Answers to Workers’ Compensation Questions From a Columbus Attorney

You opted into your employer’s long-term disability (LTD) insurance plan thinking it would protect your family if something happened to you that prevented you from working. Now that your fears have come true, you're shocked to discover that your claim for LTD benefits is denied. You’ve paid your premiums reliably for years—how could this happen? We look at common—and often petty—reasons LTD claims are denied.

Insurance Adjusters Are Paid to Deny Claims

The first thing to realize is that insurance companies only make money on the claims they deny, so their adjusters will look for any undotted "i" or uncrossed "t" to throw out your claim. You may not even be given a reason when your claim is rejected, but it's probably for one of these reasons:

• Small print in your policy. You must meet the terms of your specific LTD policy, including its definition of a disability. Most policies exclude pre-existing conditions, so if the claims adjuster believes your condition isn't new, you'll be denied.
• Lack of evidence. You must include evidence of your medical condition and your physical limitations. Medical evidence includes doctors’ reports, scans, and lab tests, which have to be dated within the period of eligibility. Statements and evaluations from doctors and occupational experts attesting to your inability to perform work must also be included.
• Application errors. Incomplete applications, or forms with even minor mistakes on them, will likely be rejected immediately.
• Missed deadlines. You must meet strict deadlines when applying for LTD benefits. If you miss a deadline, your application won't even be read.
• Evidence of duplicity. An approved LTD claim means a hefty payout by the insurance company, so it may go to great lengths to prove your claim is fake. Tactics such as monitoring your social media, spying on you in public, and speaking to friends and co-workers aren't beneath adjusters instructed to find any reason for fault. They won't hesitate to misconstrue perfectly innocent actions as being evidence of fraud.

If you're denied for any of these reasons, or have no idea why your claim was denied, you may be able to file an appeal helped by a long-term disability attorney.

But Not Just Any LTD Attorney

Employer-sponsored long-term disability insurance policies are regulated by the Employee Retirement Income Security Act (ERISA), a set of complicated federal laws originally intended to protect workers’ retirement savings. ERISA now also includes provisions that dictate how LTD claims and appeals should be handled.

Because these cases are complex and time-consuming, few attorneys take them, but I do. As an experienced Columbus workers’ comp attorney, I understand the frustration of a denied LTD benefits claim. Call the Monast Law Office to discuss the possibility of filing an appeal. We'll take a look at your claim and let you know if we can help you navigate the difficult ERISA process.

That’s a great question, and it’s one we encourage our clients to ask. The problem is that some workers’ comp doctors cave to pressure from employers to get people back on the job or to Managed Care Organizations (MCO) to cut costs.

This absolutely should not happen. Your workers’ comp doctor should only be concerned with your well-being. If this isn't the case, it may help to talk to an attorney.

The Physician’s Role in a Workers’ Comp Claim

While you can see any doctor—including your own—for your initial evaluation after a workplace injury, you must choose from a list of BWC-approved physicians after that. These doctors don't work for the BWC, but are approved by the BWC to handle workers’ comp claims.

Doctors who see workers’ comp patients are expected to provide the same medical care as they would to any other patients, such as:

• Recommending treatment, regardless of what the MCO or self-insured employer will voluntarily pay.
• Advising the patient of possible alternative diagnoses, treatment options, and associated risks.
• Evaluating all symptoms, even those that may seem unrelated to the workplace injury.
• Objectively assessing impairment or disability and the employee's readiness to return to work.
• Providing medically-appropriate restrictions when the worker returns to the job.

Potential Conflicts of Interest for Workers’ Comp Doctors

Along with helping the patient get better, the workers’ comp doctor may also be expected to make judgments about the cause of the individual’s injury and his readiness to return to work. This might create a conflict for some doctors when employers pressure them to support a claim denial or to release a patient to work before he's ready. Be especially careful when your employer refers you to a particular medical practice, in-house medical dispensary, or local "work health center" for treatment.

Again, your doctor’s primary job is to care for you, not to worry about your employer. If you feel like your care is compromised because your physician is trying to please your employer or MCO, it may be time to change doctors and talk to an attorney.

