Frequently Asked Questions About Ohio Workers’ Compensation Cases

Overwhelmed with questions after a work accident? Our legal team has the answers. Find out what to do in the days following your injury, which forms to file, and other information that can increase the odds of getting your workers’ compensation claim approved.

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  • General Workers' Compensation Claim FAQs

    Columbus employees and workers throughout Ohio who suffer injuries on the job normally have many questions running through their mind. Here we have provided many answers to common questions we are asked regarding general claim information. We have also provided many questions and answers regarding medical treatment and receiving compensation.

    Who files an Ohio workers’ compensation claim?

    You do! When an injury occurs at work, immediately report the accident to your employer.  They are supposed to help you file the claim with the company’s Managed Care Organization (MCO). Reporting the claim on the BWC website is the Bureau’s preferred way of filing a claim. When you file a claim online, you will immediately receive a claim number. Learn more about filing a claim if you have already seen a doctor.

    Do I qualify for workers’ compensation benefits?

    Unfortunately, the answer is not so simple. Workers' compensation laws are very complex and it is sensible to work with an experienced Columbus workers compensation attorney. It really does depend on your individual situation. Please call our office at (614) 334-4649.

    What kind of injuries are covered by workers’ compensation?

    In Ohio, workers’ compensation covers physical injuries sustained in the course of and arising out of employment. Pre-existing physical conditions substantially aggravated by a work injury/incident may also be covered. Psychiatric/psychological conditions that develop from or, if pre-existing, are substantially aggravated by physical injuries are also covered. Ohio is one of a minority of states that does NOT recognize as compensable psychiatric/psychological conditions that develop without a corresponding physical injury.

    Do I need an attorney for my workers’ comp case in Columbus?

    Not all claims involve serious injuries and not all claims need attorney involvement. If an injury is relatively minor, requiring maybe a trip to the emergency room and a stitch or two with no residual impairment, it may go through without a hitch. It’s likely you will want to talk with a Columbus attorney who specializes in workers’ compensation claims if your injury is serious, will likely involve lost-time from work, and/or is being contested by your employer and/or the BWC. Learn more

    How do I claim workers' compensation in Columbus? 

    Ohio workers' compensation form

    First, report the injury to your Columbus or Ohio employer in writing. While reporting in writing isn’t a legal requirement, doing so documents your actions and lessens the possibility that your claim will be contested. Second, seek medical attention from an urgent care facility, hospital emergency room, company nurse, or doctor soon. Provide a complete history of what you were doing, how you were injured, and where it hurts. Third, if you are claiming workers’ compensation, file your claim promptly. The time you have to file a claim is limited by the statute of limitations. Your hospital or employer may furnish necessary paperwork and even file the claim for you, but it is ultimately your responsibility to ensure that your claim is filed with the Ohio Bureau of Workers’ Compensation and a claim number is assigned.

    How long does it take to process a workers’ compensation claim?

    Within 28 days, the Bureau of Workers’ Compensation (BWC) will allow or deny your claim. By responding to any inquiries from them or from your managed care organization (MCO), you will speed up the decision process and receipt of benefits.

    What types of benefits will I receive?

    Injured workers in Ohio are eligible to receive medical treatment for their work-related injuries and compensation for their lost time from work. This compensation, known as Temporary Total Disability (TTD), is paid if the injury results in more than a week off work. If the lost time is less than a week, no compensation is payable. If it’s between one and two weeks, only the period during the second week is compensable. If over 2 weeks, it’s all paid.

    Temporary Total Disability compensation is paid based on a percentage of the worker’s earnings for one week, 6 weeks or 52 weeks prior to the injury, depending on how long the period of disability lasts. Injuries resulting in some permanent impairment may permit an additional award of compensation known as permanent partial disability.

    What is a C84?

    The Ohio Bureau of Workers’ Compensation requires Form C84 as proof of ongoing temporary total disability. The injured worker must complete the form, verifying the period of disability and that she has not worked and has not received other wages during the period of temporary total disability. These forms must be periodically updated for compensation to continue. Your doctor must complete a separate form certifying temporary total disability. Both forms are required before compensation can be paid.

