.png)
Employer Obligations to Cover Medical Care Costs in Ohio Workers’ Compensation Cases
- John Larrimer
- Mar 30
- 6 min read
When someone is injured on the job in Ohio, one of the most important things to do is get them proper medical treatment. Once injured workers are treated, however, questions often begin to rise. These include who pays for the hospital bill and who pays for things like surgery, physical therapy, prescriptions, or long-term care.
In Ohio, employers are required to offer workers' compensation benefits to their employees. These benefits pay for the medical care costs that are associated with work-related injuries and illnesses. Since Ohio's workers' compensation laws require this, in most cases, an employer will pay these bills through their workers' comp insurance.
If you or a family member has been injured on the job, it's important to understand the employer obligations to cover medical care costs in Ohio workers' compensation cases. Keep reading to find out more.
Ohio Is a State-Run Workers’ Compensation System for Injured Employees
Unlike other states that use private insurance carriers, Ohio employers don't have their own health insurance company for workers' comp claims. Instead, there is a third party administrator known as the Ohio Bureau of Workers' Compensation, or the BWC. This is run by the state and most Ohio employers must get workers compensation coverage through this system.
This means:
Employers pay premiums into the system.
The BWC (or a self-insured employer) pays for approved medical treatment.
Injured workers generally cannot sue their employer for negligence in exchange for guaranteed coverage of medical expenses and wage benefits.
The basics of the system is very simple - if a person is injured on the job, or develops an occupational disease, they can get medical expenses covered by making a claim through their employers' workers compensation insurance. However, things often get complicated, and an Ohio workers' compensation attorney is necessary for the employee. They can also advise on employer obligations regarding workplace accommodations.
What Medical Expenses and Medical Bills Must Be Covered?
Once the Bureau of Workers' Compensation approves the claim, Ohio law typically requires payment for all medically necessary treatment related to the claim. This includes visits to most medical providers, some out of pocket costs, lost wages, and death benefits, if the injury resulted in death.
Here are examples of commonly covered medical expenses:
1. Emergency Treatment
Ambulance transport
Emergency room care
Initial stabilization procedures
2. Physician Visits
Primary treating physicians
Specialists (orthopedic surgeons, neurologists, etc.)
Follow-up appointments
3. Surgical Procedures
Pre-operative testing
Surgery
Post-operative care
4. Physical and Occupational Therapy
Rehabilitation sessions
Functional capacity evaluations
5. Prescription Medications
Pain management
Anti-inflammatory medications
Muscle relaxers
Other medications tied to allowed conditions
6. Durable Medical Equipment
Braces
Crutches
Wheelchairs
TENS units
7. Mental Health Treatment (If Allowed)
If psychological conditions such as depression or PTSD are officially recognized as part of the claim, treatment may also be covered.
The key limitation: treatment must be related to an “allowed condition” in the workers’ compensation claim. If a condition has not been formally allowed, payment may be denied.
When Does the Employer’s Obligation Begin?
There is a specific time when employers are obligated to cover medical costs. In most cases its:
When a workplace injury or illness occurs, and
When a workers' compensation claim is filed and approved.
In Ohio, a claim must be sent to the Bureau of Workers' Compensation. Medical bills can be initially sent to the employees private insurance company, but once the claim is allowed, things change.
It's important to keep in mind that though an injured worker can use their personal insurance at first, once the claim is filed, an employer cannot force their employee to use their personal insurance.
Self-Insured Employers: How Coverage Differs
There are some large Ohio employers that are approved to be self-insured. This means that instead of paying premiums into the BWC, they pay benefits directly.
Even though they aren't in the system, they are still legally required to do the following:
Pay for medically necessary treatment
Follow Ohio workers’ compensation regulations
Approve or deny treatment requests in good faith
It's common for disputes to rise more often with self-insured employers because they control everything directly. When treatment is denied in these cases, workers can appeal through the Ohio Industrial Commission.
What Happens If Medical Treatment Is Denied?
