Answers to Workers’ Compensation Questions From a Columbus Attorney

When you're injured in a fork-lift accident at your warehouse job or think you may have developed carpal-tunnel syndrome at your office job, your first move may be to go to the nearest emergency room or your doctor for diagnosis and treatment.

Fortunately, the Ohio workers’ compensation program allows this—but only for that initial visit.

After that, you must see a Bureau of Workers’ Compensation (BWC)-certified physician for your treatment to be covered by workers’ comp. If you work for a self-insured employer such as UPS or Ohio State, your employer will decide regarding your eligibility and who you can see for treatment.

Finding a Certified Doctor

It's possible that your doctor is already BWC-certified—in which case, you won’t have to look further for a doctor to treat your work injury. However, if she's not and you continue to see her, you'll be responsible for all medical costs related to your work injury.

While your employer may suggest a doctor, you're under no obligation to visit that doctor. Instead, you can find a certified physician in your area by checking the provider look-up tool on the BWC’s website. As long as you receive workers’ comp benefits for the injury for which you're seeking treatment, medical costs related to your claim will be covered.

However, even for BWC-certified doctors, treatment has to be approved by your employer’s managed care organization (MCO) with employers who obtain workers' compensation through Ohio's state insurance fund or by your self-insured employer.

Getting Approval From Your MCO

If you're not already familiar with managed care organizations, understand how they work.

All employers who purchase workers’ comp insurance through a state fund must choose one of 13 MCOs recognized by the BWC to manage their workers’ compensation claims. The MCO oversees claim filing, and supervises medical treatment and employer return-to-work programs. Your employer’s MCO manages the medical portion of the claim, so additional medical procedures, treatments, and referrals from the treating physician have to be approved by the MCO.

If medications are prescribed, you have to inform the pharmacist that it's a workers’ comp claim and provide your BWC claim number. Any treatment or services you received before your workers’ comp claim is approved should be reimbursed after that approval. Note that some large Ohio employers are self-insured—this means they administer workers’ compensation claims directly, and your employer may manage the medical portion of your application.

Having Trouble? Call an Experienced Workers’ Comp Attorney

If you're like most of our clients, you may feel frustrated and hopeless when coverage for a needed medical procedure or prescription is denied. However, you may appeal any medical decisions made by your MCO, and you may work with an experienced workers’ comp attorney on your appeal.

If you feel like the BWC is saying you and your doctors are wrong, or even fraudulent, call me for a free review of your claim. I help many workers just like you overcome the challenges of the Ohio workers’ comp system, and I may assist you, too. We're never too busy to take your call or answer questions. Fill out the form on this page to connect with me today.

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The intent of workers' compensation in Ohio is to cover all costs related to an injury you sustain at work or an illness you develop because of your job.

The benefits you receive depend on the seriousness of the injury or illness and how much time you must take off work.

If you only miss a few days after a workplace accident, charge that time against your paid time off (PTO).

However, if your injury or illness leads to eight or more days off work, you qualify for temporary total compensation benefits from workers’ comp to replace your lost income.

Understanding Ohio Temporary Total Compensation Benefits

The Ohio Bureau of Workers’ Compensation (BWC) defines temporary total disability as “the temporary inability of the injured worker to return to his former position of employment.” If your claim for workers’ comp benefits is approved, your injury-related medical bills will be paid no matter how long you must miss work.

However, temporary total compensation benefits—or reimbursement for PTO already taken—won't start until the eighth day you're off work. If you miss two weeks of work, you'll only be compensated for the second week. If you're away over 14 days, you'll be compensated for all the days you have missed, including the initial week.

If you're approved to return to work under modified conditions and your employer cannot accommodate you, you can remain on temporary total compensation benefits as you continue to improve. It's important to note that getting these benefits doesn't mean you'll receive 100 percent of your wages. Instead, you'll receive between 72 and 66 2/3 percent of your wages, depending on how long you're off. When you return to work, temporary total compensation benefits end. However, you may be eligible for wage loss benefits if your injury causes work restrictions that lead to a reduction in earnings.

Monast Law Office Can Help Maximize Your Benefits

When you're injured on the job and cannot work, you may be eligible for many benefits. Because every case is unique, call us for a strategy session. We can explain your rights and help you pursue the maximum compensation. 