    What’s a MEDCO-14?

    A MEDCO-14 is a Physician’s Report of Work Ability. Your doctor completes this form to certify that you are temporarily and totally disabled due to your work injury or to identify any restrictions on your ability to perform your job duties due to the injury. A MEDCO-14 must be submitted every time you submit a C-84.

    What is permanent partial disability?

    Permanent partial disability (PPD) is a form of compensation that may be payable following a work injury. It is paid by the Ohio Bureau of Workers’ Compensation or a self-insured employer following an exam (or sometimes multiple exams) at which a physician is asked to provide an opinion regarding lost bodily function that has resulted from an injury or occupational disease. It is workers’ compensation’s version of a damages award for an industrial injury. Time limitations may apply in requesting an award of PPD. In addition, the percentage of disability resulting from an injury may be disputed by the injured worker, the employer, and/or the BWC. In such situations, the Industrial Commission conducts a hearing to determine a proper award. This is differs from a settlement of your claim.

    If my injury happened at work, why is my employer denying treatment?

    Treatment may be denied by your employer, your managed care organization (MCO), or the BWC if excessive, inappropriate, or not cost-effective. MCOs may deny treatment they consider too expensive, even if it is treatment your doctor believes is beneficial. You may appeal decisions denying treatment that your doctor believes appropriate.

    What if my employer tells me not to file a workers' compensation claim?

    Penalties may be assessed against employers who fail to provide workers’ compensation coverage. If an employer tells you not to file a claim for a work-related injury, maybe s/he tried to cut costs by not obtaining the mandatory workers’ compensation coverage. Reporting the injury would notify the BWC of the employer’s non-compliance. It could also be the employer has had so many claims filed against them they fear the BWC will increase their insurance premiums.

    Injured employees are still covered by the workers’ compensation system even if their employer is non-complying, so it is still best to file a claim. Learn more

    Can I appeal a denied workers' compensation claim?

    The BWC has 28 days to allow or deny your claim. If you or your employer disagrees with BWC’s decision, either party can file an appeal with the Industrial Commission (IC) within 14 days.

    There are three hearing levels for workers’ claims at the IC:

    District level hearings — These take place in locations throughout Ohio within 45 days of filing an appeal. The district hearing officer will decide within seven days. The IC sends both parties a written notice of the hearing officer’s decision. Each party has 14 days from receipt of the district hearing officer’s decision to file an appeal to the next level.

    Staff level hearings — These take place within 45 days after an appeal of the district hearing officer’s decision is filed. The staff hearing officer will decide within seven days. The IC will send each party a written notice of the staff hearing officer’s decision. Each party has 14 days from receiving the staff hearing officer’s decision to file an appeal to the next level.

    • The commission level — After studying the staff hearing officer’s decision, the commission either agrees to hear the appeal or refuses to permit further appeal. If the commission accepts the appeal, a commission hearing will occur within 45 days. The commission will decide within seven days. If the commission refuses to hear the appeal, depending upon the issue, you may appeal the matter to the court within 60 days after receipt of the commission order. Learn more about your options if your workers' comp claim has been denied.

  • Medical Treatment FAQs

    Woman receiving medical treatment for work injury

    It only takes a split second for an accident at work to turn a person’s life upside-down as the medical bills roll in. We've aimed to answer all of your questions regarding receiving the medical treatment you need. If you still have questions about workers' compensation or receiving medical treatment, please contact our office at (614) 334-4649. We've also answered many FAQs regarding general claim info and receiving compensation.

    Who approves treatment?

    Requests for treatment are submitted by your doctor to the MCO assigned to your case. If your employer is self-insured, requests are sent to your employer’s TPA (third-party administrator). The MCO or TPA may request additional information from your doctor or a medical review before approving the treatment. Denials of treatment may be appealed.

    Can I go to my family doctor?