Monast Law Office Cares About Your Recovery

The BWC allows you to switch doctors, but you must submit a change form and can have only one physician of record at a time. If you go to a doctor who isn't BWC-certified, you must pay for this care yourself.

If you're having difficulty getting the treatment you need from your workers’ comp doctor, contact my office and talk to my team. To learn more about your right to workers’ compensation, request a free download of our book, The Worker’s Guide to Injury Compensation in Ohio.  

Related Links: Ohio Workers’ Compensation Miller Criteria Ohio Workers’ Comp Modified Work Offers Unfair Treatment After a Work Injury in Ohio

 

People often think of workers’ comp as an insurance program for work-related injuries—which it is—but it also covers illnesses that are contracted due to workplace exposure. Some examples of work-related illness include respiratory conditions, hearing loss, skin diseases, heatstroke, and heavy metal or gas poisoning.

While these diseases result from dangerous conditions in the work environment, an employee may also contract an infectious disease in the course and scope of employment. In some cases, those individuals will also be covered by workers’ compensation.

No Coverage for the Common Cold

Catching an illness like a cold, the flu, chickenpox, or measles from a coworker doesn't qualify for workers’ compensation. You can take sick days and work with your private health insurance regarding payment of medical bills. Even if you catch these airborne diseases from a customer or patient as you're doing your job, you won't be covered by workers’ comp in Ohio.

So What Kinds of Infectious Disease Are Covered?

According to the Ohio Bureau of Workers’ Compensation, private employers are required under the Occupational Safety and Health Administration (OSHA) to pay for all costs related to worker exposure to infectious diseases through contact with blood or other bodily fluids. There doesn't have to be an unavoidable accident or physical injury for this coverage to apply, but it doesn't include airborne exposure.

Public employers aren't subject to OSHA rules, but under Ohio law, they must offer the same coverage for emergency workers, including peace officers, firefighters, and emergency medical personnel. If these workers, or any private employees, come in contact with the bodily fluid of a person infected with a communicable disease, they should be compensated for:

• Office visits
• Emergency room visits
• Tetanus, HIV, or hepatitis testing
• Suturing or dressing of wounds
• Physician evaluation/management, including counseling
• Prophylactic medication
• Follow-up testing/treatment required according to the current Centers for Disease Control protocol.

In order to have these costs covered, it's important that you report the exposure incident as soon as possible. If you were potentially exposed to an infectious disease by a splash or spatter in the eye or mouth, skin puncture, cut, open sore, wound, lesion, abrasion or ulcer, or in the course of performing mouth-to-mouth resuscitation, your medical costs should be compensated.

Call Monast Law Office If You Have Any Problems

These kinds of claims should be straightforward in Ohio, but if you're struggling to get medical testing or prophylactic treatment paid for by your employer, give us a call. To learn more about your right to workers’ compensation, request a free download of our book, The Worker’s Guide to Injury Compensation in Ohio.

 

Related Links: Can I File An Ohio Workers' Comp Claim for COVID-19? Workers’ Compensation Benefits for Firefighters With Cancer Unfair Treatment After a Work Injury in Ohio

 

It was big news in 2018 when Amazon was named one of the most dangerous places to work in America. Everybody’s favorite click and ship retailer was slammed for pushing hourly workers too hard and creating dangerous work environments for year-round and seasonal employees.

I took a look at the story around Christmastime and reminded readers that even part-time and seasonal employees may have workers’ compensation if they're injured in a fulfillment center.

Unfortunately, little seems to have changed since then, and individuals continue to suffer serious injuries because of the high-pressure environment Amazon has created.

On-Site Clinics Don’t Help

A lot of employers provide on-site health clinics, and Amazon is no exception. The problem with these clinics is the healthcare providers work for the company—not for the patient—and their goal is to patch people up and get them back to work.

In Amazon’s AmCare clinics, they don’t employ doctors. Instead, they hire certified EMTs to provide first aid care, which isn't even legal in some states. Workers report being given ice packs when they visit an AmCare clinic for acute and chronic injuries, but not being given the opportunity to report their injuries. This routine of giving first-aid and returning warehouse employees to the floor is exactly the situation that leads to chronic injuries and ultimately a disability that keeps people off work.

