The filing of the First Report of Injury Claim establishes an Ohio Bureau of Workers' Compensation claim number. A claim number establishes an electronic file for the injured worker. It does not assure that any benefits are paid.
If the claim is contested, the Ohio Bureau of Workers' Compensation will refer the claim to the Ohio Industrial Commission for a hearing. A hearing notice is provided to the injured worker, the employer, and their appointed representatives. In some cases, a BWC attorney will also appear on behalf of the BWC at an Industrial Commission hearing. A vast majority of workers’ compensation claims are medical only claims, are certified by the employer and are allowed routinely by the BWC.
A number of other claims are contested claims requiring Industrial Commission hearings. If an injured worker receives a hearing notice, it is a contested claim. In that case, the injured worker may wish to obtain legal representation.
There are two general types of claims. One involves an acute injury, in other words, a slip, trip or fall. A separate claim, an occupational disease, involves repetitive use over a period of time. Some claims may also be filed for an injury arising over a few days or weeks even though it is neither an acute trauma nor a repetitive use claim over a long period of time.
If an injured worker misses time from work a request may be filed for payment of temporary total compensation. Less than seven (7) days off work are not payable. Temporary total disability for less than twelve (12) weeks is paid based upon earnings in the week prior to injury or in the six (6) weeks prior to injury. If the injured worker is off longer, then the rate of compensation is based upon an average weekly wage of the year prior to injury earnings.
If an injured worker returns to work in a light duty capacity and earns less as a result of light duty restrictions, the injured worker may be paid wage loss for the difference in pay. If the employer cannot accommodate light duty restrictions, the injured worker may also undertake a light duty job search. In that case, non-working wage loss may be considered. Applications for these benefits are filed directly with the Ohio Bureau of Workers' Compensation. If the request for benefits is disputed by the employer or the BWC, the matter is referred to the Industrial Commission for a formal hearing.
Generally speaking, medical bills are payable in an allowed workers’ compensation claim. Prior authorization must be obtained. Some employers in Ohio are self-insured. In claims involving a self-insured employer, a request for benefits must be filed first with the self-insured employer. If the employer contests the benefits it is supposed to refer the matter to the Bureau of Workers' Compensation and Industrial Commission. If the employer participates in the Bureau of Workers' Compensation state insurance fund, then requests for compensation for time off work are filed with the Ohio Bureau of Workers' Compensation. Requests for medical care are filed with the managed care organization. The managed care organization is responsible for evaluating whether treatment is approved or denied initially. Then, appeals from decisions of the MCO denying care are eventually referred to the BWC for further evaluation. Appeals from any BWC denials are then referred to the Ohio Industrial Commission. Also, the injured worker has a right to choose his or her physician of record. A change of physician must be filed in writing.
Apart from temporary total and wage loss compensation other awards are available. These include Permanent Partial Disability, loss of use awards, Permanent Total Disability, and a full and final settlement payment to close a claim in its entirety.
The original allowance of a claim or an allowance of an additional diagnosis after Industrial Commission hearings may be appealed to the Ohio Court of Common Pleas in the county in which the injury occurred. In the vast majority of cases, Court of Common Pleas’ appeals always 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.
The law offices of Larrimer & Larrimer have represented injured workers for over 75 years. We do not represent employers. We do not undertake representation on matters outside of workers’ compensation cases. By focusing our law practice solely on workers’ compensation cases, our attorneys have all developed a high level of expertise in this area of law. If you were injured at work we wish you the best outcome and we hope your claim is administered properly and benefits are paid without opposition. If you experience opposition or if you have any questions regarding a filed or unfiled claim, we recommend that you call our law office for a free consultation. No fee is assessed for the initial evaluation of your case. We can usually meet with you immediately.
Remember, each claim has a two (2) year statute of limitations. If the claim is not filed within two (2) years, it may be forever barred. You should not wait two (2) years to report or file your claim. The sooner you file your claim the more likely you are to succeed with your allowance. If you decide you need legal services, we hope you will consider meeting with us. 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.
