Answers to Workers’ Compensation Questions From a Columbus Attorney

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.  

Related Links: Workers' Comp Doctors May Compromise Care Under Pressure Getting Job Injury Medical Bills Paid by Ohio Workers' Comp Ohio Workers' Compensation Miller Criteria

 

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

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

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

Workers’ Comp Is the Primary Benefit

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

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

What Can You Do If Both Insurers Deny Your Claim?

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

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

Managing Workers’ Comp and Medicare Together

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

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

Call Our Team With Your Questions

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

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

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

 

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

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

Industrial Commission Hearings Canceled

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

Filing a Claim If You Get Infected at Work

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

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

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

Contact the Monast Law Office With Questions

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

Related Links: Healthcare Workers May Qualify for Workers’ Comp for COVID-19 Workers' Compensation for Occupational Disease in Ohio Workers' Comp for Respiratory Diseases in Ohio

 

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

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

Why Are More Seniors Working?

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

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

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

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

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

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

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

 

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

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

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

Potential Problems With Company Doctors

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

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

Getting the Best Care for Your Workplace Injury

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

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

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

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

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

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

 

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

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

SSDI Is a Government Program, While LTD Insurance Is Optional

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

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

How the Two Programs Work Together

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

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

Confused? Contact ERISA Attorney Jim Monast Today!

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

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

 

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

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

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

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

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

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

Why You Should Ignore Your Employer

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

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

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

You May Need a Workers’ Comp Attorney on Your Side

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

 

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

 

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

Supporting You on the Job

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

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

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

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

How Monast Law Can Help

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

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

 

For many people, the perks of employer benefit packages are almost as important as the salary they earn. Medical insurance plans, retirement savings accounts, pensions, life insurance, and disability are just some benefits your employer may offer.

While you may have to opt into some plans and pay premiums, it's usually at a significant discount over what you would pay if you enrolled as an individual.

However, these benefits are subject to federal law and, when something goes wrong, you may need to hire an attorney who's familiar with the Employee Retirement Income Savings Act (ERISA).

How to Find an Attorney Who Takes ERISA Claims

If you submit a claim for long-term disability (LTD) with the company group plan and are denied, you may appeal. However, the process—which is established by ERISA—is complicated, and favors the insurance company that denied your claim.

Because these appeals aren't like other insurance claims, not every attorney is qualified or willing to take them. You want a disability attorney who is:

• Familiar with the law. Appeals of long-term disability claims governed by ERISA follow specific processes, and the time for filing an appeal is limited. An attorney with insight on how appeals work under ERISA can work quickly and efficiently to file a strong appeal.
• Experienced with ERISA claims. The more ERISA appeals an attorney has handled, the better prepared he or she will be to manage your application.

If an attorney doesn't advertise his services as an ERISA attorney, he's probably not well-versed in the process, even if he's willing to take your appeal. Try to find an attorney who wants these claims and will work hard to file a strong appeal.

Monast Law Office Welcomes ERISA Long-Term Disability Appeals

When your employer-sponsored group LTD claim is denied, call my office in Upper Arlington to learn more about my expertise for handling these claims. 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 Monast Law Office to get off to the right start with your appeal.

You’ve had the policy since you started in your current job, but hoped you’d never need it. Unfortunately, an illness or injury has left you unable to work, and you think it’s time to file a claim. By understanding your policy and the application process, you may be able to save yourself time and aggravation.

As a workers’ compensation and long-term disability appeals attorney, I help clients who are struggling to get approved for the benefits they deserve.

What Does Your Policy Cover?

The first thing to do is to read and understand your policy. Each policy defines what the insurance carrier considers a qualifying disability to be, so you'll have to make sure your illness or injury meets those specific standards. Disability under your policy may be defined as a condition that prevents you from performing your current type of work, or it may require you to be unable to perform any work.

Your policy also outlines time limits for applying for benefits and any exclusions, such as pre-existing conditions and specific medical issues that aren't covered. Ensuring that you meet the requirements of your policy before applying can save you a lot of trouble down the road.

Supporting Your Claim With Medical Evidence

Whatever the specifics of your policy might be, the carrier will require you to provide medical evidence to prove you're disabled. This evidence includes records from your treating physician, lab test results, hospital records, and MRIs, or other scans.

Also, ask your doctor for a detailed description of your medical history and the physical limitations you're experiencing because of the illness or injury. The space allotted on the insurance company’s form might not be sufficient to provide these details, so a separate statement may be necessary.

What If You're Denied?

Even if you understand your policy and submit a complete application, you might be denied. In some situations, you may be able to file an appeal, but this is often a complicated process. If you have long-term disability insurance through your employer, the appeal process is probably subject to the rules established by the Employee Retirement Income Savings Act (ERISA). These rules are complicated, and not many attorneys are willing to help with an ERISA appeal.

However, my team at Monast Law does accept these claims and would be happy to take a look at your application to determine if an appeal is an option for you. Contact our office in Upper Arlington to find out if we can help.