Ohio Workers' Compensation: Claim Review, Kinds of Compensation, Denials

The experienced workers’ compensation attorneys of Plevin & Gallucci have seen an increase in calls and questions regarding accidents in the workplace in Ohio. Here’s what you need to know to understand when you can claim Ohio workers’ compensation, how to file or appeal a claim, what benefits you may claim, what to do if you’ve been injured, and how we may be able to help.

Remember, if you have a question at any time you can call us for free at (855) 475-3846.

Continue down for an overview of Workers’ Compensation, or feel free to jump to the topic most relevant to you:

When Can I Claim Ohio Workers’ Compensation Benefits?

Accidents happen. But when they happen at work and affect your ability to do your job, you may be left with big medical bills and no way to earn a living. That’s where Ohio workers’ compensation benefits come in. They’re intended to help cover your expenses while you get back on your feet.

So, when are you entitled to those benefits?

Workers’ Compensation Requirements

In order to qualify, you’ll need to meet several requirements:

Your employer must be covered by workers’ compensation. Almost every employer is covered, with the exception of some religious groups, owners or partners who are the only employee of a business, and officers of family firms. Also note that federal employees must file for benefits through the federal government’s workers’ compensation system rather than Ohio’s state system.
You must be an employee. You must be an official, legal employee of the company – volunteers and people working under the table are not covered. If you are an independent contractor in Ohio, you may be eligible for workers’ compensation benefits. The attorneys of Plevin & Gallucci can help you understand your rights as a contractor if you are injured.
Your injury, illness, or death must be work-related. Ohio workers’ compensation only applies if you were injured at work, if you’re suffering from an occupational illness (caused by the requirements of your job or exposure to environmental toxins at work, for example), or if your work-related injury or illness caused your death. Your medical records and other documentation must directly link the injury or illness with your job.

Filing a Workers’ Compensation Claim

If you suffer a work-related injury — no matter how minor it may seem — be sure to report it to your employer immediately and seek medical attention if necessary.

If you do receive Ohio workers’ compensation benefits, you lose the right to sue your employer for the injury or illness. In some cases, you may be better off filing a lawsuit than claiming benefits; the attorneys of Plevin & Gallucci can evaluate your case to help you make that call.

If you decide that you do want to claim workers’ compensation, the claims process starts when the injured worker, medical provider, or employer files a First Report of Injury (FROI) with the Bureau of Workers’ Compensation (BWC) either online or by mail. This is going to set the stage for the rest of your case, so it’s a good idea to talk to an attorney at Plevin & Gallucci BEFORE you submit any information. We can help you fill out the paperwork properly to give your case the best possible chance of success.

The BWC will inform you whether your claim has been approved or denied within 28 days. To make their decision, the BWC will look at:

A detailed description of the accident;
The medical diagnosis of the injury;
Medical documentation that directly links the treatment to the work-related injury;
Information regarding the disability and the outlook for recovery.

Remember that your employer will bring in their own attorney to protect their interests and the BWC is a lot like a state-run health insurance company — they want to collect more premiums and award fewer benefits. In other words, they’re not necessarily looking out for your best interests. That’s why it’s important to bring your own lawyer on board to protect your rights.

Reasons a Workers’ Compensation Claim May Be Denied

Generally, your employer is going to want to see your claim denied. More claims means more accident compensation, which can lead to a higher premium. Your employer may argue against your version of the story; you’ll need evidence and documentation to support your version. Your employer may also try to have your claim dismissed on technical grounds. If that’s the case, it’s going to be very difficult to fight back without the help of an attorney; workers’ compensation laws are really technical and complicated and a small mistake can cost you big time.

Your claim may be denied because:

It was not filed on time;
The employer disputes the claim;
There is a discrepancy between the claim and the medical records;
You did not provide a thorough account of what happened;
The injury happened outside the scope of work;
There is a dispute about your employment status.

Appealing a Workers’ Compensation Claim Denial

If your claim is denied, you’ll get notice in writing. You only have 14 days after that to file an appeal, so make sure you check your mail regularly. You may also want to check in with the BWC regularly to ensure that you don’t miss a deadline.

When you appeal, you’ll have a hearing with the Industrial Commission of Ohio. Make sure you bring several copies of all the relevant documents with you. That includes:

Medical records and documentation of the injury or illness (including photos and witness statements);
All paperwork you’ve filed with or gotten from the BWC, including your First Report of Injury, the notice that your claim was denied, and your appeal paperwork;
Any other information you think may be relevant to your case.

Remember: You can and should bring your attorney with you to the hearing. Your employer may also be present; both sides will have a chance to explain their positions. Before the Commission makes a final decision, you may be sent for another medical examination with a new doctor.