Your Rights as an Amazon Employee

If you work at an Amazon fulfillment center in the Columbus area, you may not have been given information about workers’ compensation, but you're still entitled to it if you're injured on the job and cannot work.

With few exceptions, no matter where you're employed, your medical bills and lost wages are covered by Ohio workers’ compensation when you're hurt at work. Employers who think they are above the law—like Amazon—may violate your rights when you suffer a work-related injury.

Protect Your Rights With Reliable Information

If you want to learn more about Ohio worker’s comp, download a free copy of my book, The Worker’s Guide to Injury Compensation in Ohio. In less than 30 minutes, you'll know how to handle filing a claim, the steps to avoid contested claims, and what to expect if you have pre-existing conditions.

If you have specific questions for me about an injury in an Amazon warehouse—or any other workplace—call me. I’d be happy to help you get the benefits you deserve. 

Related Links: Ohio Workers’ Comp Modified Work Offers Unfair Treatment After a Work Injury in Ohio Workplace Accidents That Result in Traumatic Brain Injury

 

Probably. When you're collecting workers’ comp after a workplace injury, your employer’s goal is to get you back to work as soon as possible.

Depending on your injuries, your treating physician may release you for work with certain restrictions.

If your employer can provide you with work that accommodates those restrictions, you must probably take it. However, you want to make sure it's a valid offer.

What Is Modified or Light Duty Work?

If the doctor says you're able to perform work after a workplace injury, an employer may modify your previous duties or create a new position to accommodate you. The Ohio Bureau of Worker’s Compensation (BWC) encourages employers to offer options such as:

• Transitional work. Some employers offer a program that brings workers with physical restrictions into the workplace to contribute productively under the direction of rehabilitation professionals.
• Job modification. If an employer can remove or alter the physical barriers preventing an injured worker from performing the essential functions of the job, he or she may be brought back to the job before recovering.
• Gradual return. A recovering worker could be asked to return to work on a graduated basis, slowly building up to full-time work over a 13-week period.

It costs companies to have employees off for long periods, so they're motivated to get you back to work, even if you're limited in what you can do. Not every job situation lends itself well to modification, but employers may try anyway and in their rush, cross a line.

What to Watch Out for When Offered Modified Duties

When an employer is worried about the bottom line, they can easily violate your rights as an injured worker. While you have to accept a valid offer of modified work if your treating physician approves, also be aware that:

• You're entitled to wage loss compensation if the modified work you're offered pays less than what you earned before the injury.
• A supervisor may not have the authority to offer modified work. Be sure to understand who's making the offer and confirm that it's a valid offer. 
• Workplace health centers, such as OhioHealth’s WorkHealth clinics, have mixed loyalty. They work for your employer, not for you, so they may push you back to the job when you’re not ready.
• Employers can be sneaky. They may promise you modified tasks and then not follow through by honoring your doctor’s restrictions.

When you're injured at work, your employer should treat you with respect and give you the time and space you need to heal completely before returning to full duty.

How an Attorney May Be Able to Help

An Ohio worker’s comp attorney can make sure your rights are protected when you're offered modified or light duty work. It's difficult to advocate for yourself in these situations, but I can make sure you're not being taken advantage of by your employer.

Get more information about workers’ comp in Ohio by requesting a free download of my book, The Worker’s Guide to Injury Compensation in Ohio and then call me to talk about your modified work offer.

Related Links: Voluntary Abandonment Defense in Ohio Unfair Treatment After a Work Injury in Ohio Workplace Accidents That Result in Traumatic Brain Injury

 

Some people—and, unfortunately, many employers—believe that workers’ comp recipients are gaming the system and not doing the things they need to do to get better and return to work.

However, I've found over many years of practicing workers’ comp law that my clients want nothing more than to recover and get back to the work that made them feel like contributing members of society. My clients often push for newer, better, or alternative treatments to help them heal more quickly.

The problem isn't about getting better. The problem is often gaining approval for the treatment that will help them do just that.

