Frequently Asked Questions About Ohio Workers’ Compensation
An injury in the workplace can be a financial setback. You may suddenly be faced with sizable medical expenses, and if you are unable to work, simply paying your bills could prove difficult. Fortunately, workers’ compensation benefits can help you defray these costs. Attorney Mark L. Newman regularly works with Cincinnati individuals as they file claims for their work-related injuries.
Below are some frequently asked questions about workers’ compensation:
- What should I do if I get injured at work?
- How do I file a claim?
- How long does it take to process a claim?
- How does the appeal process work?
- What should I expect at an Industrial Commission Hearing?
- My claim was allowed. Will my medical bills be paid?
- How do I get reimbursed for prescription medication?
- What type of benefits am I eligible for as an injured worker?
What should I do if I get injured at work?
If you are injured at work, you should immediately report the injury to your supervisor or a representative of your employer and complete a written accident report. You should get medical treatment immediately and tell the doctor how you were injured and that the injury occurred at work. You can receive medical treatment from a doctor of your choice as long as the doctor is an Ohio Bureau of Workers’ Compensation (BWC), certified provider.
How do I file a claim?
A worker’s compensation claim is filed by completing a First Report of Injury (FROI) and filing with the Ohio Bureau of Workers’ Compensation or with your Managed Care Organization. You can also file a claim online at info.bwc.ohio.gov. An injured worker, employer, medical provider, managed care organization, or attorney can file a First Report of Injury. Once the FROI is filed, the BWC will assign you a claim number and investigate the claim. Beginning on September 29, 2017, injured workers must file a claim within one year of the date of injury.
How long does it take to process a claim?
The Ohio BWC makes initial decisions to allow or deny a workers’ compensation claim. A BWC claims specialist will contact you and the employer to discuss your claim. The BWC will also request medical records from the medical providers who treated you for your work injury. The BWC is required to issue a written decision either allowing or denying your claim within 28 days.
How does the appeal process work?
Once you receive the BWC decision, you have 14 days to file an appeal and request a hearing before a District Hearing Officer of the Industrial Commission. A DHO hearing will be scheduled within 45 days of filing the appeal. The District Hearing Officer will issue a written decision within seven days and send a copy to the injured worker, employer, BWC and the attorneys for all parties. Once you receive the District Hearing Officer’s decision, you have 14 days to file an appeal and request a second hearing before a Staff Hearing Officer of the Industrial Commission. A hearing before a Staff Hearing Officer will be scheduled within 45 days of filing the appeal to the District Hearing Officer’s decision. If you disagree with the Staff Hearing Officer’s decision, you have 14 days to file an appeal to the full Industrial Commission. After reviewing the facts of the appeal, the Industrial Commission will issue a decision either agreeing or refusing to hear the appeal. In some cases, either party may file an appeal in Common Pleas Court to contest the Industrial Commission decision. A Notice of Appeal must be filed in Common Pleas Court within 60 days of receipt of the Industrial Commission order.
What should I expect at an Industrial Commission Hearing?
A hearing before the Industrial Commission is informal and takes place in a small hearing room with only a few people present. A hearing can last from a few minutes to 30 minutes depending on the issue. There are two levels of hearing: District Hearing Officer and Staff Hearing Officer. The types of issues presented before the Industrial Commission include disputes regarding:
- Initial allowance of the claim
- Additional allowance requests
- Medical treatment requests
- Temporary total compensation
- Permanent partial disability compensation
Because this is an administrative hearing the formal rules of evidence do not apply. Both parties and their representatives will have an opportunity to present their position and present medical evidence. It is important to understand the issue so you are properly prepared for the hearing. Attorney Mark L. Newman can help you prepare for your Industrial Commission hearing.
My claim was allowed. Will my medical bills be paid?
Once your claim is allowed, all of your medical providers who have treated you for your work injury should submit their bills to the Managed Care Organization. The MCO reviews the bills and forward the bills to the BWC for payment. If you receive a medical bill, you should advise your medical provider that the treatment was for a work injury and ask them to send the bill to the MCO. The name, address and phone number of your MCO is printed on your injured worker ID card sent to you by the Ohio BWC.
How do I get reimbursed for prescription medication?
If the pharmacy submitted the bill to the Pharmacy Benefits Manager (PBM) when dispensing the prescription, you will be reimbursed when the claim is allowed. If you paid cash for your prescription and the bill was not sent to the PBM, you will need your pharmacist to complete a BWC Outpatient Medical Invoice (C-17) to get reimbursed.
What type of benefits am I eligible for as an injured worker?
Your benefits will depend on the extent of your injury and can include the following:
- Payment of medical bills
- Temporary total disability
- Wage loss compensation
- Permanent partial disability
- Permanent total disability
- Lump sum settlement