split second for an accident at work to turn a person’s life upside-down as the medical bills roll in. We've aimed to answer all of your questions regarding receiving the medical treatment you need. If you still have questions about workers' compensation or receiving medical treatment, please contact our office at (614) 334-4649. We've also answered many FAQs regarding general claim info and receiving compensation.
- Who approves treatment?
- Can I go to my family doctor?
- I want to change doctors. How?
- I can’t get my prescriptions filled. What should I do?
- What is MMI?
- Why do I have to wait for treatment?
- What is Independent Medical Examination (IME)?
- How will I know if a doctor is certified by BWC?
- How do I get my medical bills paid for?
- What should I do if I get medical bills?
- Can I get reimbursed for prescriptions?
Who approves treatment?
Requests for treatment are submitted by your doctor to the MCO assigned to your case. If your employer is self-insured, requests are sent to your employer’s TPA (third-party administrator). The MCO or TPA may request additional information from your doctor or a medical review before approving the treatment. Denials of treatment may be appealed.
Can I go to my family doctor?
An injured Ohio worker may be treated by a doctor of his choice, as long as the doctor is a BWC-certified healthcare provider. Often, family doctors do not treat job-related injuries because they are concerned about the paperwork involved and/or the hassles associated with claims procedures. Your family doctor refer you to a BWC-certified provider. You can also ask for recommendations from co-workers, your union representative, your attorney, or other people who have received treatment for a work injury. The BWC and your MCO also maintain lists of physicians who treat industrial injuries.
I want to change doctors. How?
You may decide to change physicians for a variety of reasons, ranging from the retirement of the provider, travel distance, or a desire for a different treatment option. Injured workers who wants to change physicians should notify the MCO and submit BWC Form C23. If your employer is self-insured, this form should be sent directly to the employer or its TPA.
I can’t get my prescriptions filled. What should I do?
Your pharmacist can explain why payment for a prescription is denied. It may be a coding error or a concern that the medication is inappropriate. Your doctor can provide additional information regarding the need for and the propriety of the medication. If the bill was denied pending the allowance of the claim, you will be reimbursed once your claim is allowed. Keep all receipts for medications and treatment related to your injury if you need to request reimbursement.
What is MMI?
Temporary total disability (TTD) compensation is payable following an on-the-job injury until the injured worker is released to return to her former job, actually returns to that job, or is determined to have reached maximum medical improvement (MMI). MMI indicates that the injury has reached a treatment plateau under the current treatment regimen, meaning it has gotten about as good as it will get! Although temporary benefits are no longer payable if the condition is no longer improving, other forms of compensation may be available for injured workers whose TTD has been terminated after a finding that their condition has reached MMI.
Why do I have to wait for treatment? I just want to get back to work!
During the initial processing period (i.e., when the Ohio BWC or your employer is deciding whether to allow or contest the claim), physicians may be reluctant to provide treatment, as there is no guarantee they will be paid. Some doctors will provide treatment, pending the allowance of the claim, expectating the claim will be allowed or that you have other means of paying (for example, other insurance) should the claim be disallowed. While your claim is considered, avoid large unpaid medical bills you may have to pay should your claim be disallowed. Once the claim is allowed, providers (other than pharmacies) who have treated you for the job-related injury should submit their bills to your MCO.
What is an Independent Medical Examination (IME)?
An independent medical examination (IME) is a medical evaluation scheduled by the BWC or employer's representative to opine about various medical issues related to your claim, including, but not limited to, whether treatment or testing is necessary, the degree of your permanent impairment and whether you have reached MMI. When scheduled by an employer, I believe it more accurate to describe this as a DME: Defense Medical Exam. Employers hire the same doctors over and over to render medical opinions on their behalf--they are not "independent".
How will I know if a doctor is certified by BWC?
The simplest way is to ask your doctor when you make the initial appointment. You may also call the employer's MCO, the BWC at 1-800-644-6292, or research BWC certified providers (by name, location and/or specialty) at the BWC's website.
How do I get my medical bills paid?
Medical bills should be payable in an allowed claim. Give your claim number to all of your medical providers who treat you in your claim. They will then request authorization for the medical treatment they request from the MCO. 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.
How can I prepare for my workers' comp hearing by phone?
If your initial claim for workers' comp in Ohio was denied by the Bureau of Workers' Compensation (BWC) and you filed a timely appeal, your next step will be a hearing with the Ohio Industrial Commission (IC). Once upon a time in the good old days before CoronaPalooza, these hearings were held in person. Since starting back up after the initial shut down, however, hearings before the IC have been held by phone. It seems likely this will continue for the foreseeable future, given that the IC has made a significant investment in having their hearing officers work from home. We want our clients to understand the importance of these hearings and prepared to do their best.
