Answers to Workers’ Compensation Questions From a Columbus Attorney
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As a teacher’s aide, can I get workers’ comp if I'm injured at school?
Teachers’ aides are some of the hardest-working employees in a school. Sometimes called para-professionals or para-pros, these helpers assist certain students and help with controlling chaos in the classroom.
Because of the hands-on nature of their work, they're also prone to be injured on the job. It’s important for these valuable school employees to understand that they can file for workers’ compensation if they're hurt at work, even if they're part-timers.
How Aides Get Hurt at School
If an aide is assigned to work with a student who's health impaired, their job will be physically demanding. Working with students with cognitive or behavioral challenges, as my daughter-in-law does, could mean they're at risk of being assaulted. Teachers’ aides are in the trenches with students, so to speak, and they suffer injuries as often as, or even more frequently than, classroom teachers.
Some causes of para-pro injuries include:
- Outbursts and attacks. When an aide is assigned to work with an individual student, they could bear the brunt when the student lashes out or has a tantrum. Being hit, knocked down, or shoved against a wall can cause serious injuries.
- Playground incidents. Teachers’ aides often serve as playground monitors and are the first on the scene if there's a fight. They can also suffer trip and fall injuries, be hit by playground equipment, or sustain a strain or sprain injury while playing with children.
- Handling wheelchairs. Pushing a student in a wheelchair, moving an empty wheelchair, and lifting a student in an out of the chair can all take their toll on a teacher who must do these tasks all day, every day.
- Lifting and restraining. Teachers’ aides are often responsible for physically restraining students having a meltdown and may have to lift and carry the child away to protect other students. These are physically-demanding tasks.
If you get to where the physical demands of your job as a teachers’ aide cause injuries that prevent you from working, you can qualify for workers’ compensation to pay for your medical bills and lost wages, even if you only work part-time. Learn more about your rights as a worker in Ohio by downloading my free book, The Worker’s Guide to Injury Compensation in Ohio.
If you have questions after an injury at school, call my office to speak to one of my knowledgeable team members.
Why was my short-term disability claim denied?
You opted into short-term disability insurance because you were worried about how bills would get paid if you could not work for several months. You thought you were doing the responsible thing to protect your family if an illness or injury prevented you from earning a paycheck. However, when the worst happened, and you had to make a claim, you were denied. How can this be?
It’s All in the Fine Print
Employers in Ohio aren't required to offer short-term disability policies to their employees, but some do. With this coverage, people unable to work for several weeks or months due to a non-work-related injury or illness can file a claim to recover some lost income and additional compensation while temporarily disabled. The conditions covered and the time you're insured depend on the terms of your specific policy.
Some short-term disability policies offer as little as 30 days, while others cover you for a year. However, no policy covers illness or injury caused by your job, because those circumstances fall under the umbrella of workers’ compensation.
Why Was Your Claim Denied?
Short-term disability claims are usually denied for one of these reasons:
- The condition isn't covered. You have to understand the terms of your policy before you apply for benefits. Some policies cover time off for childbirth by C-section, for example, and others don't.
- You didn't provide adequate medical evidence. Even though your disability is only expected to be temporary, you still have to provide medical proof that you're unable to work. If the insurer doesn't think the evidence is sufficient, it will deny the claim.
- The insurer thinks you're lying. Insurance adjusters check out your social media, follow you around, and even talk to your friends and coworkers to find a reason to deny your claim. If they think your behavior contradicts your application for disability, they could deny it.
If you paid your premiums and are legitimately disabled, get the insurance benefits you deserve. If you're denied, you can file an appeal, but need the help of an attorney who handles these kinds of cases. Employer-sponsored benefits are governed by the Employee Retirement Income Security Act (ERISA) and are subject to strict regulations.
Contact Monast Law Office With Your ERISA Claim
As a dedicated workers' comp attorney for over 30 years, I'm honored to provide winning strategies for clients denied an employee benefit covered by ERISA, including short-term disability. Contact our office in Columbus to discover if we can help. To learn more about ERISA and the appeals process, request a free download of our book, Don’t Go It Alone: How Insurance Companies Sabotage Disability Claims.
What changes are coming in 2020 to workers’ comp law in Ohio?