Related Links: Handling Your Workers’ Comp Claim vs. Calling a Lawyer Answers to Ohio Workers’ Compensation Claim Questions Settling an Ohio Workers' Compensation Case

As of September 29, 2017, House Bill 27 reduced the amount of time injured workers have to file a claim to one year from the date of the workplace injury or death in Ohio. For claims involving occupational disease, you have two years to file a claim. This is known as the statute of limitations.

That may seem like plenty of time. After all, why would you wait to apply for the benefits you need to pay for medical treatment and lost wages?

While most people file within the first few weeks or months after an accident, others delay their filing and jeopardize their claim. If you do not file a claim before the statute of limitations deadline, you no longer have the right to file a claim.

Why Injured Workers Delay Filing

When injured on the job, immediately report the accident to your employer and seek medical attention. Not doing so could hurt your claim before you've even filed. While those steps are essential, they're not the same as actually filing a claim for compensation.

I've found that injured workers sometimes delay filing a workers’ compensation claim and risk hitting the ​statute of limitations because:

• Fear of employer retaliation. Some workers are worried they'll be fired, demoted, or moved to a bad shift if they pursue claims, especially for injuries they hope go away on their own. Retaliatory actions are illegal, and fear of them shouldn't discourage you from applying for needed benefits.
   
• Fear of what people will think. If the injury seems minor, sometimes a worker doesn't want to be a whiner who complains about every little ache and pain. He or she may also worry about the stigma of being on “workmen’s comp” or that co-workers will treat him or her differently.
   
• Fear of missing work. Some employees worry if they take the time needed to treat their injuries, they'll lose wages they won’t be able to get back. Ohio workers’ comp authorizes payments for lost wages during the period of recovery, so a successful claim will help you more than toughing it out and working while injured. Continuing to work while hurt may lengthen your recovery time or lead to increased problems later. Remember, most of us aren't eighteen anymore: injuries we used to "walk off" take longer to heal as we age.
   
• Employer pressure. Some employers may encourage or even push injured workers to use their health insurance to pay for treatment. Some small business owners also tell injured employees not to file because their premiums will skyrocket, promising to “take care of them” through other means. Remember: you should have the benefits offered by Ohio workers’ compensation, and it's not up to your employer to decide how you take care of yourself.
   
• Waiting to see how severe the injury is. It's not uncommon for individuals to push themselves to work through injuries to see if they get better without treatment. However, filing the claim permits a doctor to request diagnostic tests to confirm or rule out a diagnosis, setting you on the road to health much more quickly.

Don’t let these reasons affect your filing. At Monast Law, we've helped hundreds--actually, thousands--of people just like you who have fears about filing claims, and we can help you, too.

Don't Delay, the Statute of Limitations Gives Strict Deadlines to File a Work Injury Claim in Ohio

A year can pass by quickly when recovering from a workplace accident, especially if you're hesitant to file. It's important to take action immediately when injured at work. If you were hurt, or your employer isn't cooperating fully, call me to schedule a free consultation. If I can help, I'll work quickly to make sure you meet the deadlines and present the most persuasive claim possible.

Meanwhile, request a download of my free book to learn what you need to know about workers’ comp in Ohio.

Related Links: Ohio Workers’ Compensation Additional Allowances Settling an Ohio Workers' Compensation Case Workers’ Comp for Construction Site Back Injuries

 

Vocational rehabilitation is a program offered to individuals unable to return to the work they did before being injured on the job. However, they may be able to work in another capacity, whether with the same employer or a different employer. Vocational rehab helps workers transition to jobs they're able to do despite the physical and sometimes emotional restrictions and limitations caused by workplace accidents.

Failure to pursue opportunities for re-employment is required under Ohio Revised Code §4123.58 which prohibits an award of permanent total disability if "the employee has not engaged in educational or rehabilitation efforts to enhance the employee's employability, unless such efforts are determined to be in vain."

During this transition, workers will be eligible for Living Maintenance or Living Maintenance Wage Loss benefits.

What Happens in a Vocational Rehab Program?

A vocational rehabilitation program tries to help injured workers get or keep a job. The rehab process may consist of:

• Evaluation of the disability or limitation
• Vocational counseling and training
• Job search and placement assistance
• Educational assistance
• Transportation, occupational tools, and equipment
• Personal attendant services

These services are not always available through the Ohio Bureau of Workers’ Compensation (BWC), so it may be necessary to work with other agencies. The BWC, your managed care organization, and the Ohion Bureau of Vocational Rehabilitation (BVR) can work together to help find the right program for you.