    An injured Ohio worker may be treated by a doctor of his choice, as long as the doctor is a BWC-certified healthcare provider. Often, family doctors do not treat job-related injuries because they are concerned about the paperwork involved and/or the hassles associated with claims procedures. Your family doctor refer you to a BWC-certified provider. You can also ask for recommendations from co-workers, your union representative, your attorney, or other people who have received treatment for a work injury. The BWC and your MCO also maintain lists of physicians who treat industrial injuries.

    I want to change doctors. How?

    You may decide to change physicians for a variety of reasons, ranging from the retirement of the provider, travel distance, or a desire for a different treatment option. Injured workers who wants to change physicians should notify the MCO and submit BWC Form C23. If your employer is self-insured, this form should be sent directly to the employer or its TPA.

    I can’t get my prescriptions filled. What should I do?

    Your pharmacist can explain why payment for a prescription is denied. It may be a coding error or a concern that the medication is inappropriate. Your doctor can provide additional information regarding the need for and the propriety of the medication. If the bill was denied pending the allowance of the claim, you will be reimbursed once your claim is allowed. Keep all receipts for medications and treatment related to your injury if you need to request reimbursement.

    What is MMI?

    Temporary total disability (TTD) compensation is payable following an on-the-job injury until the injured worker is released to return to her former job, actually returns to that job, or is determined to have reached maximum medical improvement (MMI). MMI indicates that the injury has reached a treatment plateau under the current treatment regimen, meaning it has gotten about as good as it will get! Although temporary benefits are no longer payable if the condition is no longer improving, other forms of compensation may be available for injured workers whose TTD has been terminated after a finding that their condition has reached MMI.

    Why do I have to wait for treatment? I just want to get back to work!

    During the initial processing period (i.e., when the Ohio BWC or your employer is deciding whether to allow or contest the claim), physicians may be reluctant to provide treatment, as there is no guarantee they will be paid. Some doctors will provide treatment, pending the allowance of the claim, expectating the claim will be allowed or that you have other means of paying (for example, other insurance) should the claim be disallowed. While your claim is considered, avoid large unpaid medical bills you may have to pay should your claim be disallowed. Once the claim is allowed, providers (other than pharmacies) who have treated you for the job-related injury should submit their bills to your MCO.

    What is an Independent Medical Examination (IME)?

    An independent medical examination (IME) is a medical evaluation scheduled by the BWC or employer's representative to opine about various medical issues related to your claim, including, but not limited to, whether treatment or testing is necessary, the degree of your permanent impairment and whether you have reached MMI. When scheduled by an employer, I believe it more accurate to describe this as a DME: Defense Medical Exam. Employers hire the same doctors over and over to render medical opinions on their behalf--they are not "independent".

    How will I know if a doctor is certified by BWC?

    The simplest way is to ask your doctor when you make the initial appointment. You may also call the employer's MCO, the BWC at 1-800-644-6292, or research BWC certified providers (by name, location and/or specialty) at the BWC's website.

    How do I get my medical bills paid?

    Medical bills should be payable in an allowed claim. Give your claim number to all of your medical providers who treat you in your claim. They will then request authorization for the medical treatment they request from the MCO. There are advantages of using the workers' compensation system as opposed to using private health insurance for a work injury

    What should I do if I get medical bills?

    You should forward the bills to your MCO or self-insured employer. Unpaid bills can be appealed to the BWC for further investigation.

    Can I get reimbursed for prescriptions?

    Like medical bills, prescriptions for allowed conditions in your claim should be payable in an allowed claim. Inform your pharmacist that the prescription is for a workers' compensation claim. You may need to pay for the initial prescription, but if the BWC determines the medicine was for the allowed conditions, you will be reimbursed.

    Obviously, you are responsible for any bill or prescription that the BWC determines is not related to your claim.

     

  • Compensation FAQs

    Workers who suffer injuries on the job normally have many questions running through their mind. Here we have provided answers to the questions we are commonly asked. We have also provided many questions and answers regarding medical treatment and general questions.