Ohio House Bill 81 (HB 81) was signed into law by Governor DeWine on June 16, 2020. What started as an initiative to expand workers’ comp coverage for post-exposure testing of safety officers will now address several other key issues when it goes into effect later this year.
While the changes might just be legalese to a layperson, they represent significant changes to workers’ comp attorneys like me.
Ohio Workers' Comp Changes Effective September 15, 2020
While testing of peace officers, firefighters, emergency medical workers, and corrections officers exposed to blood and bodily fluids on the job is already covered by workers’ comp, HB 81 expands that coverage. Beginning September 15, 2020, workers' comp extends to employees of detention centers and includes exposure to drugs or other chemical substances. Also, these changes will be implemented when the law goes into effect:
- The voluntary abandonment doctrine regarding temporary total disability claims—which had been based on 25 years of case law—will now be subject to new, specific standards.
- The statute of limitations for reporting violations of specific safety standards will change from two years to one year from the date of injury.
- Funeral benefit cap increases from $5,000 to $7,500 but isn't retroactive.
- Employers can no longer withdraw from a proposed settlement agreement when the claim exceeds their premium calculation, and the employee in the claim no longer works for them.
- HB 81 changes the date that the Industrial Commission can invoke continuing jurisdiction to the time of medical services, rather than the date of payment.
- Expands the time you have to appeal an Industrial Commission decision from 60 to 150 days in specific circumstances for claims pending on and arising after September 29, 2017.
Fortunately, don't worry about how these changes affect your workers’ comp claim because, if you're already a client, my team is taking care of everything.
If you need to file a claim or are struggling with an existing application, please call my office to discover how we may help. At Monast Law Office, we stay informed of changes affecting the Bureau of Workers’ Compensation, the Ohio Industrial Commission, and your claim.
How long do I have to file an appeal of my LTD denial, considering the restrictions imposed under the COVID-19 pandemic?
In March 2020, the world as we knew it changed almost overnight. Most of us were told to shelter in place, work from home, and only go out for essential purposes. Many businesses came to a standstill, at least while everyone adjusted to the changes, and any medical, legal, and government problems not related to COVID-19 were pushed aside or put on hold.
Were you facing a denial of your long-term or short-term disability benefits as this went down, you're probably wondering when you'll be able to continue pursuing an appeal.
Among all the bad news around us these days, one bright spot is that the U.S. Departments of Labor and Treasury unprecedentedly decided to loosen some of the restrictions imposed by the Employee Retirement Income Security Act (ERISA).
What Does This Mean for Your ERISA Appeal?
While ERISA gives you the right to appeal denials of your employer-sponsored long-term disability (LTD) insurance, it does so with fairly rigid restrictions, including a short, 180-day time limit from the date of denial. If you received a denial in the last six months, you were probably just figuring out what to do about it when COVID-19 hit.
Whether you were affected by the pandemic and let the claim slip your mind, or you've been unable to get help because of the restrictions, you might be panicking that your time is running out. To file an appeal, you must see your health providers to get medical reports. If you've been unable to leave your home or your doctors’ offices were closed, you haven't been able to get the evidence you need to support your appeal.
However, given the National State of Emergency issued on March 13, the 180-day time limit has been lifted. On May 4, the following rule change was announced:
“All group health plans, disability and other employee welfare benefit plans, and employee pension benefit plans subject to ERISA…must disregard the period from March 1, 2020, until sixty (60) days after the announced end of the National Emergency or such other date announced by the Agencies in a future notification.”
As of June 1, the National State of Emergency had still not been lifted, so this means that the period from March 1 to an indefinite date cannot be counted against the 180-day time limit for your LTD appeal.
Monast Law Office Is Open for Business and Ready to Discuss Your LTD Appeal
Appealing an LTD denial is difficult in the best of times, and it's especially difficult now. As a board-certified workers’ comp attorney for over 30 years, I'm dedicated to providing people the guidance and representation they need to get the long-term disability benefits they deserve. Contact our office in Columbus to discover how we can help! To learn more about ERISA and the appeals process, request a free download of our book, Don’t Go It Alone: How Insurance Companies Sabotage Disability Claims.
I was injured at work in a grocery store. Can I file for workers’ comp?