Tips for a Successful Telephone Hearing
As my client, you will be informed of every step of the claim process. I will make sure you know your hearing's date and time and that you are comfortable with the procedure for calling in, typing in your code, and accessing the hearing. Also, I want all my clients to be prepared with these tips for success:
- If you are using a cell phone, make sure it is charged, you have a strong signal, and you have enough minutes to cover the call. The time allotted for your hearing is indicated on your hearing notice.
- Call in from a quiet place where you will not be interrupted—preferably at home.
- Set aside plenty of time for the hearing. The IC conducts several hearings each hour. You might have to wait for your turn, so allow them time and be patient.
- Do not use your phone's speaker or poor quality headphones or earbuds (some hearing officers do not permit headphones or earbuds; they will tell you this at the beginning of the hearing). Talk into the phone like a normal phone call.
- Call in five minutes early. You will be placed in a virtual waiting room. If everyone involved in your case is there on time, your hearing could be first, and you will be done that much faster.
- Do not interrupt when someone else is talking.
- Answer the questions that are asked of you succinctly.
- If you have trouble hearing, say so politely and respectfully. Do not pretend you can hear just to keep things moving.
In general, remember all the rules you were taught (or should have been taught!) as a child. Be respectful—using "Sir" or "Ma'am" is appropriate. Don't speak unless you are spoken to. Speak clearly and confidently. You want the hearing officer on your side, so you do not want to offend or anger them. Let common sense prevail!
Monast Law Office Is Ready for Anything
Had you told me a year ago that we would be conducting Industrial Commission business by telephone, I would have said you were crazy. So much has changed in a year, but the BWC and the IC have pivoted to keep the workers' comp train chugging, and my team has rolled with the punches. We will help you put your best foot forward no matter what is thrown at us. Meanwhile, please download a free copy of my e-book, The Worker's Guide to Injury Compensation in Ohio, to learn more about workers' comp issues in Ohio.
Does Ohio workers' comp cover spinal cord stimulator (SCS) implantation?
A workplace fall or other accident has left you with chronic back pain. Physical therapy and pain medication haven't solved the problem, so your physician recommends implanting a spinal cord stimulator (SCS). You're willing to try anything that will stop the pain and get you mobile again, but you're worried about the procedure and the cost.
If you're collecting workers' comp for the back injury and your doctor orders SCS, it should be covered by workers' compensation. Here's what you should know.
How Spinal Cord Simulators Work
It may sound like a space-age medical device, but the idea behind SCS is actually simple. A small device, similar to a heart pacemaker, is implanted in the lower back. Tiny wires called electrodes are placed in the space between the vertebrae and the spinal cord. When the patient feels pain, he uses a remote control device to send electrical impulses from the device to the spinal cord, blocking further pain signals from reaching the brain. The implantation process is minimally invasive, and for some patients, it is an effective treatment.
However, not everyone is a candidate for SCS, and uninsured patients can pay as much as $50,000 out of pocket for the device and implantation. That is why it's so important to make sure your workers' comp claim will cover it. This will likely involve the recognition of specific conditions in your claim.
Why You May Need the Help of an Attorney
Back injuries can be tricky workers' comp claims. Because debilitating back pain is often the result of wear and tear over time, it's sometimes hard to connect the injury to a specific workplace incident. Even if you can document a fall or other on-the-job accident and connect it to your chronic back pain, a Bureau of Workers' Compensation doctor could claim you had an underlying degenerative condition and that your resulting disability wasn't caused solely by the workplace accident. This argument could come up again when you request coverage for SCS implantation.
However, as your workers' comp attorney, I'll gather the evidence to support coverage of the treatment you need to relieve your back pain.
Learn more about the workers' comp process and getting approval for treatment by requesting a download of my free book, The Worker's Guide to Injury Compensation in Ohio. Then, call me to discuss SCS implantation or any other concerns about your workers' comp claim.
What is a medical-only workers' comp claim?
The cost to treat any injury in the workplace should be covered by workers' compensation, no matter how minor it is. If you sustain an injury that requires medical treatment but doesn't keep you off the job for over eight days, you have a medical-only workers' comp claim. If your employer is cooperative, these claims are fairly simple to manage on your own.
An injury that is serious enough to sideline you for more than a week might cause a lost-time claim, which is a little more complicated. We explain the difference here.
If you're hurt at work and report your injury, get prompt medical treatment, and are back to work in seven days or fewer, you should be able to file a workers' comp claim to have your medical costs covered by workers' comp.