    When will I get paid? How much will I be paid?

    Filing a claim doesn’t guarantee payment of compensation or benefits. Your claim may be denied or disputed by the BWC or your employer. The Ohio Bureau of Workers’ Compensation has 28 days from claim filing to accept or deny a claim. Learn about your options if your claim has been denied. Compensation won’t be paid until a claim is allowed.

    The amount you are paid depends in part on how long you cannot work. The Ohio BWC or a self-insured employer will calculate your earnings prior to your injury, and you will be paid a percentage of those wages. The wage calculation and rate of payment often change, depending upon how long you cannot work. Wages may be set too low, and in these cases we can request an adjustment to consider special circumstances, periods of unemployment, or additional wage information, including wages from a second job.

    How long will I be paid for the work I miss?

    Generally, you could be compensated until you are released to return to your former job, actually return to that job, or are determined to have reached maximum medical improvement (MMI).

    How is the money I am paid determined?

    Your benefits are based on the money you earned working for the year prior to injury. Your Full Weekly Wage (FWW) is determined by the greater of your gross wages (including overtime) earned over the 6 weeks prior to injury, divided by 6; or your gross wages (excluding overtime) for the 7 days before the injury. The first 12 weeks of temporary total disability (TTD) compensation will be paid at 72% of your FWW. Benefits after the first 12 weeks of TTD will be paid based on your Average Weekly Wage (AWW), which is generally calculated by taking your earnings from all employers for the year prior to the injury and dividing that amount by 52 weeks. Those benefits are paid at 66⅔% of your AWW.

    Can I ask for a settlement?

    This is an issue you should consult an attorney about. There may be factors you are not aware of, and an experienced attorney can help secure the maximum settlement amount. At a minimum, wait until you are sure you will have no further complications from your work injury. Most employers will not settle with an employee while they are still working there, as the risk of re-injury and a new claim is present.

    What happens if I go back to work after being deemed permanently and totally disabled?

    You will lose any permanent total disability (PTD) benefits and likely be charged with fraud if you collect PTD compensation while working (unless you are receiving statutory PTD). If you believe you have medically recovered to the point of returning to work, consult an attorney about options before you do.

    Do I still get any benefits when I return to work?

    There are other benefits that may be available after returning to work. For instance, you may be entitled to a Working Wage Loss if your injury prevents you from making the same salary as you did prior to the injury. This is something you should consult with an attorney about.

    Is any tax taken out of my benefits check?

    No. Workers' compensation benefits are tax-free.

    Why do my Worker's Comp checks come in for different amounts?

    The first 12 weeks of TTD compensation are paid at 72% of your FWW. After the first 12 weeks, it is paid at 66⅔% of your AWW. It is possible that, because of the day of the week a check is originally issued or other factors, a check may only cover a portion of the standard 2-week pay period. The period covered will be listed on the payment. You will receive the amount you are entitled to, and eventually, the checks will be for a consistent amount and released on a consistent basis.

    How long does it take for me to receive my benefits check?

    Unfortunately, there is no definitive answer to this question. It may take many weeks (and sometimes, months) before compensation is received after it is awarded.

  • As a teacher’s aide, can I get workers’ comp if I'm injured at school?

    OH teachers' aides are eligible for workers' comp if injured on the jobTeachers’ aides are some of the hardest-working employees in a school. Sometimes called para-professionals or para-pros, these helpers assist certain students and help with controlling chaos in the classroom.

    Because of the hands-on nature of their work, they're also prone to be injured on the job. It’s important for these valuable school employees to understand that they can file for workers’ compensation if they're hurt at work, even if they're part-timers.

    How Aides Get Hurt at School

    If an aide is assigned to work with a student who's health impaired, their job will be physically demanding. Working with students with cognitive or behavioral challenges, as my daughter-in-law does, could mean they're at risk of being assaulted. Teachers’ aides are in the trenches with students, so to speak, and they suffer injuries as often as, or even more frequently than, classroom teachers.