What Kind of Compensation Can I Get?

If your Ohio workers’ compensation claim is approved, the compensation you receive will depend on the type and severity of injury or illness you have suffered:

Temporary total compensation is awarded when you are deemed temporarily unable to work due to your injury. It will pay for related medical expenses and some lost wages. This is the first and most basic form of workers’ compensation.
Wage loss is compensation that may be available if your injury and its effects lead to decreased wages due to job reassignment or a forced career change. The law includes either working wage loss or non-working wage loss, depending on the individual’s employment status. The first seven days a worker is injured, he or she does not receive payment of lost wages. If the worker is out of work with the injury for 14 or more days, however, the first seven days of lost wages will be paid.
Living maintenance is compensation given while a recovering worker is participating in an approved rehabilitation plan to get back on his or her feet and back to work. These payments can continue for up to six months.
Permanent total disability is potentially lifelong compensation to Ohioans who are indefinitely unable to return to work and perform their job duties due to a job-related injury or illness.

The BWC’s website offers further detail on the categories of workers’ compensation benefits.

Is a Worker’s Death Covered by Workers’ Compensation?

If an injured worker in Ohio dies as a result of a job-related injury or illness, his or her dependents have the right to file a claim with the BWC for death benefits. It does not matter whether or not the worker collected workers’ compensation benefits before death.

The amount paid is based on an assessment of the level of support the family had from their late loved one. Effective September 29, 2017, these claims must be filed within one year of the person’s death.

What’s an Occupational Illness?

In addition to injuries, workers’ compensation benefits are also available in Ohio to those who suffer from a job-related illness.

This can include ailments like carpal-tunnel syndrome for those who type all day or diseases linked to exposure to asbestos or other environmental hazards found in some Ohio workplaces.

Due to the physical effects and symptoms, the attorneys of Plevin & Gallucci will help you determine whether to make your claim an injury case instead of an illness claim. You may be able to receive additional compensation as you recover.

If You’ve Been Injured or Gotten Sick at Work

If you’ve been injured at work or developed a work-related illness, there are several steps you should take to protect your workers’ compensation claim (and your health!):

Doctor’s orders: Be a good patient. Your doctor sees a lot of patients every week, so take steps to make it easy for them to give you the best possible care. Prepare for your appointment in advance — keep a written list of your symptoms and think about how to describe them clearly. Write up a list of questions in advance to make sure you know how to speed up your recovery and what you need to avoid. Write down their instructions and follow them. Putting everything down on paper means you won’t forget anything and makes it easier for your doctor to give you an accurate diagnosis and a good treatment plan.
Don’t give up: The human spirit and our ability to heal can be powerful. Focus on your healing, and be careful to not re-injure yourself by returning to work until ready. Hopefully you are excited to get back to work, and that’s the attitude to get you there!
Don’t trust your claims coordinator: They do not understand your pain, and may not want to. Their job is to save the state or an insurance company money. They just don’t necessarily have your best interests in mind. They may also try to pressure you into making decisions when you’re in pain and under stress, worrying about your health and your family. Consider contacting an attorney to deal with the claims coordinator for you.
Don’t jeopardize your claim: Unfortunately, your employer may try to use every possible weapon to make sure your claim is denied and these days, that can mean things like photos on social media. Be very mindful of the pictures and other media you’re in — they could use an image of you smiling at a barbecue as evidence that you’re not in that much pain.
Keep records: You’ll need to keep a written record of everything to do with your claim. Keep copies of all medical records and test results. Keep records of any relevant phone calls with your doctor, the claims coordinator, and any other party to the case. Those records will be crucial evidence for your claim.

And one more thing: Do not accept a settlement without consulting with a lawyer first. They’ll pressure you to settle because that generally saves them money. If you settle, you lose the opportunity to claim any more compensation. So make sure you’ve talked to the lawyers of Plevin & Gallucci to know how much compensation you may be entitled to.

How Can We Help Your Workers’ Compensation Case?

Workers’ compensation cases can be extremely complicated and the outcome can have a serious impact on you and your family. And unfortunately, the other parties are going to try to pay you as little as possible.

That’s where Plevin & Gallucci comes in. We have been fighting for the rights of injured Ohio workers for more than 40 years. Your case and your injury matter to us. We understand the pain and inconvenience your injury or illness can cause as you try to get through your daily life. We became lawyers to fight against these big companies and claims adjusters and help protect our fellow Ohioans when they need it most. We’re here to stand with you and fight for your rights. We can help you gather the evidence you need, navigate the bureaucracy and paperwork, and support you against the pressure of big companies and big agencies.

Contact us today by calling 1-855-4-PLEVIN or fill out the form on this page for a no-obligation consultation with one of our attorneys.