For these types of injuries, you may not even need to submit medical evidence to the Bureau of Workers' Compensation (BWC) to determine if the injury is compensable:
- First-degree burns over less than 10 percent of your body
- Superficial lacerations
- Minor contusions
- Insect stings
- Superficial foreign body in the eye
- Corneal abrasion
- Superficial abrasion
These and other injuries have presumptive approval with the BWC, and you should have no problem getting your treatment covered.
If your injury or illness prevents you from working for eight days or more, you might qualify for lost wage benefits. You would have to file a lost-time claim and provide medical evidence of your inability to perform work tasks.
If your allowed injury or illness requires you to miss over 14 days of work, you'll be compensated for the entire period of time you're disabled. Lost-time claims can be more difficult to manage, and you might need help submitting an initial claim or an appeal if your claim is denied.
Monast Law Office Is Here for You
Not every workers' comp claim requires the help of an attorney—in fact, very few do. However, when your employer is playing games with you or a legitimate claim has been denied, then it's probably time to talk to an experienced workers' comp lawyer. Learn more by requesting my free guide, The Worker's Guide to Injury Compensation in Ohio, and then contact my Columbus office to talk to someone who can help.
As a worker on a family-owned farm, can I get workers’ compensation if I’m hurt on the job?
Every employer in Ohio must carry workers’ compensation insurance. This includes small farms and orchards with only a few seasonal employees—even if those employees are family members.
If you're hurt on the job, and your employer has the required insurance, you'll file a claim with the Bureau of Workers’ Compensation (BWC).
What If My Employer Doesn’t Have Workers’ Comp Insurance?
Small farms rarely turn much of a profit, and survival is often a matter of cutting costs to the bone. If the farm owner where you work hasn't paid into the state fund to save money, they'll be fined—and more—by the BWC.
However, this won't affect your ability to collect the compensation you're entitled to receive from the BWC. The BWC has funds set aside just for this purpose. That your employer doesn't have workers’ comp also opens the door for you to sue them if your injury was caused by faulty equipment or other negligence.
What If I’m Told to File With My Health Insurance?
If you have health insurance, your uninsured employer might suggest you get medical treatment through that policy. This is a problem.
Under Ohio law, on-the-job injuries must be compensated through workers’ comp, not health insurance. To cover treatment by health insurance, you would have to lie to your doctor about the cause of your injury, and then you and your employer would be breaking the law. You could also lose your health insurance.
Farms With No Employees
For farms, the only exceptions to the workers’ compensation requirement in Ohio are sole proprietors, partnerships, or family-farm corporate officers with no employees. So, for example, if you own a small commercial farm but only you and your spouse do the work, you're not required to carry workers’ comp insurance.
However, if one of you is injured, your health insurance company could deny your claim because the injury was work-related. With no insurance coverage, one serious injury could be enough to bankrupt the farm. For this reason, it's a good idea for even owner-operated farms to carry elective workers’ comp insurance.
If You're Getting the Runaround, Call Us!
If you're hurt while working on a farm and your injuries are serious enough to require medical treatment and keep you away from work for an extended period, you're entitled to file a workers’ comp claim under Ohio law.
If your employer is trying to persuade you not to file, we suggest you talk to a workers’ comp attorney. You should have comprehensive medical treatment and lost wages, which you will get no other way. The team at Monast Law Office will help protect your rights and ensure you get the care you need after an injury at work. Call us or fill out the form on this page today.
What does the Bureau of Workers' Comp mean by maximum medical improvement?
Sometimes, an injured worker will never recover completely from a work-related injury but, if they were awarded workers’ comp temporary total disability (TTD) benefits, these are payable until the employee has healed as much as they're going to.
This point of recovery is called maximum medical improvement (MMI), and it's an important milestone in a workers’ comp claim.
How Maximum Medical Improvement Is Determined
The goal of TTD benefits is to allow an injured worker to get the medical treatment and time off work they need to recover and return to work. Your physician of record may determine, based on a medical assessment, you reached this point after treatment and sufficient recovery time. This doesn't necessarily mean you are able to return to your former job or that you're able to do what you did before the injury. Regardless, TTD benefits stop when you reach MMI, as determined by one of the following:
- Physician of record. When your workers’ comp doctor decides that your recovery has plateaued and you will not get any better, the Bureau of Workers’ Compensation (BWC) or the self-insured employer is informed and will terminate TTD benefits as of the date indicated by the doctor.
- Independent Medical Exam (IME). If it's determined at one of your periodic medical exams that you have reached MMI, it will be reported to the BWC, which confirms the conclusion with your physician of record. If the doctor agrees, your TTD benefits will be terminated.
