The short answer is yes, you can work with a lawyer even if your employer is self-insured, but only if your case is referred to the Ohio Industrial Commission (IC) on appeal.
If you are injured on the job and unable to work in Ohio, it probably doesn't matter to you whether your employer has workers' comp insurance through the Ohio state fund or a private insurance company. All you care about is getting approved for coverage for medical expenses and lost wages.
However, there are major differences between these kinds of coverage, so whether your employer has state-funded insurance or not will matter if you have any problems with the claim. Know that even if your company is self-insured, you still have rights, including the right to an attorney if you need to appeal a denied claim.
How a Self-Insured Claim Is Different
Ohio is one of the few states that manages its own workers' compensation fund and requires most employers to participate in the state fund. However, there are exceptions for employers with at least 500 employees operating in Ohio for at two years and meet more requirements. Big employers such as Honda, Giant Eagle, Ohio State, and Cleveland Clinic are all self-insured in Ohio.
While these companies use private insurers to manage injured worker claims, they must adhere to all of Ohio's requirements for coverage. The process of reporting an injury and filing a claim will be similar whether your employer is self-insured or not. However, while claim decisions are made by the Ohio Bureau of Workers' Compensation (BWC) when an employer participates in the state fund, they are made by the employer—or rather, their Third-Party Administrator (TPA)—when they are self-insured.
As you can imagine, when the people paying the bills are also the ones deciding about claims, injured workers could be in for a fight. Some self-insured employers protect their bottom line by using tactics like:
- Making the process difficult. Some employers make the claim process cumbersome on purpose to dissuade workers from filing a claim. When co-workers see the difficulty an injured employee is having with a claim, they might be less likely to file a claim if they get hurt.
- Requiring the use of certain doctors. Self-insured companies often also have on-site doctors or contracts with medical clinics that workers must see. Because these medical providers are paid by the employer, it is against their interests to diagnose serious injuries, order expensive treatments, and advocate for the patient.
- Creating inappropriate modified jobs. Under Ohio law, an injured worker could have to accept any modified job their employer offers. Some companies use this as an opportunity to humiliate the worker and set an example for others. Requiring an injured machinist to fold t-shirts at a workstation in a high-traffic area is an example of demeaning modified work.
Because self-insured employers are still bound by Ohio workers' comp law, they can and should be reported for violation. You can file a complaint to the BWC if your right to workers' comp has been violated by your employer.
When You Should Call an Ohio Workers' Comp Attorney
Another difference between a state-funded and a self-insured employer is when you can bring a lawyer into the process. When your employer has insurance through the state, the claim is filed with the BWC, and a lawyer could help you with the initial claim if you are having difficulty. However, because a claim with a self-insured employer is an internal process specific to that company, a lawyer cannot help you. If they dispute or deny your claim, it will be referred to the Ohio Industrial Commission (IC) for a hearing. At this point, you should consult a workers' comp attorney to help with your appeal.
