In Ohio if you sustain a workplace injury or work accident you can file a claim for workers compensation or Ohio workers comp in a form called a First Report of Injury or FROI-1. This triggers an entire immune like response from both the Bureau of Workers Compensation and your employer which starts the claim process. Depending what kind of employer you work for can dictate what kind of experience you may have pursuing your Columbus workers comp claim. Ohio workers comp attorney explains the distinctions below.
The BWC is a state government agency in Ohio that administers the multi-billion dollar Ohio Workers Compensation Fund. Your employer may be a state fund employer, a self-insured employer, or a dollar-for-dollar employer. Self-insured employers are typically massive companies like Amazon, Lbrands, Cardinal Health. They administer their own workers comp fund and are required to follow requirements set forth in the Ohio Administrative code. If you are an Amazon worker and you suffer a workplace injury, any compensation or medical benefits would be paid out by Amazon, not through the Ohio Workers Compensation Fund.
If you have suffered a work injury at a self-insured employer then you will find that the self-insured employer will typically be quicker to authorize medical treatment and certify the claim. However the downside is that medical documents and other claim related documents do not always get uploaded to the the claim file on either the BWC’s website or the Industrial Commission. Things are less transparent. There are other procedural hurdles and distinctions that you will encounter if you work at a self-insured employer.
One difference is how denied medical treatment is appealed. If your workers comp doctor submits medical treatment, the self-insured employers risk management company reviews that treatment request. The treatment will either be authorized, that it is the risk management company is saying “yes, we will pay for this treatment, or deny authorization. If treatment is denied you are required to submit a motion for the treatment to be paid by the self-insured employer through a C86 motion. You will then need to tap the self-insured claim rep at the BWC on the shoulder, they will give notice to your self-insured of the filed motion. The SI Employer will then have 30 days to grant or deny the motion. If denied, the motion is referred to a hearing before the Industrial Commission.
Probably the biggest difference you may encounter is that if you file a denied workers comp claim to the common pleas court, the lawsuit will involve you and your self-insured employer’s representative. The BWC will not be involved. Likewise if you negotiate a settlement it will be between you and your self-insured employer.
The most common employer in Ohio, is a state-fund employer. If you work for a small to medium sized employer, you will probably have a state fund claim. That means any comp or medical benefits will be paid of the workers compensation state fund. You will have a claim representative assigned to your claim at the BWC. Medical documents and other related information will likely be thrown on both the BWC site in your claim file, and the Industrial Commission site.
Treatment denied in the context of a state fund claim is appealed through a modified alternative dispute resolution process. Your Ohio workers comp lawyer will submit an appeal of the treatment denial to the BWC. The BWC will then submit the treatment request to either a medical file review, or possibly have you undergo an independent medical review. If the treatment is denied by the BWC, the BWC will issue an order. Your Ohio work injury attorney will submit an appeal of the BWC order. The denied BWC order will then be referred to the Industrial Commission.
If you file a denied Ohio workers comp claim to court, you will face both your employer’s representative but also an attorney general representing the BWC. Your Columbus, Ohio workers comp lawyer will also need to negotiate any settlement not only with your employer, but the workers comp AG assigned to your case. The BWC will also have an attorney present. That AG attorney will advise the BWC attorney the amount the BWC should pay out to settle the claim. The BWC attorney will either authorize that amount or not. The BWC attorney is the keeper of the bank. Workers comp lawyer Kip Malek discusses how to calculate settlement values in this helpful youtube video.
Dollar-for-dollar employers are typically city entities. The claim for a dollar-for-dollar will look indistinguishable from a claim for a state-fund employer. Treatment denials will be appealed in the same way. The transparency of information will be similar. The biggest difference will be encountered when you try to negotiate a settlement of your workers comp claim. Any settlement that the dollar-for-dollar employer pays out in your claim will in essence be paid by the dollar-for-dollar employer. The more money paid out, the bigger the impact to the dollar-for-dollar workers comp premiums. This can be significant. As a result, the dollar-for-dollar employer will typically offer less depending on the impact the settlement may have.
Non-complying employers and no coverage employers are typically encountered in construction situations. The significance in this case , is that if the claim is allowed the BWC surplus fund will pay for authorized medical treatment and compensation. The BWC will then take measures against the non-complying employer to get their money.
I’ve just scratched the service of what the BWC it is a good idea for a worker who has suffered a workplace injury or work accident to seek the services of a workers compensation lawyer . A workers compensation lawyer can navigate the claim process pursuant to the specifications of the BWC and meet all the required deadlines. This stuff is not rocket science, more akin to fixing a car engine. Easy for someone who has been years of experience and knowledge, very hard for someone who has never suffered a work injury.
If your claim is denied by the Bureau of Workers’ Compensation and Industrial Commission , it will be necessary to file an appeal pursuant to R.C. 4123.512 into the court of common pleas in the county in which you sustained your injury. At a workers comp lawyer in Columbus Ohio at Malek & Malek will represent you at both the Industrial Commission and throughout the administrative process all the way through to a jury verdict in the court of common pleas. Our workers’ compensation attorneys have achieved great success this year in representing our clients in jury trials. Many other workers’ compensation firms will refer your claim out to a different attorney to handle the more difficult aspect of litigating your workers’ compensation claim through court litigation while your case is pending in the court of common pleas. This is unfortunate as often times these “trial attorneys” to whom the workers’ compensation case is referred either do not have much experience in the workers’ compensation realm or simply do not have the personal relationship with the injured worker. This is not the case at Malek & Malek.
At some point in time during the course of litigating your workers’ compensation claim, it might be advisable to seek a settlement of your claim or lump sum payment in exchange for closing your claim. Having a workers compensation attorney present during any negotiations with the BWC will help ensure that any offer that they make to you as compensation for your injuries is fair and takes into consideration the likelihood of future compensation and/or medical benefits.
CASE: Employer and BWC contested allowance of a claim on the basis injured worker was a sub-contractor. The claimant sustained a serious left arm/upper extremity condition as a result of an approximate 30 foot fall. Fortunately there was no other injuries other than the injury to the arm. Prevailed in having claim allowed. After claim was allowed, Attorney filed an application for a Violation of a Specific Safety Requirement against the employer. Attorney prevailed in establishing a VSSR penalty against the employer at the maximum penalty rate of 50 percent. This entitled the claimant to not only receive compensation, but an additional award of compensation at 50 percent of the max rate for the year of his injury. Attorney prevailed in securing a loss of use of the arm award for the claimant, totaling over $200,000 with the additional compensation paid as a result of the VSSR penalty. Attorney eventually prevailed in securing permanent total disability compensation for the claimant. As a result of this, the BWC offered $420,000 to settle the claim. After the settlement was paid, there was over $1million paid in compensation and medical benefits.