- Ohio Industrial Commission. If your physician disagrees with the IME conclusion, the BWC will refer the case to the Ohio Industrial Commission (IC) to make the final determination. You and your attorney will be notified of the date for the hearing. If the IC decides that you have reached MMI, you can appeal the decision.
If your TTD benefits were terminated because you have reached MMI, you still have options. If you return to work making less money than you did before, you might be eligible for wage loss benefits. If you can’t return to any work, you might qualify for permanent total disability benefits. You could also qualify for a retraining program.
Let Monast Law Office Help You
I've been practicing workers’ comp law in Ohio for over 35 years. If you were told you have reached maximum medical improvement, you need help understanding what that means and your options. Request my free guide, The Worker’s Guide to Injury Compensation in Ohio, and then contact my Columbus office to talk to someone who can help.
Unum denied my claim for long-term disability. What can I do?
If you work for Ohio State University, Wendy’s International, or Worthington Industries, and you opted into their long-term disability (LTD) insurance coverage, you probably have a policy with Unum Group. When a huge international insurance company like Unum denies your claim, you shouldn't attempt an appeal without the assistance of an ERISA attorney.
Monast Law Office would be happy to review your claim and discuss the possibility of an appeal.
Your Attorney Will Help You Throughout the Process
When Unum denies your claim, you have a right to appeal. While the Employee Retirement Income Security Act (ERISA) guarantees this right, it also requires that you follow a rather complicated and restrictive process.
When appealing a Unum denial, we recommend that you:
- Call an attorney. Not every disability attorney accepts claims involving ERISA, but it's important that you find one who does as soon as you receive an adverse benefits decision.
- Understand your policy. Many claims are denied because the condition that caused your disability is excluded or is considered pre-existing. Knowing what's excluded in your policy before appealing saves you time and money.
- Work on your appeal immediately. ERISA limits the time you have to file a complete appeal. Your attorney knows of these deadlines.
- Get your claim file from Unum. You and your attorney can review the file to see what you’re up against in trying to win an appeal. What was the denial based on? Did Unum correctly represent your job duties? What evidence does it have? All of this information is in the file.
- Gather your evidence. You'll have to stack your Unum appeal with an abundance of evidence proving that you're unable to work, have seen doctors, and followed treatment plans. You only get one opportunity to present this evidence, so your attorney will make sure your appeal is loaded with the appropriate information.
If this process sounds stressful and overwhelming, that’s because it is. However, when you work with an attorney experienced with ERISA appeals, you don’t have to carry the burden alone.
Request Our Free Guide to ERISA Claims
You’d have to be an insurance adjuster to know all the tactics an insurer will use to deny your long-term disability claim, but you can understand more about what you’re up against by calling my office and by downloading and reading my free resource, How Insurance Companies Sabotage Disability Claims. If your LTD claim has been denied, please contact Monast Law Office for help.
Should I take a lump-sum payout for my long-term disability claim?
When you suffered a catastrophic injury and could not work, it might have been a struggle to get the long-term disability (LTD) benefits to which you were entitled. Now that your claim is approved, an important decision in the next part of the process is whether you want to payments over time or in one lump sum. The insurance company will do what costs the least money, so if it's offering a lump sum, consider several factors before you accept.
Advantages of a Lump-Sum LTD Payment
The biggest advantage of accepting a lump-sum payment is that it ends your relationship with the carrier. Rather than dealing with the company over a period of months or years as you get monthly payments, you'll receive one payment and be done with the process once and for all.
A lump-sum payment is also helpful if you have substantial and immediate financial needs—such as altering your home to accommodate your disability or paying off a high-interest credit card.
The Downside to a Lump-Sum Payment
An important factor you must consider when thinking about a lump-sum payment for LTD benefits is your own spending habits. If you're not good at budgeting and planning for the future and are likely to spend the money all at once on frivolous things, getting a lump-sum settlement is probably not a good idea.
Also, a lump-sum payment will always amount to less than the total you would get over time. Just how much less is another important consideration.
Finally, you might owe income tax on your LTD benefits, depending on how the insurance premium was paid. If you paid for the policy with after-tax dollars, you wouldn't owe income tax. However, if your employer provided the policy or you paid with pre-tax dollars, you must pay income tax. This could have a negative impact if you accept a large settlement in one payment.
Your ERISA Attorney Can Help You Decide
If you worked with an attorney to get the LTD benefits you deserved, your attorney will help you decide whether a lump sum makes sense for you. As an ERISA attorney, I make sure your rights are protected throughout the entire claim process. If you want to learn more about ERISA and long-term disability policies, request a copy of our free book, How Insurance Companies Sabotage Disability Claims.