There area number of reasons medical treatment requests can be denied. These include:
The condition is not officially allowed in the claim
The treatment is seen to be unrelated to the work injury
The treatment is considered unnecessary or excessive
There is insufficient medical documentation
If treatment is denied, the injured worker can appeal through the Ohio Industrial Commission. An experienced workers compensation attorney can help with this. They can provide insight on employer obligations when you return to work after injury as well.
Are Employers Required to Cover All Medical Costs Forever?
It depends. Workers' compensation covers treatment for conditions that are work related and those that are part of the claim. If a doctor says that an injury needs treatment forever, than its possible that workers compensation would cover it for many years.
Travel Reimbursement and Additional Medical Costs
It's also possible that injured workers may be entitled to reimbursement for mileage, parking, and certain medical supplies.
What Employers Cannot Do
In Ohio, employers cannot do the following:
Refuse to report a workplace injury
Discourage an employee from filing a claim
Force an employee to pay out-of-pocket for approved treatment
Retaliate against a worker for seeking medical care
Interfere with authorized medical treatment
It is illegal for an employer to fire an employee for filing a workers' compensation claim. If an employer does this, it's recommended that the employee reach out to this workers compensation lawyer in Columbus.
Independent Medical Examinations (IMEs)
In some cases, the BWC or a self-insured employer may request an Independent Medical Examination (IME).
An IME physician evaluates:
Whether the condition is work-related
Whether treatment is necessary
Whether the worker can return to work
While IMEs are permitted under Ohio law, their conclusions can significantly impact medical coverage. If an IME report results in termination of benefits, the injured worker may challenge the findings.
What If You Need Additional Conditions Added?
Many workplace injuries evolve over time. For example:
A back strain may later reveal a herniated disc.
A physical injury may lead to depression.
Surgery complications may create new medical issues.
If a condition is not listed in the claim, the BWC will not pay for treatment related to it.
In these cases, a motion must be filed to add (or “allow”) additional conditions to the claim. Supporting medical evidence is required. If the employer or BWC contests the addition, a hearing may be scheduled.
Wage Benefits vs. Medical Benefits
Medical coverage and wage replacement benefits are separate components of workers’ compensation.
Even if wage benefits (such as Temporary Total Disability compensation) are denied or terminated, medical benefits may still continue for allowed conditions.
Understanding this distinction is important when evaluating your case.
Common Medical Cost Disputes in Ohio
Some of the most common issues injured workers face include:
Delays in surgery approval
Denial of advanced imaging like MRIs
Refusal to cover certain prescription medications
Disputes over psychological treatment
Termination of physical therapy
These disputes often center on whether treatment is “medically necessary” and directly related to the workplace injury.
Strong medical documentation from treating physicians is often critical in resolving these disputes.
What To Do If Your Employer Is Not Covering Medical Costs
If you encounter resistance regarding medical treatment coverage, consider the following steps:
Confirm your claim has been officially allowed.
Ensure the condition requiring treatment is listed in the claim.
Request detailed medical reports from your physician.
File appeals promptly if treatment is denied.
Consult an experienced Columbus workers’ compensation attorney.
Delays in treatment can worsen injuries and prolong recovery. Early legal intervention may help expedite approvals and prevent improper denials.
How Larrimer & Larrimer Helps Injured Workers in Columbus
Medical care is the most important part of any workers' comp claim. When treatment is delayed or denied, an injured worker's recovery and financial stability are at risk.
In Columbus, Larrimer & Larrimer has been working with injured workers for decades and offers the following assistance:
Help filing and managing claims
Appealing denials for medical treatment
Adding more conditions to claims
Challenging improper findings
Protecting benefits and wages
Ohio's workers compensation system is confusing, especially when employers or self-insured companies dispute the injury or illness. Oftentimes, to have a successful claim, a workers compensation attorney is necessary.
Ohio law is very clear - employers must cover medical bills and costs for work-related injuries through the workers compensation system. These costs are not optional - they must pay.
If you or a family member has been injured on the job and facing treatment delays, denials, or disputes, understanding your rights is important. Properly navigating the system can mean the difference between full recovery and years of pain, both physically and financially.
Larrimer & Larrimer is here to help you and your family navigate Ohio's confusing workers compensation system. Reach out today for a free consultation.
Comments