MCOs Must Apply the Miller Criteria to Requested Treatments

As with everything related to Ohio workers' comp, getting approval for a medical procedure, service, or treatment is a process. When you or your doctor request approval from your Managed Care Organization (MCO) for a new treatment, the state Bureau of Workers’ Compensation (BWC) requires that a three-pronged test, referred to as the Miller Criteria, be applied.

The medical service you're requesting has to meet all three of these criteria:

• It must be reasonably related to the industrial injury.
• It must be reasonably necessary and appropriate to treat the industrial injury or allowed condition.
• The costs of the services must be medically reasonable.

The MCO may consult the Official Disability Guidelines when deciding, but ultimately, the choice is up to its judgment.

Miller v. Industrial Commission Ruling

The Miller Criteria arose from a 1994 Ohio Supreme Court ruling on a case involving an injured woman who was obese. Even though her weight wasn't a factor in her workplace injury, her doctor believed it was preventing her from recovering, so he recommended that she enter a supervised weight-loss program.

Her employer’s MCO denied coverage of the program, and she appealed to the Supreme Court. The Supreme Court drafted these criteria and ruled that they must be applied to her request for medical service. Her weight loss treatment was approved, with the requirement that the weight loss would help her overcome her injury and not just ease her discomfort—standards now routinely applied to weight-loss programs paid for by workers’ comp.

The Miller Criteria were later embedded in Ohio workers’ comp law and are now applied to every treatment request, not just weight loss.

Do the Miller Criteria Sound Vague and Subjective to You?

That’s because they are. If you're facing a denial of treatment, an experienced workers’ comp attorney might have to argue for the validity of the treatment your doctor says you need.

Learn more by requesting my free guide, Worker’s Guide to Injury Compensation in Ohio. Then call my office to schedule a meeting to discuss your specific situation.  

Related Links: Unfair Treatment After a Work Injury in Ohio Releasing Medical Records to the Ohio BWC Workplace Accidents That Result in Traumatic Brain Injury

 

Lawyers are just like anyone else – we have only so much time in a day.  Some lawyers charge by the hour while others charge a flat fee for a service. Other lawyers charge a contingent fee, which means they get paid only if they win your case. When the case is won, they take a percentage of the money they earn on your behalf.

When a lawyer says that he or she will provide a free consultation, it means they will sit down with you, hear about your problem, and give you initial thoughts about it, at no charge or obligation to you.  This meeting gives you a chance to "interview" the lawyer and the lawyer to interview you. After the meeting, you may decide that you do not want to hire the lawyer and, likewise, the lawyer may decide that he or she cannot help you with your problem.

During our visit, you can ask about our experience with matters similar to yours, our thoughts on the best course of action for your situation, and the timeline for a case like yours. You will also get to meet the people assigned to your case if we represent you. 

The discussion should help you discover your rights and whether you need an attorney to represent you.  Sometimes, the consultation itself may provide you with enough information to solve your workers’ compensation issue.

The meeting usually lasts somewhere between 15 and 30 minutes and can be done in person or over the phone—sometimes both. We will discuss the facts of your case, review the legal and practical issues you may expect to face and outline how we might pursue your case if we work together. If your claim is more complicated, the consultation can take a little longer.  We want to take the time to understand your situation.

Preparing for Your Free Consultation

The more prepared you are, the less time it will take for us to understand and discuss your legal issue with some level of intelligence. Look through my website for answers to lots of questions you may have and download a copy of my book The Worker’s Guide to Injury Compensation in Ohio. It’s free, jam-packed with thrilling information about Ohio workers’ compensation and more fun to read than just about anything you can imagine! (OK, even I have to give that statement a few Pinocchios). Also, if we meet in person,

• Bring all documents. Make copies of all the materials you have collected regarding your case. Give these copies to the lawyer.
   
• Get organized and take notes. Write down notes outlining your legal problem, or questions you may have. We need details to decide what is essential and how to move forward in your best interests.
   
• Be honest. You should give an accurate account of your legal problem. This includes issues that may be sensitive to you or your family. Remember that the conversation with us is private, and cannot be discussed with others without your permission.
   
• Talk about how much this will cost you. We strictly work on a contingency fee basis for our workers’ compensation clients.
   