How Do You Qualify for a Program?

To apply for vocational rehabilitation, your doctor should fill out a C-9 Request for Authorization form and submit it to the BWC. To qualify, you need an allowed claim with eight or more days of lost time from work and a “significant impediment” to returning to work. You'll also have to meet certain criteria related to the extent of your injuries and type of compensation you're awarded.

How Monast Law Can Help

If you were turned down for vocational rehabilitation and are struggling to get the workers’ comp benefits you need to make up for losses related to a work injury, request a free copy of my book, The Worker’s Guide to Injury Compensation in Ohio.

And call our office today! We've helped hundreds of injured workers just like you get the benefits they deserve, and we can help you, too.

Related Links: Ohio Workers’ Compensation Additional Allowances Settling an Ohio Workers' Compensation Case Workers’ Comp for Construction Site Back Injuries

 

If you were injured on the job and are collecting workers’ compensation benefits, you may be approached by your employer or the Ohio Bureau of Workers' Compensation (BWC) about settling your claim. Or, you yourself may decide you'd like to pursue a settlement so you no longer have to deal with the BWC or your self-insured employer.

As with anything, there are pros and cons to settling a workers’ comp claim.

What Is a Settlement?

When you settle your workers’ comp claim, you agree to a lump sum payment from the BWC or your self-insured employer and give up coverage for injury-related medical care and wage replacement payments. You also release any further right to compensation related to the injury or illness that led to the claim.

It's important to be aware of the following:

• The date the BWC mails a settlement approval letter is your effective settlement date.
• Payments for medical bills or wage replacement stop on the effective settlement date.
• If you owe child support, it will be taken from the settlement before you receive any money.
• Any overpayment of compensation you received is recouped from the settlement.

Your attorney will explain the terms of a settlement to be sure you understand what you agree to.

How Does a Settlement Proceed?

A workers’ comp settlement can be initiated by either the injured worker or his employer, but all parties involved, including the BWC, must ultimately agree to the settlement. The BWC administers and approves the claim settlement, which must also be reviewed by the Industrial Commission of Ohio to make sure it's fair to all parties.

While not a requirement, it's a good idea to get the advice of an experienced Ohio workers’ comp attorney to make sure the financial recovery offered is in your best interest. If you have an attorney, the BWC works directly with him or her to negotiate the settlement. 

What to Think About When Considering a Settlement

While the thought of a lump sum payment from the BWC or your self-insured employer may be appealing, you need to understand what you're giving up. Sometimes, it makes sense to initiate or agree to a settlement. There are also pivotal circumstances when it doesn’t make good financial sense.

Some questions to consider include:

• Are you receiving ongoing treatment? If you're seeing a doctor or physical therapist regularly to treat your injury, will you be able to continue to pay for visits if you need to? If you require surgery later—for example, for a back injury sustained while loading heavy packages for UPS—will you have the money for it? Workers' comp benefits will cover these costs for the duration of the injury, but if you agree to a settlement, you won't have this coverage. This may not be a concern if you have other health insurance to cover current and future treatment.
• Need you keep working? Settlement agreements usually require your resignation from Kroger, Walmart, or another Ohio employer settling your claim. If you require continuing income, make sure you can get another job.
• Are you moving out of state? If you're relocating from Ohio, it may make sense to settle, because it's difficult to pursue claims with the BWC for medical treatment received in another state.
• Are you receiving other benefits? If you're receiving Social Security disability, Medicare, or VA benefits, you must work with an experienced attorney to properly structure a workers' comp settlement to your best advantage.

While these questions can get you started, you should not consider a settlement until you talk to an Ohio workers’ comp attorney.

You Need an Experienced Lawyer by Your Side

You're faced with a big decision when thinking about settling a workers’ comp claim, and you shouldn't trust the decision to just any attorney--and certainly not to the BWC or self-insured employer's representative. Hiring the right legal counsel could pocket you thousands of additional dollars.

I handle hundreds of Ohio workers’ comp claims each year, but you'll never be simply a number. At Monast Law, you get the personal time and attention your claim deserves as we help you reach a workers’ comp settlement you can be happy with. To learn more, request our free book, The Worker’s Guide to Injury Compensation in Ohio, or call us today.

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A traumatic workplace accident, chemical exposure, or eye strain could lead to permanently losing vision that limits your ability to continue working.