    Some causes of para-pro injuries include:

    • Outbursts and attacks. When an aide is assigned to work with an individual student, they could bear the brunt when the student lashes out or has a tantrum. Being hit, knocked down, or shoved against a wall can cause serious injuries.
    • Playground incidents. Teachers’ aides often serve as playground monitors and are the first on the scene if there's a fight. They can also suffer trip and fall injuries, be hit by playground equipment, or sustain a strain or sprain injury while playing with children.
    • Handling wheelchairs. Pushing a student in a wheelchair, moving an empty wheelchair, and lifting a student in an out of the chair can all take their toll on a teacher who must do these tasks all day, every day.
    • Lifting and restraining. Teachers’ aides are often responsible for physically restraining students having a meltdown and may have to lift and carry the child away to protect other students. These are physically-demanding tasks. 

    If you get to where the physical demands of your job as a teachers’ aide cause injuries that prevent you from working, you can qualify for workers’ compensation to pay for your medical bills and lost wages, even if you only work part-time. Learn more about your rights as a worker in Ohio by downloading my free book, The Worker’s Guide to Injury Compensation in Ohio.

    If you have questions after an injury at school, call my office to speak to one of my knowledgeable team members. 

     

  • What changes are coming in 2020 to workers’ comp law in Ohio?

    Ohio House Bill 81 makes changes to workers' compOhio House Bill 81 (HB 81) was signed into law by Governor DeWine on June 16, 2020. What started as an initiative to expand workers’ comp coverage for post-exposure testing of safety officers will now address several other key issues when it goes into effect later this year.

    While the changes might just be legalese to a layperson, they represent significant changes to workers’ comp attorneys like me.

    Ohio Workers' Comp Changes Effective September 15, 2020

    While testing of peace officers, firefighters, emergency medical workers, and corrections officers exposed to blood and bodily fluids on the job is already covered by workers’ comp, HB 81 expands that coverage. Beginning September 15, 2020, workers' comp extends to employees of detention centers and includes exposure to drugs or other chemical substances. Also, these changes will be implemented when the law goes into effect:

    • The voluntary abandonment doctrine regarding temporary total disability claims—which had been based on 25 years of case law—will now be subject to new, specific standards.
    • The statute of limitations for reporting violations of specific safety standards will change from two years to one year from the date of injury.
    • Funeral benefit cap increases from $5,000 to $7,500 but isn't retroactive.
    • Employers can no longer withdraw from a proposed settlement agreement when the claim exceeds their premium calculation, and the employee in the claim no longer works for them.
    • HB 81 changes the date that the Industrial Commission can invoke continuing jurisdiction to the time of medical services, rather than the date of payment.
    • Expands the time you have to appeal an Industrial Commission decision from 60 to 150 days in specific circumstances for claims pending on and arising after September 29, 2017.

    Fortunately, don't worry about how these changes affect your workers’ comp claim because, if you're already a client, my team is taking care of everything.

    If you need to file a claim or are struggling with an existing application, please call my office to discover how we may help. At Monast Law Office, we stay informed of changes affecting the Bureau of Workers’ Compensation, the Ohio Industrial Commission, and your claim. 

     

  • I was injured at work in a grocery store. Can I file for workers’ comp?

    grocery store employees' workers' compensationGrocery store workers, like everyone else who works for a company with more than one employee in Ohio, are covered by their employer’s workers’ compensation policies if they're injured or contract an occupational disease on the job. So the answer is yes, you can file for workers’ comp.

    Typical Grocery Store Employee Injuries

    As governors across the country issued stay-at-home orders in the early days of the COVID-19 pandemic, grocery store workers were suddenly included on the list of essential workers along with doctors, nurses, and postal workers. While it’s generally a good thing to be employed while many others have lost their jobs, working in a grocery store isn't without hazards.

