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The Anatomy of an Ohio Workers’ Compensation Claim

Workers' Compensation

Filing a workers’ compensation claim allows you to collect benefits for an on-the-job injury or illness. But, to collect the benefit you deserve, you need to handle each step in the process appropriately, and this means that you need to have a clear understanding of what to expect along the way.

10 Components of a Workers’ Compensation Claim in Ohio

So, what can you expect? What are the steps you need to take in order to secure benefits after getting hurt or sick on the job? Here is an overview of the 10 major components of a workers’ compensation claim in Ohio:

1. Suffering an Injury or Illness on the Job

In Ohio, workers’ compensation only covers job-related injuries and illnesses. This means that you must get hurt or sick within the scope of your employment. It does not mean that you necessarily have to get hurt or sick while doing your job. For example, if you slipped and fell on your way to the bathroom, your injuries would generally still qualify even though you were not performing your job duties at the time of the accident.  

2. Getting Treatment for Your Injury or Illness

After suffering a job-related injury or illness, you should seek treatment promptly. Under Ohio’s workers’ compensation laws, you have the right to choose your own doctor for your first visit. When seeking treatment, you should be sure to tell your doctor that you got hurt or sick at work and that you are planning to file for workers’ compensation benefits.

3. Confirming that You Are Eligible for Workers’ Compensation

Before you go through the process of filing a workers’ compensation claim, you will want to make sure you are eligible for benefits. While most workers are eligible, some are not. If you are eligible, you will need to continue being careful to protect your workers’ compensation claim. If you are not eligible, you will want to talk to a lawyer about the other options you may have available.

4. Reporting Your Injury or Illness at Work

After confirming that you are eligible for benefits, you should report your injury or illness at work. Your manager or supervisor should be able to point you in the right direction; but if not, you can contact your employer’s HR department. When reporting your injury or illness, make sure the information you provide is as accurate and complete as possible; and, if possible, keep a copy of the report for your records.

5. Completing a First Report of Injury (FROI)

In addition to reporting your injury or illness to your employer (which you should do as soon as possible), you may also need to complete a First Report of Injury (FROI). This is an official form that is available online from the Ohio Bureau of Workers’ Compensation (BWC). Your employer may complete this form for you—but you need to make sure it gets filed, so you can complete an FROI yourself or contact the BWC to see if your employer has already submitted the form.

6. Filing Your FROI with the Ohio BWC (Unless Your Employer is Self-Insured)

Once you complete your FROI, you will need to file it with the Ohio BWC. However, there is one major exception: You must file your claim with your employer instead if it is self-insured. Under Ohio law, employers have the option to self-insure for workers’ compensation if they meet certain requirements. If your employer is self-insured, then you will be dealing with your employer throughout the claims process instead of dealing with the Ohio BWC.

7. Seeing a Certified Provider for Your Ongoing Care

If your employer is not self-insured, then you will need to see a certified provider for treatment following your first visit. You can find a certified provider using the Ohio BWC’s Provider look-up. Once you start seeing a certified provider, you should not receive any medical bills for the treatment of your job-related injury or illness. Instead, your provider should submit your bills to its managed care organization (MCO), which will then forward them to the Ohio BWC for payment.

8. Keeping Track of Your Medical Care and Time Missed from Work

While you should not have to pay any of your medical bills directly, it is a good idea to keep track of the care you receive just in case there is an issue. It is also a good idea to keep track of the time you miss from work. If you miss enough time from work, you may qualify for workers’ compensation disability benefits in addition to medical coverage. But you may also need to prove your eligibility for these benefits, and you don’t necessarily want to rely solely on your employer’s records.

9. Following Up with Your Claim

Ideally, the workers’ compensation claims process will go smoothly, and the Ohio BWC (or your self-insured employer) will simply pay the benefits you are owed. Unfortunately, this doesn’t always happen. Workers’ compensation claims can take much longer than necessary, and employees will often wait for weeks only to find that their claim is being denied. With this in mind, it is important to be proactive, and this means following up on your claim regularly.

10. Going to a Hearing if Necessary

Finally, if the Ohio BWC (or your self-insured employer) denies your workers’ compensation claim for any reason, you may need to go to a hearing. When appealing a denied workers’ compensation claim, you need to make sure you are thoroughly prepared. Importantly, while you have the option of representing yourself, you also have the option of hiring a lawyer to handle your claim on your behalf.

Get Help from an Experienced Workers’ Compensation Lawyer in Columbus, OH

At Malek & Malek Law Firm, we help injured and sick workers in Ohio throughout the workers’ compensation claims process. If you need to file for benefits (or appeal a denial), we strongly encourage you to contact us for more information. For a free, no-obligation consultation, call 888-444-7440 or request an appointment online today.