In certain industries, these injuries happen regularly. The Centers for Disease Control and Prevention report that over 700,000 eye injuries requiring medical treatment occur in workplaces each year across the country.

Vision loss, even loss caused by a traumatic accident, is often treatable with surgery or corrective lenses. But a workers’ comp loss of vision award is based on your condition before you receive any treatment.

Qualifying for Vision Loss Benefits

To qualify for an Ohio Bureau of Workers’ Compensation loss of vision award, you must have lost at least 25 percent of sight in one eye due to a workplace accident or exposure.

The percentage of loss is based on your vision after the injury but before receiving treatment or corrective lenses. This assessment is compared to your sight ability before the accident to confirm the vision loss was caused by the accident or other workplace conditions.

If your vision is expected to improve without medical intervention, your scheduled loss award won't be determined until the healing process is complete. Even if your vision is 100 percent correctable with surgery, glasses, or contact lenses, you'll still qualify for benefits based on your pre-treatment vision. If a workplace injury results in a removal of the eye or a traumatic cataract, you may also qualify for a facial disfigurement award.

Causes of Workplace Vision Loss

The most common cause of traumatic vision loss is a workplace injury caused by debris in the eye. Flying metal shards, broken glass, dirt, dust, sand, and other particulates lodge in the cornea, causing permanent damage. Other causes of on-the-job vision loss include:

• Tools. Nail guns, staplers, saws, wire cutters, and other tools send dangerous projectiles into the eyes of the user or bystanders. Line workers at Honda, Whirlpool, and Worthington Industries are at high risk.
• Chemicals. Splashes from industrial chemicals and cleaning products cause burns that damage the eyes. Workers at local companies such as GFS Chemical, Hexion, and Capital Resin handle chemicals daily that pose risks of permanent vision damage.
• Thermal burns. Welders at companies like Honda, Cardington Yutaka Technologies, and Battelle may experience thermal burns to the retina, causing significant loss of vision.

Most injuries can be prevented by using protective eyewear, but because workers’ comp is a no-fault insurance, it shouldn't matter whether your eye injury was preventable. If your vision is damaged while performing a task related to employment, you're entitled to workers’ comp benefits. The amount of your award depends on the percentage of impairment and increases if vision loss is complete and permanent in one or both eyes.

Contact Me If You Have Been Denied

If you suffered vision loss due to a workplace injury and your benefits were denied, or you're unhappy with the way your claim is being handled, contact me for a personalized assessment of your claim. I also encourage you to request a free copy of my book, The Worker’s Guide to Injury Compensation in Ohio.

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Managed Care Organizations

MCOs are the principal connection between injured workers, employers, medical providers and the Bureau of Workers’ Compensation. Created by the Ohio legislature and then-Governor Voinovich after voters overturned their efforts to privatize Ohio’s workers’ compensation system in 1997, MCOs are medical cost containment companies. They oversee claim filing and supervise medical treatment and employer return-to-work programs. MCOs add additional levels of bureaucracy to claims processing previously managed by BWC Claims examiners (now known as CSS or Claims Service Specialists) as its decisions may be appealed through two levels before reaching the BWC. This can delay treatment by months.

MCOs direct the medical management of workplace injuries and occupational diseases. They assemble initial injury data and medical documentation, approve or deny treatment and testing, pay bills related to the claim and focus on returning injured employees to work soon.

All employers must choose one of 13 MCOs recognized by the BWC to manage their workers’ compensation claims. MCOs are paid by the BWC through premiums paid by employers into the State Insurance Fund. Employers can select or change their MCO every two years.

Third Party Administrator

Unlike MCOs, required for all Ohio employers to direct medical management of workers’ compensation claims, TPAs are neither required nor regulated by the BWC. They can be hired by employers at any time or not.

TPAs are private businesses hired by employers to help with the financial and administrative details of workers’ compensation claims. Slightly less than half of Ohio employers have a TPA representative.

TPAs can assist employers in reducing their workers’ compensation premiums through discount plans such as group rating, retrospective rating, self-insurance and others. They also represent employers at Industrial Commission hearings, process appeals, schedule defense medical examinations, file motions to terminate treatment and compensation payments and negotiate claim settlements.

To summarize, MCOs direct the medical aspects of a workers’ compensation claim while TPAs represent employers in processing claims and minimizing their workers’ comp expenditures and claim costs.