    Besides the risk of being exposed to infected customers, grocery store cashiers, stockers, and food preparers are at high risk of other kinds of injuries depending on the work they do, including:

    • Lacerations and stab wounds. Food preparation workers handle sharp knives, meat slicers, and even power saws to package food in the butcher shop, deli, bakery, and produce department.
    • Lifting injuries. Stocking shelves involves lifting heavy items and repetitive motions, resulting in back strains and other musculoskeletal injuries.
    • Leg, back, and foot injuries. The prolonged standing required of cashiers and baggers can cause a variety of leg, back, and foot injuries.
    • Fall injuries. Wet floors, particularly in the produce department, can cause workers to slip and fall. Climbing on ladders to stock shelves or build displays also puts workers at risk of fall injuries.
    • Repetitive-use injuries. Almost every worker in a grocery store in engaged in repetitive tasks. Reaching for items, scanning at the checkout, bending and lifting, and bagging groceries can take their toll during an eight-hour shift.

    Because many stores are understaffed these days, the pressure on workers has increased, and so has the likelihood of injury.

    Contact Monast Law Office If You Have Trouble Filing a Claim

    If you're injured as an employee at Kroger, Giant Eagle, Walmart, or another grocery store in Ohio, report your injury right away and ask your supervisor about filing a workers’ comp claim. If you have any problems with the process, contact Monast Law Office for help. We also offer a free resource, The Worker’s Guide to Injury Compensation in Ohio, available as an instant download. You've worked hard to support a community in need at a difficult time and get the workers’ comp benefits to which you're entitled if injured on the job. 

     

  • I've been ordered to work from home because of COVID-19. If I'm injured, will I be covered by workers’ comp?

    Can I get workers' comp if I work from home?The quick answer to this question is yes—if you were covered in your workplace before you were sent home, you should be covered while working from home.

    However, just like an injury that happens in a traditional workplace, you must show that the injury occurred while you were doing work-related tasks. We consider what that could mean for you.

    Who's Working From Home?

    If you shifted your workplace from the office to home after Governor DeWine issued Ohio’s stay-at-home order, you're one of the lucky ones. Rather than losing your job or risking your life as an essential worker, you're able to continue working in the relative safety of your own home. I say "relative safety" because accidents do happen there, and workers can be injured in a home office as easily as in an employer’s office.

    Typical work-from-home injuries include:

    • Falls. Tripping over inventory, computer cords, or equipment, or falling down the stairs to a basement office should qualify for workers’ comp because you were injured while performing work tasks. However, tripping over the family dog or falling down stairs while checking on laundry will likely not be covered, even if they happen during the workday.
    • Repetitive-use injuries. Some of us are putting in even more hours on the computer at home than we did in the office. As in-person meetings and physical tasks have become virtual, the likelihood of developing carpal tunnel syndrome or other soft tissue injury increases.
    • Strains from heavy lifting. If you had to move merchandise or equipment to your home to keep working, you could suffer an injury while lifting and carrying heavy boxes. These work-related tasks should be covered by workers’ comp.

    Even before the COVID-19 pandemic changed the way we work in Ohio, many of us were working from home. It's likely that more of us will continue to have this option even after the governor’s orders are loosened and eventually lifted. As remote workers and telecommuters, it’s essential to understand your right to workers’ compensation in Ohio.

    Jim Monast Is Right There With You

    The staff at Monast Law Office has been working from our offices to continue to meet the needs of our clients and to help new clients with workers’ comp claims. Whether you were injured while working from home or as an essential worker in a hospital, retail outlet, grocery store, delivery service, or other positions, filing a workers’ comp claim is likely to be more challenging than usual, given the CoronaPalooza 2020 situation. Now more than ever, don’t try to go it alone. Contact us to discover how we can help you get the benefits you deserve. 

     

  • Will Ohio workers’ compensation cover my plastic surgery?

    Will workers' comp pay for plastic surgery?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.  

     

  • Why was my Medicare claim denied?

    Medicare denies workers' comp claimsWe 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

     

  • Can I file an Ohio workers' comp claim for COVID-19?

    Are Ohio employees who get coronavirus eligible for workers' comp?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.