• Ask questions. For us to serve you better, I want you to understand your case and the legal procedure. My job is to guide you through this process that can be lengthy and frustrating. It's no help to either of us if we don’t have clear communication. I’d prefer you ask questions than not.
   
• Read all documents carefully before signing. Before you sign a document, we will explain to you what exactly it is that you are signing. If you do not understand the material you are being asked to sign, ask us to go over it again.
   
• Keep your own files. We’ll do our best to copy you on all letters and documents prepared on your case. Also, keep the written fee agreement between you and your lawyer for your records.
   
• Listen! My evaluation of your situation is based on legal training and experience. Remember that I cannot work magic. No lawyer wins every case, and sometimes the best legal advice may not be what you want to hear. I will advise with your best interests in mind.

A free consultation with us is easy to set up by calling 614-334-4649.

Unfortunately, the answer to that question in Ohio right now is no. This is because rideshare drivers are considered independent contractors and aren't eligible for workers’ comp or other employee benefits.

However, if you drive for Uber or Lyft to supplement your earnings from another company where you're a regular employee, you may get wage replacement benefits for the Uber job if you're collecting workers’ comp from your primary employer.

In this age of gig employment, it’s critical for workers to understand what they're entitled to if injured on the job.

Independent Contractors Aren't Covered

Whether you drive for Uber, write articles on a freelance basis, pick up day jobs in construction, or shop for and deliver groceries for Shipt, you're an independent contractor. This means you're self-employed and not eligible for the benefits and protections given to regular employees, such as minimum wage, unemployment, and workers’ comp.

Companies like Uber and Lyft save a lot of money hiring independent contractors, and these workers have the advantage of flexibility. But if you are injured while driving for Uber, you're on your own.

Pay Attention—This Could Change

For companies like Uber, the key to denying benefits like workers’ comp is classifying their drivers as independent contractors. This is changing in a few states. New York, Pennsylvania, and California have ruled for drivers, forcing Uber and Lyft to classify their drivers as employees.

However, a ruling in May 2019 by the National Labor Relations Board concluded that drivers are contractors, not employees, striking a significant blow to millions of workers. This debate will undoubtedly continue—not only for rideshare drivers but for other workers classified as independent contractors.

Meanwhile, if you're injured in Ohio as an Uber or Lyft driver, you cannot collect workers’ comp.

Wage Replacement and Private Insurance

Many Uber drivers have regular jobs and take passengers to earn extra income after hours. This will be important to note if you're injured at your primary place of employment and granted workers comp benefits through that employer. That’s because you may collect wage replacement benefits for all the money you earned before your injury—including as an Uber driver.

If driving for Uber is your only or primary source of income, consider purchasing private driver injury insurance through Uber to pay medical bills and replace earnings if you're injured while driving and unable to work. This isn't Ohio workers’ compensation, but it’s a way to protect yourself—if you can afford it.

Consult a Workers’ Comp Attorney

Unfortunately, there’s nothing an Ohio workers’ comp attorney can do if you're injured while driving for Uber.

However, if you're eligible for workers’ comp through your primary company because of an on-the-job injury there, and want to make sure you receive all the wage replacement benefits allowed to you, I may help. Call my office in Upper Arlington to discuss your situation.

To learn more about Ohio’s workers’ comp system, request a free download of my book, The Worker’s Guide to Injury Compensation in Ohio. 

Related Links: Unfair Treatment After a Work Injury in Ohio Workplace Accidents That Result in Traumatic Brain Injury Understanding Workers’ Compensation Fraud in Ohio

 

Your Ohio workers’ comp claim was approved, and you're ready to start medical treatment to overcome your workplace injury.

Unfortunately, like almost everything with the Bureau of Worker’s Compensation (BWC), it’s not that easy.

As we’ve discussed in other articles on this website, you have to go to a BWC-certified doctor who assesses your condition and decides on a course of treatment.

He or she will then have to fill out a C-9 form to request the treatment be approved by your employer’s Managed Care Organization (MCO). If the procedure is authorized, you’re all set. However, if it’s not, things become more complicated.

Next Steps After Denial of Treatment by Your MCO

If you don’t already have a workers’ comp attorney, now would be a good time to get one. Your attorney will guide you through the appeals process and make sure you're providing complete information at each step.

