Answers To Frequently Asked Workers’ Compensation Questions
If you are injured at work, you should immediately complete and file a written accident report with your employer. You should also file a First Report of Injury with the Ohio Bureau of Workers’ Compensation (“BWC”) as soon as possible. The First Report of Injury form may be completed and filed by an injured worker, a treating physician, or the injured worker’s employer of record.
Once the First Report of Injury form is filed, BWC will generate a workers’ compensation claim number and assign it to the case. The claim number establishes an electronic file for the injured worker. The mere fact that a claim number has been generated, however, does not assure that any benefits will be paid in connection with the claim.
The vast majority of workers’ compensation claims are “medical only” claims. These claims are often certified (that is, accepted) the employer and are routinely allowed by the BWC.
Many claims, however, are contested by either the employer or the BWC. If a workers’ compensation claim is contested, the BWC will refer the matter to the Industrial Commission of Ohio for a hearing. A hearing notice will be provided to the injured worker, the employer, and their authorized representatives. In some cases, a BWC attorney will also appear on behalf of the BWC at Industrial Commission hearings.
If an injured worker receives a hearing notice, their claim (or an issue arising under the claim) has been contested. In such cases, the injured worker may wish to retain legal counsel.
There are two general types of claims. One involves an acute injury – in other words, a slip, trip, or fall at work, an injury on a machine, etc. Another type of claim, known as an occupational disease claim, involves repetitive use injuries that occur over a period of time or exposure to substances (such as asbestos) that results in an illness. A third type of claim may also be filed for an injury that arises over a few days or weeks, even though that injury involves neither an acute traumatic event nor repetitive use or a bona fide occupational illness.
Generally speaking, medical bills are payable in an allowed workers’ compensation claim. Prior authorization for treatment must, however, be obtained.
Some Ohio employers are self-insured. In claims involving a self-insured employer, a request for benefits must be filed first with the employer. If the employer disputes payment of medical bills or the necessity of the treatment requested, it is required to refer the matter to the Bureau of Workers’ Compensation and the Industrial Commission.
If the employer participates in the BWC’s state insurance fund, requests for treatment must be submitted to the employer’s managed care organization (“MCO”). The MCO is responsible for determining whether the requested treatment will initially be approved or denied. Appeals from the MCO’s initial decision are eventually referred to the BWC for further evaluation. Appeals from BWC denials are then referred to the Industrial Commission for hearing.
An injured worker has the right to choose his or her own health care provider. The worker can change his or her physician of record at any time, so long as the intent to change is filed in writing. Treatment requests and documents submitted by medical doctors (M.D.s), doctors of osteopathic medicine (D.O.s), and chiropractors (D.C.s) can all be considered in a workers’ compensation claim.
If an injured worker misses more than seven days of work as a result of their injury, a request may be filed for payment of temporary total disability compensation. If the worker is temporarily and totally disabled from working for less than twelve (12) weeks, compensation is paid based upon the worker’s earnings in the week prior to the injury (or earnings in the six (6) weeks prior to the injury). If the injured worker is unable to work for more than twelve weeks, the rate of compensation is based upon the worker’s average weekly wage for the year prior to the injury.
Once a claim is allowed, and depending on the circumstances, an injured worker may also be eligible to receive other benefits. These benefits may include wage loss compensation (working or non-working), living maintenance compensation, permanent partial disability and loss of use awards, and permanent total disability compensation. An employer and an injured worker may also agree to a full and final cash settlement which, if approved, will close the claim forever.
Following Industrial Commission hearings, the original allowance of a claim or the allowance of an additional diagnosis may be appealed by either party to the Court of Common Pleas in the county in which the injury occurred. Such appeals generally involve attorneys representing the Ohio Attorney General, the employer of record, and the injured worker. The employer and the injured worker are responsible for retaining their own legal representation. If the parties do not agree to a settlement of the claim, a jury trial will be scheduled.
There is a two (2) year statute of limitations applicable to a workers’ compensation claim. If the claim is not filed within two (2) years, it may be forever barred. Under no circumstances should any injured worker wait two (2) years to report an injury or file a claim.
Remember – the sooner you file your claim, the more likely you are to succeed in its allowance.
The law offices of Larrimer & Larrimer have represented injured workers for over 80 years. We do not represent employers, and we do not undertake representation on matters outside of the workers’ compensation area. By focusing our law practice exclusively on workers’ compensation cases, our attorneys have all developed a high level of expertise within this area of law.
If you were injured at work, we wish you the best outcome. Hopefully, your claim will be administered properly and you will receive any benefits to which you are entitled without opposition or undue delay. If you experience opposition or problems, however, or if you have any questions regarding a filed or unfilled claim, you should not hesitate to call our office for a free consultation. No fee will be assessed for the initial evaluation of your case, and we can usually meet with you immediately.
If you decide that you need legal assistance with your claim, we hope that you will consider meeting with us to discuss the matter further.
Thank you for taking the time to review our website.
Practice consists of exclusively representing injured workers before the Ohio Bureau of Workers' Compensation and Industrial Commission of Ohio.
Helping injured workers since 1928.
