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What Does It Mean if My Employer is Self-Insured for Workers’ Comp in Ohio?

Workers' Compensation

Ohio’s workers’ compensation system is unique in that most employees must file their claims with the state’s Bureau of Workers’ Compensation (BWC) instead of with their employers. But, there is an exception for employers that are “self-insured.” If your employer is self-insured, you will need to file your claim with your employer instead of the Ohio BWC—and this means that you will need to deal directly with your employer throughout the claims process.

As the Ohio BWC explains:

“Self-insuring . . . employers administer their own workers’ compensation program . . . . If an injured worker files a claim with a [self-insured] employer, the employer makes the initial determination and subsequent decisions regarding the medical treatment and procedures (medical allowances), and benefits (compensation or additional condition allowances).”

What can you expect if you have a workers’ compensation claim in Ohio and your employer is self-insured? Here is an overview of what you need to know:

Seeking Workers’ Comp Medical Benefits When Your Employer is Self-Insured

Regardless of whether your employer is self-insured, you are entitled to medical benefits through workers’ comp from the day you get injured on the job (assuming you are an eligible employee). Your employer must pay for all of the care you need as a result of your job-related injury. With that said, there are some rules and restrictions you need to keep in mind, including:

  • You must “usually” obtain prior authorization for your medical care from your employer—unless you need to visit the emergency room immediately after getting injured.
  • Either you or your medical provider must submit your bills within one year of the date of service in order for them to remain eligible for payment.
  • Your employer is required to pay your medical bills within 30 days of submission unless it is denying coverage for any reason (i.e., because it believes your treatment is not related to your on-the-job accident).

If your employer denies coverage, you have the right to file a request for payment. If your employer still denies coverage, then you will need to file a motion with the Ohio Industrial Commission.

Seeking Workers’ Compensation Disability Benefits from Your Self-Insured Employer

Self-insured employers must also pay disability benefits to eligible employees who miss eight days or more from work as a result of their injuries. These are referred to as “temporary total benefits,” and although you are not immediately entitled to temporary total benefits for the first seven days of work, you are entitled to these benefits retroactively if you miss 14 consecutive days or more.

Your employer must continue paying temporary total benefits until you are able to return to work (or until you transition to permanent disability benefits). However, after 90 days, your employer has the right to require you to undergo an examination, “to see if [you] still qualif[y] for temporary total disability, ha[ve] vocational rehabilitation potential and if [you are] receiving the right medical treatment.”

Initially, your temporary total benefits should be calculated as 72 percent of your weekly wage. After 12 weeks, however, your temporary total benefits may be reduced to 66.67 percent of your weekly wage.

If you are never able to return to work, you will become eligible to receive permanent total disability benefits from your self-insured employer. However, self-insured employers will often fight their employees’ claims for permanent total disability—so it is especially important to work with a lawyer if you think that you may be permanently disabled due to your on-the-job injury. If you truly do not qualify for permanent total disability, you may be eligible for other types of workers’ compensation benefits instead, including permanent partial disability and living maintenance.  

What Happens if Your Self-Insured Employer Denies Workers’ Compensation Coverage?

While self-insured employers are supposed to pay workers’ compensation benefits to employees who get injured on the job, many do not. Unfortunately, many employees struggle to collect the benefits they clearly deserve.

If your self-insured employer denies workers’ compensation coverage, you will want to discuss your claim with a lawyer as soon as possible. In some cases, getting a lawyer involved can convince an employer to pay without the need to take formal legal action. But, if you need to take formal legal action, then you will need to rely on your lawyer to effectively present your claim to the Ohio Industrial Commission. An experienced workers’ compensation lawyer can help you decide if this is your best option, and, if it is, your lawyer can deal with your employer and the Industrial Commission on your behalf.

How Do You File a Workers’ Comp Claim with a Self-Insured Employer?

As the Ohio BWC explains, “[a]n injured worker’s first step to getting benefits is to report the injury to his or her employer so the employer can complete an accident report.” When you report your injury to your self-insured employer, your employer should tell you where you can go for medical care.

When you see a doctor, be sure to tell your doctor that your injury is job-related, and ask your doctor to send your medical bills directly to your employer. Your self-insured employer should have a department that handles workers’ compensation claims, and, if necessary, you can contact this department to find out exactly where your medical bills need to get sent for payment.

All of this can be stressful, and if you have been seriously injured on the job, mistakes can prove costly. As a result, we strongly recommend that you hire an experienced lawyer to help you. This will give you the best chance to collect the benefits you deserve without needing to go to the Ohio Industrial Commission. Additionally, if you need to take your self-insured workers’ compensation claim to the Industrial Commission, having a lawyer who is already familiar with your claim will help ensure that this process goes as smoothly and favorably as possible.

Contact Us for a Free Consultation in Columbus, OH

Do you need to know more about how to file a workers’ compensation claim with your self-insured employer? If so, we can help. For a free, no-obligation consultation, call 614-656-3548 or contact us online today.