If the MCO denies treatment, you or your attorney has 14 days to appeal the decision to the BWC. If the BWC also issues a denial, your next step will be to request a medical treatment hearing with the Ohio Industrial Commission (IC). This hearing is your chance to explain why the treatment is necessary and demonstrate how it will help you.

Preparing for Your Medical Treatment Hearing

While not as formal as a trial, this is an official proceeding you should take seriously. Dress appropriately, be on time, and have a positive attitude. The hearing is held in a state building, so you'll need an ID and will pass through security to get in. If you have an attorney, he or she will be with you, but you're answering the questions yourself. And, for heaven's sake, make sure to be there. Clients occasionally ask me whether they need to attend treatment hearings and the answer is a resounding "yes!". It's my belief, based on experience, that hearing officers will conclude you don't care one way or another about treatment if you don't even bother to show up to argue for it.

I encourage my clients to be honest and tell the Hearing Officer about:

• Limitations you have because of the injury
• Treatments tried in the past and how they did or didn't help
• Why a doctor is recommending this treatment now
• How this treatment will help you get better and return to work more quickly
• If you’ve had this treatment before, how it helped, and how long it lasted
• Your commitment to following this treatment

The job of the Hearing Officer who's deciding your appeal is to determine if the therapy is advantageous and if it's cost-effective. The clarity you use to explain how the treatment will help improves your chances of success.

If the District Hearing Officer denies your request, you can appeal again. You'll be referred to a Staff Hearing Officer at the IC.

I Can Help You Tell Your Story

As your workers’ compensation attorney, I'll guide you in how to explain the importance of your requested treatment. You need not be a medical expert to succeed in a medical treatment hearing—just tell the story in your words.

If you're struggling with a work-related illness or injury, I invite you to download my free book, The Workers' Guide to Injury Compensation in Ohio and contact my office for a personalized assessment of your claim. 

Related Links: Releasing Medical Records to the Ohio BWC How Ohio BWC Uses National Guidelines to Deny Treatment Choosing a Workers' Compensation Attorney in Ohio

 

Let’s be clear: workers' comp fraud hurts everybody. When a worker collects compensation illegally, the cost of the scam eventually trickles down to employers, workers still on the job, and, ultimately, consumers.

It's estimated that over $7 billion—that’s billion with a “b”—is paid out annually on fraudulent grounds nationwide.
 

With such losses, the Ohio Bureau of Workers' Compensation (BWC) will make every effort to catch these fraudsters.

However, sometimes the methods of the Special Investigations Department (SID) are a little too far-reaching, and innocent people are accused.

Special Investigations Department Methods

Workers’ comp fraud can involve employers, healthcare providers, and workers. The BWC assigns investigators to each area but relies heavily on reports from employers, co-workers, neighbors, and even family members to catch employees committing fraud. Often, these reports are anonymous tips called to the SID or submitted on its website.

When the SID receives a report about a suspicious worker, it may investigate by:

• Following the worker to catch him on another job, hitting the gym, or engaging in some activity that “proves” he’s not disabled. This may even involve taking video or photos of the target.
• Talking to neighbors, employers, or other people familiar with the accused to locate eyewitnesses to the alleged fraud.
• Interviewing the employee to get him or her to admit to something illegal. The investigators’ line of questioning can be extremely manipulative and confusing.

Don’t get me wrong. If people are collecting workers’ comp on fraudulent grounds, they should be stopped. However, the reliance on anonymous tips and the sometimes enthusiastic efforts of the SID can mean innocent people get accused.

Don’t Talk to a BWC Investigator

If you were accused of defrauding the BWC and are innocent, contact me before talking to an investigator. It’s far too easy to fall victim to the SID’s aggressive tactics and not only lose the benefits you need and deserve—but also face a criminal conviction.

To learn more about workers’ comp in Ohio, request a free digital copy of my book, The Worker’s Guide to Injury Compensation in Ohio, and call me for a consultation about your case.

Related Links: Unfair Treatment After a Work Injury in Ohio Releasing Medical Records to the Ohio BWC What to Tell Your Ohio Workers’ Compensation Doctor