Answers to Workers’ Compensation Questions From a Columbus Attorney
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What should I consider before settling my workers’ comp case?
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.
Can I collect workers’ comp benefits if my work-related vision loss is correctable?
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.
What Is The Difference Between Managed Care Organizations and Third Party Administrators?
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.
Do I have to be injured in my office, on my job site, or at my usual place of employment to qualify for workers' compensation benefits?
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.
Are all Ohio businesses required to carry workers’ compensation insurance?
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.
Can I use my health insurance to obtain medical treatment after a work injury?
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.
Can I be denied workers’ compensation benefits if I fail a drug test?
One of the main tenets of the workers’ compensation system across the U.S. is an injured employee’s ability to obtain benefits regardless of fault. In exchange for reduced liability, employers agree to provide care and compensation even if an employee played a role in the accident or situation that resulted in the illness or injury. There are, however, some key exceptions to this rule. Besides injuries suffered in fights or that occur when an employee violates company policy, drug use can disqualify workers from benefits. Many workers wonder both if their employers may perform drug tests and if it is possible to lose workers’ compensation benefits as a result of a failed test. Here, we look at drug testing and drug policy relevant to Ohio’s workers.
Employers’ Rights to Use Drug Testing in Ohio
Ohio employers are within their rights to perform drug tests on employees. The Ohio Bureau of Workers’ Compensation (BWC) even encourages employers to do so, offering incentives for employers to enroll in a state drug-free workplace initiative. The Drug Free Safety Program (DFSP) calls for employers to drug test employees after an accident and upon return to work as two of several requirements of the program. Employers are also permitted to test an employee when reasonable suspicion of intoxication or drug use arises. While this program is voluntary and not every Ohio employer will participate, know that drug testing is a common practice and may occur at your place of employment regardless of whether your employer is involved with DFSP or not.
What to Expect From a Drug Test and What They Test For
There are several ways to test a person for drug use, and different employers may elect to use different methods. The most common forms of drug testing include examining samples of urine, hair, blood, breath, or even sweat.
Employers most commonly follow the guidelines set by the national Substance Abuse and Mental Health Services Administration. Under these guidelines, employers will test for:
- Amphetamines (meth, speed, ecstasy)
- THC (marijuana)
- Cocaine and crack
- Opiates (heroin, morphine, oxycodone)
- Phencyclidine (PCP)
Failing a Drug Test Does Not Automatically Disqualify Workers From Benefits
So, you were involved in an accident at work and failed a subsequent drug test. What now? You still may have workers’ compensation benefits. State law mandates that an employee can only be denied benefits if:
- He or she was under the influence during the accident or injury. It must be shown that the employee was under the influence when the injury occurred. This means a drug test days or weeks later may not matter. Only timely tests that can scientifically and reliably indicate impairment at a specific time are relevant.
- The drug or alcohol use was the proximate cause of the injury. Proving an employee was impaired during an injury is not enough. In addition, an employer must show that the impairment directly led to the accident or injury. If any other circumstances contributed to the injury besides the employee’s drug use, it can still be possible to obtain benefits.
And there are a several other defenses against benefits denial after a failed drug test. Workers taking medication prescribed by a doctor for a legitimate medical reason, those singled out unfairly among other employees, and anyone subject to inappropriate testing methods could dispute the drug test results.
If you or someone you love has suffered an injury at work, and you are worried about drug testing by your employer, contact the experienced workers’ compensation attorney at Monast Law Office. Attorney Jim Monast and his staff can provide information about your rights to medical care and compensation, and they may help you protect those rights. Call our Upper Arlington office today, or take a moment to fill out our online contact form for a prompt response from our team.