Grocery store workers, like everyone else who works for a company with more than one employee in Ohio, are covered by their employer’s workers’ compensation policies if they're injured or contract an occupational disease on the job. So the answer is yes, you can file for workers’ comp.
Typical Grocery Store Employee Injuries
As governors across the country issued stay-at-home orders in the early days of the COVID-19 pandemic, grocery store workers were suddenly included on the list of essential workers along with doctors, nurses, and postal workers. While it’s generally a good thing to be employed while many others have lost their jobs, working in a grocery store isn't without hazards.
Besides the risk of being exposed to infected customers, grocery store cashiers, stockers, and food preparers are at high risk of other kinds of injuries depending on the work they do, including:
- Lacerations and stab wounds. Food preparation workers handle sharp knives, meat slicers, and even power saws to package food in the butcher shop, deli, bakery, and produce department.
- Lifting injuries. Stocking shelves involves lifting heavy items and repetitive motions, resulting in back strains and other musculoskeletal injuries.
- Leg, back, and foot injuries. The prolonged standing required of cashiers and baggers can cause a variety of leg, back, and foot injuries.
- Fall injuries. Wet floors, particularly in the produce department, can cause workers to slip and fall. Climbing on ladders to stock shelves or build displays also puts workers at risk of fall injuries.
- Repetitive-use injuries. Almost every worker in a grocery store in engaged in repetitive tasks. Reaching for items, scanning at the checkout, bending and lifting, and bagging groceries can take their toll during an eight-hour shift.
Because many stores are understaffed these days, the pressure on workers has increased, and so has the likelihood of injury.
Contact Monast Law Office If You Have Trouble Filing a Claim
If you're injured as an employee at Kroger, Giant Eagle, Walmart, or another grocery store in Ohio, report your injury right away and ask your supervisor about filing a workers’ comp claim. If you have any problems with the process, contact Monast Law Office for help. We also offer a free resource, The Worker’s Guide to Injury Compensation in Ohio, available as an instant download. You've worked hard to support a community in need at a difficult time and get the workers’ comp benefits to which you're entitled if injured on the job.
I've been ordered to work from home because of COVID-19. If I'm injured, will I be covered by workers’ comp?
The quick answer to this question is yes—if you were covered in your workplace before you were sent home, you should be covered while working from home.
However, just like an injury that happens in a traditional workplace, you must show that the injury occurred while you were doing work-related tasks. We consider what that could mean for you.
Who's Working From Home?
If you shifted your workplace from the office to home after Governor DeWine issued Ohio’s stay-at-home order, you're one of the lucky ones. Rather than losing your job or risking your life as an essential worker, you're able to continue working in the relative safety of your own home. I say "relative safety" because accidents do happen there, and workers can be injured in a home office as easily as in an employer’s office.
Typical work-from-home injuries include:
- Falls. Tripping over inventory, computer cords, or equipment, or falling down the stairs to a basement office should qualify for workers’ comp because you were injured while performing work tasks. However, tripping over the family dog or falling down stairs while checking on laundry will likely not be covered, even if they happen during the workday.
- Repetitive-use injuries. Some of us are putting in even more hours on the computer at home than we did in the office. As in-person meetings and physical tasks have become virtual, the likelihood of developing carpal tunnel syndrome or other soft tissue injury increases.
- Strains from heavy lifting. If you had to move merchandise or equipment to your home to keep working, you could suffer an injury while lifting and carrying heavy boxes. These work-related tasks should be covered by workers’ comp.
Even before the COVID-19 pandemic changed the way we work in Ohio, many of us were working from home. It's likely that more of us will continue to have this option even after the governor’s orders are loosened and eventually lifted. As remote workers and telecommuters, it’s essential to understand your right to workers’ compensation in Ohio.
Jim Monast Is Right There With You
The staff at Monast Law Office has been working from our offices to continue to meet the needs of our clients and to help new clients with workers’ comp claims. Whether you were injured while working from home or as an essential worker in a hospital, retail outlet, grocery store, delivery service, or other positions, filing a workers’ comp claim is likely to be more challenging than usual, given the CoronaPalooza 2020 situation. Now more than ever, don’t try to go it alone. Contact us to discover how we can help you get the benefits you deserve.
