Self-Insured Companies Manage Their Own Workers’ Comp Claims—But You Still Have Rights

Ohio requires every company based in the state—with very few exceptions—to provide their workers with insurance coverage for on-the-job injuries and job-related illnesses. Ohio is one of just four states that manage their own workers’ comp fund and requires most employers to participate in the state fund. While most companies have insurance through the Ohio Bureau of Workers’ Compensation (BWC), there is an exception for large companies that meet specific requirements. These companies are “self-insured.” If you have never had to make a workers’ comp claim, you might not even know whether or not you work for a self-insured company. Even when you have to make a claim, the process should be much the same, whether or not your employer is self-insured or insured through the BWC. We take a look at filing a claim with a self-insured employer.

What Do I Do If I Work for a Self-Insured Company in Ohio?

Dozens of prominent manufacturers, companies, hospital systems, colleges, and universities are self-insured in Ohio, including Honda, Cleveland Clinic, Giant Eagle, Big Lots, The Ohio State University, and many more. Each employer should provide you with information about their process for filing a workers’ comp claim, but each will generally follow a process similar to the following:

• Complete an employee accident report form if you have been involved in a workplace accident, experienced a work-related injury, or believe your occupational illness results from your work. Most employers expect you to submit the report within 24 hours of the incident or awareness of the disease or injury.
• File a claim according to your company’s instructions. You should include supporting medical evidence.
• Your employer is responsible for making a claim determination—usually within 30 days of submitting your application. The BWC is not involved in approving or denying your claim. You will likely deal with the company’s third-party administrator (TPA) throughout the process.
• If your claim is approved, the TPA will issue compensation payments for medical care, prescriptions, total temporary disability, lost time, and any other coverage you have been approved for.
• If your claim is denied, it will be referred to the Ohio Industrial Commission (IC) for a hearing. You can—and should—consult a workers’ compensation attorney to prepare for your appeal hearing with the IC.

Your company is required by law to provide workers’ comp coverage, so if you discover that they do not participate in the state fund and aren't self-insured, report them to the BWC. In this situation, the state does have a program—funded by self-insured employers—to assist injured workers without workers’ comp coverage.

The BWC provides oversight of workers’ comp for self-insured employers, so if you work for a self-insured company and are having trouble with a claim, you can file a complaint with the BWC.

Monast Law Office Helps All Injured Workers

Whether your employer is part of the state fund or is self-insured shouldn’t matter to you as a worker in Ohio. All that matters is that you understand your rights as an injured worker. If you are injured on the job, your medical bills should be paid by workers’ comp. If you cannot work for eight days or more, you should receive temporary total disability (TTD) benefits. And if your work injury or occupational illness prevents you from ever working again, you should get permanent total disability (PTD) benefits. Whether these benefits come from the BWC or a private insurance company is beside the point.

As a workers’ comp law firm, we help injured workers regardless of how their employer is insured. If your employer is self-insured and you are having problems submitting a claim, contact us soon. If your claim was denied and referred to the IC, we can help you prepare for the hearing.

We are here to answer your questions and help you every step of the way!