A workers’ compensation claim checklist is a valuable resource when pursuing compensation for on-the-job injury or illness in Cincinnati, Ohio. A clear and detailed checklist should outline the rights of employees who get injured or ill in the line of duty, types of recoverable benefits, and steps to take after getting injured on the job. It should also provide the steps for filing a workers’ compensation claim and what to do if your claim gets denied.
How Do Workers’ Comp Claims Work?
The employer and the worker have tasks to perform in a workers’ compensation claims process. A worker who suffers a workplace injury or illness must report it to the employer on time to qualify for worker’s comp benefits.
The employer should provide the injured or ill worker with all the proper paperwork and forms. These documents will be necessary when initiating a workers’ comp claim with the responsible insurer.
The employer is usually responsible for starting a claim with the relevant insurance provider upon receiving the completed documents from the employee. The employer may also report the injury or illness to the workers’ compensation agency.
In Ohio, the Bureau of Workers’ Compensation (BWC) funds workers’ comp insurance offered by around two-thirds of employers. The employer remits some money to Ohio worker’s comp fund and selects or gets allocated a managed care organization (MCO). An MCO is a private entity hired to plan medical care and manage worker’s comp claims.
The insurance provider will determine whether the worker has a valid claim after reviewing all the paperwork submitted alongside the claim. The insurer will send an initial settlement offer to the injured or sick worker if it approves the claim.
Around one-third of employers in Ohio are self-insured. They, therefore, compensate injured or sick employees directly. These employers must, however, comply with rules established by Ohio’s Industrial Commission (IC) and the BWC.
The worker can accept the initial payout or negotiate a better settlement with the insurer. It is a wise decision to have a skilled lawyer familiar with workers’ comp laws in Ohio handle the claim and review any settlement offer received from the insurer. Such a lawyer can help you determine a reasonable compensation for your situation and engage the insurer in an aggressive negotiation.
The worker can file an appeal if the insurance company denies the claim. Your lawyer can work closely with you throughout the appeal process, increasing the odds of a favorable outcome.
Ohio Workers’ Compensation Benefits You Can Recover
There are a variety of benefits available through workers’ compensation.
These benefits fully cover all reasonable and necessary medical expenses arising from a workplace injury or illness. Inform your doctor that your treatment is for a workplace injury or disease, and the doctor should bill your employer’s MCO. Likewise, the doctor should send the bill directly to your employer if the employer is self-insured.
Bills for prescription medication for your on-the-job injury or illness should also get submitted to your employer’s MCO or directly to your employer. You may have to cover the cost out of pocket if a prescription gets filed before your claim is successful. Fortunately, however, the BWC will repay you using its approved fee schedule.
Wage Loss Benefits
You qualify for wage loss benefits if you miss work while recuperating from your work-related injury. These benefits become valid after you stay away from work for eight consecutive days because of a job-related injury or illness. The initial seven days of missed time from work are not eligible for compensation. Worker’s compensation will, however, account for those first seven days in your total compensation amount if you miss work for 14 consecutive days or more.
You may be entitled to disability benefits if your injury or occupational illness reduces your ability to work or prevents you from working completely. The different types of disability benefits that you can obtain via workers’ comp include:
Temporary Total Disability
This benefit applies if you cannot work completely for a temporary duration due to work-related injury or disease. The benefits amount depends on your pre-injury or -illness average wages. The statewide average weekly wage (SAWW) for the period you got injured or sick determines the minimum and maximum benefits you can receive.
Permanent Partial Disability
This benefit applies if your injury or illness leaves you with a permanent impairment but not a total disability. The disability benefits amount you receive will depend on the severity of your impairment and the method used by your workers’ comp insurer to arrive at those benefits. Workers’ comp may determine the amount of your benefits based on the loss of specific body parts, percentage of total disability, or nature of disfigurement.
Permanent Total Disability
You might be entitled to permanent total disability benefits if your work injury or occupational illness keeps you from returning to work permanently or holding any other sustainable job.
Other Ohio workers’ comp benefits include:
- Mileage reimbursement: Workers’ compensation may pay you for travel costs required to obtain approved medical care or a diagnostic test not offered in your community. You will only get mileage reimbursement if the round trip is more than 45 miles. You may get reimbursed for taxi services, meals, and accommodation in some instances.
- Vocational rehabilitation: This benefit covers the cost of helping you return to your pre-injury job or secure a new job. The help may be physical therapy, workplace modifications, and training.
- Death benefits: The surviving dependents may be entitled to death benefits if the worker dies due to a workplace injury or disease. The level of financial dependence on the deceased work will determine the amount of death benefits.
- Funeral expenses: Funeral expenses of up to $7,500 are also available through workers’ compensation.
Steps to Take After a Work-Related Injury in Ohio
Your workers’ comp claim may get approved if you take the right steps after a work-related injury or illness. These steps include:
Documenting the Accident Scene
Take time-stamped photos of the accident scene and any noticeable injuries shortly after the accident. The photos should show your location at the time of the accident and the task you were performing. If equipment or a tool is responsible for your injury, take a picture of it.
Pictures that include computer time display and job tasks can help pursue workers’ comp for remote workers. Such pictures can prove that the accident happened during work hours and the remote worker was performing a work-related task.
Getting Medical Help
Seeing a doctor shortly after getting into a workplace accident helps protect your health and eligibility for workers’ compensation benefits. Symptoms of internal injuries can take days or even months before becoming apparent. Seeking medical attention is the only way to detect such injuries. What’s more, seeing a doctor enables you to get your injury documented.
Reporting the Injury or Illness to Your Employer
Let your employer know that you have sustained an injury or contracted a disease at the workplace. Besides verbal notification, you should submit a written injury report. A written report proves that you notified your employer of your injury. Be sure to adhere to your employer’s procedure for reporting work-related injuries or illnesses.
Your employer should guide you on how to file a worker’s comp claim after receiving your injury notification. The employer should also give you all the paperwork and forms required to start the claim.
Completing the Paperwork and Filing a Claim
Your employer’s MCO will initiate a worker’s comp claim for you after receiving notice of the injury from your employer. It is, however, advisable to directly call your employer, the MCO, or the workers’ comp agency to find out whether your workers’ comp claim process has been initiated.
You can also open a claim by mailing a completed First Report of Injury (FROI) to a local BWC office, or you can visit the BWC website and fill out the FROI.
What to Do if Your Claim Has Been Denied
You have a right to appeal once you receive a letter that your claim has been denied. Appealing a denied workers’ comp claim involves submitting an appeal to the workers’ compensation board or any relevant agency available in your state. In Ohio, appeals have three levels: District, Staff, and Commission.
Appeals usually begin at the district level. A hearing occurs within 45 days of initiating an appeal at all levels. A hearing officer has up to seven days to hear and rule on the appeal.
You can submit an appeal to the next level if you get another denial decision. The deadline for appealing to the next level is 14 days.
Note that you can appeal the denial decision in court if the commission declines to hear your appeal. Your deadline, in this case, will be 60 days.
Your Ohio Workers’ Comp Claim Checklist
Your Ohio workers’ comp claim checklist should outline your rights as an employee, the types of injuries or diseases eligible for compensation, and timelines and steps for reporting injuries and occupational diseases. It should also outline benefits in a workers’ comp claim, how to file the claim, and the next course of action if your claim gets denied.