Will I have to pay income tax on my ERISA long-term disability settlement?
You had a long-term disability insurance policy through your employer, but when you were injured and needed the benefit, your claim was denied. You sued under the Employee Retirement Income Security Act (ERISA) and won. You agreed to a lump-sum settlement amount and hoped that was the end.
However, be aware that you probably owe federal income tax on the settlement for the year you received it. Why is this? We look here.
Some Lump-Sum Settlements Are Taxable
The U.S. Tax Code is about as easy to decipher as the Rosetta Stone. Tax laws regarding disability settlements are no exception.
Generally, if the long-term disability (LTD) policy was provided by the employer as a fringe benefit, the payments you receive—or the lump-sum settlement in an ERISA lawsuit—would be taxed as income. This rule applies even if your disabling injuries are purely physical, despite the tax law that says disability payments for physical injuries are not taxed. That rule only applies to self-funded long-term disability policies.
Several U.S. Tax Court rulings over the last several years have upheld that ERISA lump-sum settlements are subject to federal income tax.
How to Avoid Losing Settlement Funds to Taxes
While there’s no way to get around federal tax laws, you may ease the pain by choosing monthly payments of your long-term disability benefits instead of a lump-sum settlement. When you work with an ERISA attorney to appeal your long-term disability denial, tax implications will be considered along with your right to the benefits you deserve.
Monast Law Office Welcomes ERISA Long-Term Disability Appeals
If your employer-sponsored group LTD claim was denied, I can help you sort through your options for filing an appeal that preserves the settlement. As a workers’ compensation attorney with over 30 years of experience, I know what it takes to build a strong disability claim, and I understand how the ERISA process works. Time isn't on your side with a denied LTD claim. Contact the Monast Law Office today and get off to the right start with your appeal.
Will Ohio workers’ compensation cover my plastic surgery?
Whether your plastic surgery is covered by workers' comp depends on what kind of procedure you're talking about. Elective cosmetic surgery rarely is covered by workers' compensation.
However, reconstructive surgery necessary to correct an issue caused by a workplace accident should be covered. To ensure this, the plastic surgeon you choose has to be certified by the Bureau of Workers' Compensation (BWC).
As a workers' comp attorney with over 34 years of experience in Ohio, I've helped clients get approval for various kinds of medical treatment by the BWC, including reconstructive procedures. Here's what you should know.
When Plastic Surgery May Be Deemed Medically Necessary
Certain catastrophic workplace injuries require the expertise of a reconstructive surgeon for you to function again. Examples of conditions that may be approved for plastic surgery include:
- Crushing injuries. When bones are crushed by falling objects, in machinery accidents, or by a forklift, reconstructive surgery is often required over and above the work an orthopedic surgeon may do.
- Scalp avulsion. This horrific injury occurs if hair gets caught in machinery and the scalp, and sometimes part of the face, is torn off. Correcting this condition requires multiple complicated surgeries by a skilled plastic surgeon.
- Degloving. This is another form of avulsion where the skin is torn away from the underlying tissue, usually in the hand or foot. Skin grafts and extensive follow-up care may be necessary.
- Burns. A severe burn destroys nerve endings and can limit the functionality of the affected body part. A plastic surgeon may restore some functioning through ongoing procedures.
- Facial fractures. There are over a dozen bones in the human face. When a vehicle crash or crushing accident causes facial fractures, reconstructive surgery may be necessary.
You may have cosmetic surgery to fix scarring or disfigurement caused by a workplace accident. But if the injury doesn't affect your physical functioning, these procedures will likely be considered elective and won't be covered by workers' comp.
Talk to a Workers' Comp Attorney Before Filing a Claim
Any time a non-traditional type of treatment is indicated after a workplace injury, talk to a workers' comp attorney about improving your odds of approval. If your doctor thinks that plastic or reconstructive surgery is necessary for your full recovery, it should be covered by workers' comp. Contact the Monast Law Office to discover how we may help. In the meantime, we invite you to request a free download of our helpful book, The Worker's Guide to Injury Compensation in Ohio.
Why was my Medicare claim denied?
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.
Can I file an Ohio workers' comp claim for COVID-19?
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.