In Ohio, when you suffer a work-related illness or injury, workers’ compensation benefits are available to help you during your recovery. If you file a worker’s compensation claim and your claim is approved, it’s important to understand what to do and what not to do while on workers’ comp to protect your benefits.
Workers’ Compensation in Ohio
Most states, including Ohio, provide ill and injured workers with workers’ compensation benefits when they become sick, injured, or contract an occupational disease due to work-related duties. Workers’ compensation benefits are paid directly to the worker to provide financial assistance during the recovery period. This keeps workers financially afloat while they can’t work by paying for lost wages and medical bills that are incurred.
In Ohio, workers’ compensation benefits are handled through the designated state agency, the Ohio Bureau of Workers’ Compensation (BWC). Ohio workers who are injured on the job or suffer an occupational illness or disease can request medical benefits, and if applicable, other compensation by filing a claim when the injury occurs. Additionally, surviving dependents of a worker who suffers a fatality due to a job-related accident, illness, or occupational disease can also file a claim to request death benefits.
Misconceptions About Workers’ Compensation
There are many misconceptions about workers’ compensation, particularly about eligibility, filing for benefits, and claim denials, which can all impact what not to do while on workers’ comp. Common misconceptions include:
Myth #1 – You Must Be Performing Your Job Duties at Work When You Get Injured
An injury does not have to be sustained in the actual performance of work. An injury is compensable if it’s sustained while engaging in activities that are consistent with employment and required by the employer’s business. This may include traveling, attending seminars, dining with clients, walking to the office cafeteria, or participating in business-related recreational activities.
Myth #2 – Your Employer Will Help You Maximize Your Benefits
Unless you get lucky, your employer will not help you maximize your workers’ comp benefits. If you are eligible for workers’ compensation, your benefits will come from your employer’s insurance provider. Your employer may dispute your claim, but he or she will play an otherwise limited role in the filing process. You will be the only person involved who has a vested interest in maximizing your workers’ compensation benefits.
Myth #3 – You Can Be Fired if You File for Workers’ Compensation
It is illegal for employers to fire employees who exercise their legal right to file for workers’ compensation benefits. Many workers are afraid to file a claim for workers’ compensation because they fear they may lose their jobs. While filing for workers’ compensation does not protect your job while you’re out, it should not put you at greater risk of losing your job. In most cases, an employer will find another employee to fill in for you during your recovery period. However, if your recovery takes longer than a month, your employer may consider hiring someone new to prevent lost production time and lower company profits.
The Implications of Fraudulent Claims
The Ohio Bureau of Workers’ Compensation has strict rules and regulations that address fraudulent claims by workers and employers. Regulations state that no person shall purposely facilitate fraud through the following actions:
- Receiving workers’ compensation benefits to which the person is not entitled
- Making false or misleading statements to receive benefits
- Altering, concealing, or falsifying personal or employment-related information
- Altering payroll records and classification of employees
- Altering or creating a fraudulent workers’ compensation certificate for coverage
- Failing to maintain workers’ compensation coverage
To avoid filing complications and errors that may result in a denied workers’ compensation claim and benefits, make sure you are accurate with the required information. If you have questions or need help with your claim, talk to a workers’ compensation lawyer who can help you file a claim with the required information.
What Not to Do While on Workers’ Compensation in Ohio
When you apply for workers’ compensation benefits in Ohio, the BWC has strict regulations that must be followed. The following examples of what not to do while on workers’ comp could cause delayed or denied benefits.
Failing to Report Your Injury
Work-related illnesses and injuries should be reported to your employer as soon as possible after the injury occurs. Although Ohio law allows up to one year to file a claim for workers’ compensation benefits, and two years for occupational disease claims, you must complete an incident report and provide other paperwork to your employer before your employer can file a claim with the BWC. It takes time to submit workers’ comp claims, and employers don’t always follow the guidelines.
Engaging in Activities That Contradict Your Claimed Injuries
Workers’ compensation claims are based on medical records that show proof of illness or injury. State offices like the BWC have staff members and insurance investigators who review cases and medical records. These staff members also watch for red flags. If your claim says you’re an injured worker with a severe back injury, lifting weights at the gym will likely be a red flag in your claim and cause your benefits to be denied.
Failing to Follow Medical Advice and Treatment Plans
Failing to seek medical care and follow the doctor’s medical advice and treatment plans can result in a denied claim. Workers’ compensation benefits are provided to help injured workers recover. Failure to comply with a doctor’s recommendation for medical treatment will be viewed negatively by the BWC. Failure to get treatment can suggest that no injury exists, or no treatment is necessary, and the BWC will likely determine that no benefits are warranted.
Earning Other Income While on Workers’ Compensation
Workers’ compensation benefits are intended to pay for medical bills and provide wage benefits for injured workers. Once the injured worker is able to return to work, the benefits will generally stop. In some cases, partial benefits may continue if the worker can only return to light or modified work duties. When an injured worker returns to work, he or she must immediately notify the state workers’ compensation department to report part-time jobs, temporary work, second jobs as an independent contractor, or self-employment.
Concealing Relevant Information From Employers and Insurers
Concealing relevant information from employers and insurers will likely result in a claim denial. The BWC regulations clearly state that making false statements on a claim or altering, concealing, or falsifying personal or employment-related information shows purposeful facilitation of fraud. The insurance company will most likely consider this grounds for denying workers’ compensation benefits.
Consequences of Improper Actions on Workers’ Compensation
Making common mistakes in a workers’ compensation claim can cause claimants to face claim denials or reductions, legal penalties for fraudulent activity, or job loss in severe cases.
Denial or Reduction of Benefits
Understanding what not to do while on workers’ comp can protect your benefits. Workers’ compensation claims are frequently denied because of missed filing deadlines, filing after leaving a job, disputes about whether the claim is work-related, and medical conditions that don’t meet state guidelines. If your claim is denied, a lawyer can help you with the appeals process for denied workers’ compensation claims in Ohio.
Reduced benefits pay a portion of the difference between what a disabled worker is making now and what he or she was making prior to the injury. To receive a reduced earnings benefit, the worker must prove three things: 1- he or she is partially disabled, 2- he or she is earning less than his or her average weekly wage at the time of the injury, and 3- he or she is earning less because of the disability.
Legal Penalties and Fines for Fraudulent Activities
Workers’ compensation fraud is an attempt by someone to benefit financially from a workers’ comp claim or policy by falsifying information. There are two main types: 1- claim-based fraud filed by workers who falsify claims to receive benefits, and 2 – policy-based fraud filed by employers who misclassify employees or falsify data in their payroll system to reduce premium payments. Penalties for workers’ compensation fraud can include fines, cancellation of a policy, and jail time.
Loss of Job and Reputation
Workers and employers commit workers’ compensation fraud for personal financial gain. For example, a worker may want to stay home and receive partial wage replacement without suffering a work-related injury. An employer may want to reduce his expenses for workers’ comp insurance. In either case, workers’ compensation fraud can result in the loss of a job and a stained reputation that impacts future employment.