Ohio workers’ compensation is designed to help support employees that are injured on the job through medical care and wage replacement. The system has fairly simple requirements—most basically, the injury must occur because of employment conditions and the worker must be an employee of the company. Injured workers or their employers file for benefits, and the Ohio Bureau of Workers’ Compensation (BWC) and its managed care organizations (or your employer, if self-insured) coordinate care and wage replacement payments. There are many gray areas, however, including how to address worsening symptoms after an initial injury. The BWC has certain rules about obtaining further benefits if a worker's circumstances change. Here, we take a look at the laws that govern these situations and what options may be available to you.
Worsening of Work Injury Symptoms and Your Benefits
At times, a worker is injured on the job, files for benefits, and receives them. Then, the injury worsens. The prognosis or symptoms change or your ability to work changes. The options available to injured workers in these situations depend on the nature of the injury and the initial claim. The three most common circumstances include:
- Currently receiving weekly benefits for the initial claim. There are a number of forms that can be filed to request that the BWC modify your claim allowances. With the help of an attorney, injured workers can file a motion to include additional conditions causing the worsening or persistent symptoms. This will permit consideration of additional forms of treatment such as surgery, pain management, therapy, injections, etc. Medical evidence is required to support the request.
- Received weekly benefits which have since ceased. It can be possible to reactivate the claim, depending on how much time has passed. When a certified medical provider acknowledges the need for further care, forms can be filed for additional benefits (compensation and treatment) for the same injury. It is also possible to request in increase in a partial disability rating even if you are currently working.
- Accepted a lump sum settlement for the injury. The ability to revisit a settlement depends on the terms of the agreement. Indemnity-only settlements are left fairly open-ended concerning medical issues and allow the injured worker to return to address treatment requests related to the initial injury. More often, however, settlement agreements include language that prevents workers from pursuing any further benefits. In these situations, it's worth exploring whether filing a new claim is a possibility. An attorney can help injured employees examine their situations to determine what options are available.
Ohio Law and Aggravation of Pre-Existing Conditions
In some cases, job conditions cause workers to experience an onset of or a worsening of symptoms related to a pre-existing condition. Pre-existing conditions (ones the worker had before the work injury occurred, whether or not they were symptomatic) are typically not covered under workers' compensation unless the underlying condition has been impacted by a work incident. While it can be possible to obtain benefits for new or increased symptoms, it can be difficult. In the past, Ohio workers simply had to report that work conditions were causing a worsening of an old injury to obtain workers’ compensation benefits. There were no stipulations as to the degree of the worsening other than the increased symptoms caused someone to seek medical treatment. However, Senate Bill 7 changed the mandate, which now states that a worker must experience a “substantial aggravation” of a pre-existing condition in order to obtain benefits. The substantial aggravation must be documented by “objective diagnostic findings, objective clinical findings, or objective test results.” Simply reporting the change in the pain level of the condition is no longer sufficient. This can make it very difficult to get benefits approved, though every case is unique and an experienced Ohio workers’ compensation attorney may be able to help.
How an Attorney Can Help When Your Injury Worsens
In either case, it is likely that the BWC or self-insured employer will investigate your claim, seeking ways to avoid paying additional benefits. It is important to have an experienced advocate on your side who can help you:
- Understand your rights
- Gather supporting medical evidence
- File appropriate paperwork
- State your case at a hearing
- File an appeal if necessary
If you or someone you love has experienced a worsening of a pre-existing condition because of your job, you are likely entitled to workers’ compensation benefits. To learn more about your options, and how our legal team may be able to help, call the Upper Arlington law office of Monast Law today. Our experienced staff can answer your questions and schedule a free, no-obligation consultation.