Frequently asked questions regarding Ohio Workers' Compensation.
The Ohio Workers' Compensation system can be confusing and difficult to understand. These questions provide an overview of the Ohio Workers' Compensation system and answers frequently asked questions about the system.
•1. What is workers' compensation?
The essential purpose of workers' compensation is to provide compensation for injuries, disease or death caused by employment. Compensation is provided to the injured employee or to the employee's dependents in case of death. The amount and types of compensation available are determined by the Ohio Legislature.
The Ohio Workers' Compensation Act is codified in the Ohio Constitution. It has been in place since 1912. The Ohio Workers' Compensation Act is a mandatory law whereby all Ohio employers are required to provide workers' compensation coverage to all of their employees.
The Workers' Compensation Act eliminates any issue as to fault. It does not matter who is to blame if an employee is injured in the course of or arising out of employment.
•2. What are the administrative agencies which Workers' Compensation claimants have to deal with?
There essentially are two agencies which govern Ohio Workers' Compensation Law. The Ohio Bureau of Workers' Compensation handles the administrative functions of the Ohio Workers' Compensation system. The Bureau of Workers' Compensation has limited decision making powers, mainly related to the initial allowance of a claim. The Bureau of Workers' Compensation handles the processing of claims and the payment of money.
The majority of the decision making functions in the Workers' Compensation system are handled by the Industrial Commission. The Industrial Commission is responsible for decision making when there is a contested issue in a claim.
•3. What are the different types of employers?
There are two different types of employers in the Ohio Workers' Compensation system: state fund employers and self-insured employers. Although the same compensation and benefits should be paid regardless of who the employer is, the way the system works depends on what type of employer is involved.
State fund employers participate in the State Insurance Fund by paying a premium. They do not pay workers' compensation benefits directly. State fund claims are initially processed by the Bureau of Workers' Compensation. No payment can be made of state fund claims without a Bureau or Commission order.
Self-insured employers do not pay premiums. They pay all compensation and benefits directly to the injured workers. Because self-insured employers pay compensation directly, they can do so without an Industrial Commission order.
Both state fund employers and self-insured employers are subject to the decisions of the Industrial Commission of Ohio.
•4. How long do I have to file a claim?
Under Ohio law, your workers' compensation claim must be filed within two years from the date of injury. There are certain exceptions to this rule. For example, if a self-insured employer has paid a claimant's medical bills for a work related injury, this would toll the statute of limitations, allowing a worker to file a claim beyond the two year statute of limitations. In some cases, the time limit can be extended for occupational disease claims where the worker has sustained a disease but has not yet had to leave work as a result of the disease.
•5. How do I file a claim?
A claim can be filed by using the FROI form. This form can be downloaded from the Bureau of Workers' Compensation's website. Many claims are now electronically filed by the managed care organization when an injured worker seeks medical treatment. It must be emphasized that it is the injured worker's responsibility to insure that a claim has been filed.
If the claim has been filed, the injured worker will receive a claim number from the Bureau of Workers' Compensation. If you have not received a claim number, check to ensure that a claim has actually been filed. The claim number identifies the claimant and should be put on all documents filed with the Bureau of Workers' Compensation or the Industrial Commission. The claim number should also be given to the injured worker's physicians, hospitals, etc. for billing purposes.
•6. What are the three different types of workers' compensation claims?
There are three different types of claims. The most common type of claim is an injury claim where an injured worker sustained a physical injury on the job.
The second type of claim is an occupational disease claim where the injured worker incurred a disease or condition which occurred over time, instead of as a result of a specific event.
Finally, there is a death claim which arises when an injured worker dies as a result of a work related injury or disease.
•7. What happens when an issue is contested?
When issues are contested, they may enter the hearings and appeals process. As noted above, the initial decision in state fund claims is made by the Bureau of Workers' Compensation. Sometimes the Bureau may refer the matter to the Industrial Commission for a hearing without making a decision.
The initial decision in self-insured claims is made by the self-insured employer. If the self-insured employer denies compensation of benefits, a motion may be filed by the injured worker to seek a hearing.
