After a work injury, many workers are entitled to workers’ compensation benefits. These benefits provide medical care and wage replacement to ensure that injured employees can recover as fully as possible and avoid any undue financial hardship. Many times, workers fail to receive these important and useful benefits because they simply don’t understand the process. Either they do not file for benefits because the system seems overwhelming, or an error along the application process results in a claim denial. Here, we share information about how the Ohio workers’ compensation claims process works to help you and your family understand both what to expect from the system and what is expected of the injured worker in the process.
Report Your Injury to Your Employer as Soon as Possible
The first and most important step in a workers’ compensation claim is to report the injury. In Ohio, the law allows up to two years to report a work injury. However, the more time that passes will lead to more doubt about where the injury occurred and if the injury is indeed work-related. Additionally, most companies have a written policy that requires employees to report on-the-job injuries as immediately as possible.
Employees should provide their employer with a written report of the injury. Some employers will have workers fill out an incident report, while others will be satisfied with just a simple written or emailed notification.
Opening a Claim With the Ohio Bureau of Workers’ Compensation
After the injury has been reported to an employer, a workers’ compensation claim is handled by the Ohio Bureau of Workers’ Compensation (BWC). The claim will begin with the completion of a First Report of Injury (FROI) form. This form can be mailed in or completed online, and they can be submitted by:
- An injured worker
- Healthcare provider
- Other authorized representative
- Managed care organization (MCO)
According to the BWC, many Ohio workers’ compensation claims are filed by an MCO after they are notified by a healthcare provider. It is important to note that the injured worker should tell providers that the injury is work-related when seeking care. The MCO is selected by the employer and works with the BWC to manage claims and present care options.
Pursuing a Work Injury Claim After the Initial Report
After the FROI has been submitted, the BWC will respond to the claim within 28 days. In some cases, the MCO will need additional information regarding your claim, and they may contact you with questions. Responding promptly and completely will help speed up your claim and increase the likelihood your claim will be approved. Many claims are denied simply due to a lack of information. An experienced workers’ compensation attorney can help injured workers file their claim. An attorney can provide the necessary follow-up information and gather evidence to support that claim.
After reviewing your claim, the BWC will decide to approve or deny your claim. If approved, medical bills will be paid and weekly wage replacement will begin. If you receive a denial, it can still be possible to obtain benefits.
Appealing a Workers’ Compensation Claim Denial in Ohio
There is an appeals process for claims that are denied. Once an injured worker receives the notification from the BWC of the claim denial, he or she has 14 days to file an appeal. Appeals must be filed in writing, typically using an IC-12 form. The Ohio Industrial Commission (IC) decides all workers’ compensation appeals. Injured workers are usually required to attend a hearing, and they will be notified of the time and date of the hearing in writing by the IC. After the hearing, the IC will send a written decision to the injured worker and/or his representatives within 45 days.
In Ohio, there are three levels of appeals, so it is possible to appeal the decision to a higher level more than once. At each point, it is necessary to appear for the hearing and to state your case. During the appeals process, an experienced Ohio workers’ compensation attorney can provide valuable guidance, as well as help tell your story and provide compelling evidence for the approval of a claim.
Important Tips for Filing an Ohio Workers’ Compensation Claim
While facing the workers’ compensation claims process can feel overwhelming, the process is manageable and can be used to obtain vital benefits. To help support your claim, it is important to:
- Seek medical treatment. Obviously, your health is the most important thing. Seek care for an injury as soon as possible. This not only protects you and your family, it also supports your claim that your injury is real and inhibits your ability to work.
- Make your reports in writing. With these records, it is easier to prove that an injury is work-related and prevents an employer or insurer from claiming an injured worker missed a deadline.
- Complete the FROI. While it is possible that an MCO or a medical provider will complete this step, don’t count on them to do so.
- Appeal promptly. If you need to appeal a claim denial, you need to act quickly before the deadline runs out.
If you or someone you love has suffered an injury at work, you may be eligible for workers’ compensation benefits. The process to obtain these benefits does work and can provide the vital care and financial support your family needs during a difficult time. To learn more about your options and how to obtain Ohio workers’ compensation benefits, call our workers' compensation law office in Upper Arlington, OH. Talk to a member of our team, and schedule a free, no-obligation consultation today.