WORKERS' COMPENSATION - SOCIAL SECURITY DISABILITY - MEDICAL MALPRACTICE - PERSONAL INJURY - PERS

Workers’ Compensation Process

Workers’ Compensation Claim Process Columbus Ohio

Employees who find themselves injured at work must complete the necessary steps to seek compensation.  The very first thing to do is report the injury to your employer.  The injury may be the result of dangerous conditions, or perhaps just a misstep.  As mentioned above, employee negligence will not be grounds for dismissing a claim.  However some employers will require drug testing within 24 hours of the incident.  If this is the case, it is important to comply with all company specific directives.

Most employers have a clear process for filing on-the-job injury claims; however, many employees are not be familiar with it.  Employers try to combat fraudulent claims by mandating employee drug testing and other steps to ensure that the injury did in fact occur on the job.  While it may seem like extra work to find out an employer’s workplace injury policy, fraudulent worker’s compensation claims are common in many industries, and employers must do everything they can to prevent them.  Clear policies are valuable tools that help both parties in understanding each other and finding common ground.  It is important to check your employee handbook to see what steps you need to take after an accident at work.

In order to report the claim, you must complete the application for workers’ compensation benefits.  This for is called the First Report of Injury.  Under Ohio Workers’ Compensation law, 3 people can fill out form: the injured worker, the employer, or an attending physician/ health care provider.  This document should be submitted to the Ohio Bureau of Workers’ Compensation where the injured worker will receive a claim number.  The First Report of Injury form can also be completed online. 

Once you have a claim number, then you can search for your general claim information on the Ohio Bureau of Workers’ Compensation website.  Generally, most claims are wither allowed or denied within 28 days.  The Bureau of Workers’ Compensation will review your information as soon as the initial report has been submitted. 

Common Problems with Workers’ Compensation Claims

  • Denied claims– Insurance companies want to deny as many workers’ compensation claims as they can in order to appease employers trying to keep their premium costs low.  Work with a workers’ compensation lawyer to appeal your unjust claim denial.
  • Denied approval for medical services– You have the right to choose your own doctor.  If a doctor recommends specific medical services, your workers’ compensation claim should cover those.  If there is a dispute over your doctor or medical services, talk to a workers’ compensation attorney.
  • Inaccurate employment status– Some employers might erroneously claim you were an independent contractor and thus not eligible for workers’ compensation benefits.  A lawyer can help you prove your employment status.

Ohio Self-Insured Employers

Certain Ohio employers qualify to be self-insured. Self-insurance is a privilege that the Ohio Bureau of Workers’ Compensation grants to employers that meet the criteria listed under Ohio Revised Code 4123.35 and Ohio Administrative Code 4123-19-03.

What is a Self-Insured Employer?

A self-insured employer pays compensation and medical costs directly to employees for on-the-job injuries, rather than paying insurance premiums to the Ohio State Insurance Fund. This means that self-insured employers assume liability themselves, pay their own claims, and administer their own workers’ compensation programs. 

Employees of self-insured employers do not need to deal with outside insurance companies.  Employees of self-insured employers should file workers’ compensation claims with their employers, directly.  When an employer is granted the privilege of administering their own workers’ compensation claims, they are given decision-making authority similar to that of the Ohio Bureau of Workers’ Compensation (BWC).  In taking on this role, a self-insured employer agrees to abide by both BWC and Industrial Commission of Ohio rules and regulations.

According to the BWC, responsibility of each workers’ compensation claim will reside with the self-insured employer, which must do the following:

  • Inform the injured employee and BWC, in writing, within thirty days from the date of notification of injury or occurrence, of the conditions it has recognized as related to the injury and what, if any, it refuses to recognize;
  • Address and respond to all medical bills within thirty days of receipt;
  • Provide or make arrangements for reasonable medical services during working hours;
  • Assist employees in completing all necessary forms and/or applications to receive workers’ compensation benefits;
  • Review for allowance and disallowance of the reported claims and issue payment of compensation and benefits in a timely manner;
  • Maintain an office in the state of Ohio and have at least one employee who is knowledgeable and capable of administering a workers’ compensation program;
  • Organize and maintain claim files and make all appropriate information available to injured workers and their representatives for review. The employer may retain a third party administrator or other individual to assist with the administration of workers’ compensation claims; and
  • House all Ohio workers’ compensation claim files within the state at one of the employer’s locations. An employer must obtain prior approval from BWC before housing claim files out of state.

What if a Self-Insured Employer Denies Compensation?

If a self-insured employer denies compensation, or if an injured employee is having problems with the process, it is best to first try to resolve the issues with the employer.  If additional steps are necessary, the employee should consult a workers’ compensation attorney.



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    Workers’ compensation exists to help individual who get injured or fall ill on the job. Therefore, only someone hurt or sickened at work or while engaged in activities directly related to fulfilling the duties of their job can claim workers’ comp benefits. The health problem must be significantly disabling, meaning the person has to stop working or accept a lower-paying position for several months. Also, the problem can affect any part of the person’s body or physical functioning. Losing a finger, going deaf or blind, having a heart attack, and developing a permanent lung disease are all examples of injuries and illnesses eligible for workers’ comp.

     

    Location Matters

    Distinguishing what counts as a work-related activity sometimes requires going to court. Clarifying the issue somewhat, general rules that have developed over time that indicate that driving a company vehicle during business hours qualifies, but taking your own car to the office in the morning before the start of the business day does not. Similarly, falling while putting on a safety suit in the factory locker room could be what lawyers call compensable, but tripping while dressing for work at home would not be. Parking lot injuries are whole separate category of worker’s comp case law.

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    Cause Matters

    The state-run program to cover injured and ill workers’ medical bills and temporary disability expenses does have a list of circumstances that automatically disqualify applications. It looks like this:

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    • Injuries suffered while engaging in clearly illegal activities, including trespassing or violating environmental laws
    • Injuries suffered while fighting with co-workers
    • Injuries suffered while purposely ignoring safety rules, which includes engaging in horseplay
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    • Strictly mental difficulties such as stress

    This list of workers’ compensation exclusions leave space for interpretation, especially since employers may attempt to convince the program administrators who investigate workers’ comp applications that a hurt or sick worker caused their own health problems. A skilled and caring workers’ comp lawyer in Cleveland, Cleveland, Ohio, can help a client gather and present evidence to counter such claims.

     

    Options Exist When Workers’ Comp Doesn’t

    Speaking with an Agee Clymer Mitchell and Portman personal injury attorney could help you explore options other than workers’ compensation. While filing and succeeding with civil lawsuits against one’s employer has become increasingly difficult in Ohio, evidence of reckless indifference to employees’ health and safety remains actionable. Another possibility could be pursuing a defective or dangerous product claim against the manufacturer of a tool or device that inflicted an injury. That tactic can succeed when a machine malfunctions, a hand tool breaks, or a walkway railing or ladder collapses.

    To discuss workers’ comp and related issues at no cost, call Agee Clymer Mitchell and Portman at (800) 678-3318 or schedule an appointment online.

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I want to thank you for representing me with my Worker’s Compensation claim. Obviously, I am very happy with the decision of Hearing Officer. I know that my employer can still appeal the decision but I hope that will not be the case. Regardless, I...

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