No. There is no requirement you be hurt at your usual place of employment to qualify for workers’ compensation benefits in Ohio. However, your injury must be work-related regardless of where it occurred.

Was Your Injury Work Related?

A work-related injury is one that happened while you were fulfilling the duties of your job or while on company property. This includes not only work accidents that happen in your office or on your jobsite, but also injuries that occur while you are:

• Traveling for your job. This does not include your regular commute, which is excluded under Ohio’s “going and coming” rule, but it could include running a work-related errand or traveling to another site as part of your work day.
• Attending an off-site meeting or appointment. If you are hurt while attending a meeting or working at a site other than your usual place of business, your injury may be considered work related.
• Attending a job-related social event. If you are hurt at the company holiday party, a company picnic, or a dinner with clients, your claim may be covered by workers’ compensation if your attendance was logically related to your employment.
• Parking lot accidents. If you are in a car accident or fall in the parking lot, and the parking lot is owned by the employer, your injuries are compensable. If the parking lot is not owned by your employer, your injuries may still be covered by workers' compensation.
• Injuries while on a lunch break. If you are injured while “off-duty” but still on work property, your injuries will be covered. If you are having lunch somewhere off property—or are on your way to or from lunch—your injuries will not be covered.

Make Sure Your Rights Are Protected

If you are hurt somewhere other than your usual work location or while you are on a break, a dispute may arise about whether you were hurt in a work-related event. This could affect your recovery of workers’ compensation benefits in Ohio. Accordingly, contact an experienced workers’ compensation lawyer who can make sure that you get the benefits to which you are legally entitled. To learn more, contact our legal team and download a complimentary copy of our book, The Worker’s Guide to Injury Compensation in Ohio.

Related Links: Compensation for Work Related Auto Accidents Do I Qualify for Workers’ Compensation Benefits in Ohio? Do I Need a Lawyer for My Workers’ Compensation Case?

Yes. Ohio companies with any employees—even if they just have one person working for them—must purchase workers’ compensation insurance to protect their employees when they suffer work-related injuries. Employees must be covered as soon as they begin their first day of work. Most employers fulfill this requirement by obtaining insurance through the Ohio Bureau of Workers’ Compensation (BWC), but a few of the state’s larger employers are self-insured.

There are no exceptions to this rule if a business has employees, but coverage is optional for Ohio businesses or religious organizations with no employees.

Types of Businesses That Do Not Have to Carry Workers’ Comp

These types of businesses do not have to carry workers compensation coverage:

• Sole proprietors with no employees
• Partnerships with no employees
• Family farm corporate officers with no employees
• Individuals incorporated as a business with no employees
• Limited liability companies acting as sole proprietors with no employees
• Limited liability companies acting as partnerships with no employees
• Ordained or associate ministers of religious organizations exercising of their ministries (but any paid employees of the church must be covered).

These businesses may carry workers’ comp in case the owner or minister is injured on the job. If they carry the insurance, they can report a work injury against their policy and, if approved by the BWC, medical bills and lost time wages can be paid.

Coverage for Volunteer Workers

Workers’ compensation is not available to cover volunteers who work for non-profit organizations or private companies. However, public employers who use volunteers to provide emergency services—such as volunteer firefighters—must provide workers’ compensation for them.

Employees Should Not Have to Worry About Coverage

You may wish to discover what kind of workers’ compensation insurance your employer has even before you are hurt. The workers’ comp process is different if your employer is self-insured rather than carrying BWC insurance, so knowing this information can be helpful. If you have been hurt, get accurate information right away so you can protect your recovery. Talk to your employer about your company’s coverage, or you can contact the Bureau of Workers’ Compensation to get this information.

If you are not satisfied with the treatment you are receiving because of your injury, or if you feel that it's not being taken seriously or handled properly, see how we can help. To learn more, please download a free copy of our book, The Worker’s Guide to Injury Compensation in Ohio, and call us directly to schedule an initial meeting.

Related Links: Do I Qualify for Workers’ Compensation Benefits in Ohio? Do I Need a Lawyer for My Workers’ Compensation Case? Understanding the Ohio Workers’ Compensation System

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 at (614) 334-4649 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.

Related Links: Employer Retaliation After a Work Injury The Cost of Hiring an Ohio Workers' Compensation Attorney 5 Common Mistakes That Hurt Your Workers' Compensation Claim