NOTE THAT THERE ARE STRICT TIME DEADLINES WHICH MUST BE FOLLOWED FOR FILING APPEALS. THESE DEADLINES MUST BE COMPLIED WITH, OR THE RIGHT TO APPEAL MAY BE LOST.
The Industrial Commission will initially hear the case at the District Hearing Officer level. In the event the injured worker is successful at the District Hearing Officer level, payment of lost time compensation to the worker will commence at that time.
Please note that either the employer or the injured worker or the Bureau of Workers' Compensation can appeal the decision of the District Hearing Officer. This will result in a hearing before a Staff Hearing Officer. These hearings are de novo hearings which means that no deference is to be given to what happened at the District Hearing Officer level.
Either party may appeal the decision of the Staff Hearing Officer to try to obtain a third level hearing before a Hearing Officer appointed by the Industrial Commission or the Industrial Commission itself.
Depending upon the final decision of the Industrial Commission, the injured worker or employer may still have other remedies. Depending upon the issues to be heard, an appeal may be taken to the Court of Common Pleas where the injury occurred. If the issue being appealed does not involve the right to participate in the Workers' Compensation Fund, a writ of mandamus may be filed in the Franklin County Court of Appeals. Your attorney is in a much better position to explain to you your appeal options from any decision of the Industrial Commission.
•8. What types of workers' compensation benefits are available?
The amount of workers' compensation benefits paid in a claim depends on the type of compensation being paid and the year of injury. The most basic types of workers' compensation benefits are:
•1. Medical benefits
•2. Temporary total compensation
•3. Wage loss compensation
•4. Permanent partial compensation
•5. Permanent total compensation
•6. The award for an employer's violation of a specific safety requirement
•7. Loss of use awards.
Medical benefits are paid for the specific injury and/or occupational disease that the worker sustained while working. A medical provider, such as a physician or hospital, cannot bill the injured worker for the difference in what it receives from workers' compensation and the balance of their bill.
Temporary total compensation is the type of compensation paid to an injured worker who misses work as a result of his or her injury and/or occupational disease. The injured worker must miss at least seven days of work before being eligible for temporary total compensation. The rate that an injured worker is paid temporary total compensation is based upon his or her earnings for the year prior to his or her injury.
Temporary total disability compensation is terminated when an employee has returned to work, or the employee's physician has made a written statement that the employee can return to his or her former position of employment, or employment within the employee's physical capabilities is made available, or the employee has reached maximum medical improvement.
Wage loss compensation provides compensation for the injured workers' loss of earnings resulting from an injury. The injured worker is eligible for wage loss compensation if he or she return to work in a light duty capacity and he or she make less money than they did at the time that he or she sustained their injury.
Permanent partial compensation is an award to pay for residual disability. Permanent partial disability is generally paid in a lump sum. The permanent partial award is not a settlement, and the claim remains open after receipt of a permanent partial award.
For claims arising before June 30, 2006, there is a 40 week waiting period from the date of injury or the last payment of temporary total compensation or wage loss compensation to apply for a permanent partial disability award. For claims arising on or after June 30, 2006, there is a 26 week waiting period.
Permanent total disability compensation is an award given to an injured worker who is permanently not capable of performing work as a result of his or her injury and/or occupational disease. To apply for permanent total disability compensation, the injured worker must submit evidence from a physician that he or she can never return to work as a result of his or her injuries. The decision whether to award permanent total disability is heard by a Staff Hearing Officer of the Industrial Commission.
Loss of use awards are lump sum payments made as a result of amputation injuries or injuries so severe that an injured worker can no longer use a body part, such as an arm or leg. There are also loss of use injuries for loss of vision and total loss of hearing.
The award for an employer's violation of a specific safety requirement is a penalty assessed upon an employer for violating a safety rule or rules, which gave rise to the injured workers injury or death. Applications for these awards must be filed within two years from the date of injury or death. Applications for an award based upon a violation of a violation of a safety requirement are investigated by the Industrial Commission and referred to a hearing before a Staff Hearing Officer.
It is important that if you have any question regarding the type and nature of benefits available under the workers' compensation system, that you contact a qualified attorney to have your specified questions answered. Always search for an attorney whom the Ohio State Bar Association has designated as a certified specialist in the area of Ohio Workers' Compensation law.
