Overview Of Ohio Workers’ Compensation Benefits
The purpose of workers’ compensation is to provide compensation for injuries, disease or death caused by employment. All Ohio employers are required to provide workers’ compensation coverage to their employees.
Two agencies govern Ohio workers’ compensation law — the Ohio Bureau of Workers’ Compensation (BWC) and the Industrial Commission of Ohio (IC). The BWC handles the processing of claims and the payment of money. It has limited decision-making power related to claims, as outlined below. The IC handles most of the decision-making in the workers’ compensation system by conducting hearings on issues.
Types Of Employers
There are two types of employers in Ohio — state fund and self-insured. Injured workers receive the same compensation and benefits regardless of whether they worked for a state fund or self-insured employer, but the claim process varies depending on the employer type.
- State fund employers pay premiums into the state insurance fund and do not pay workers’ compensation benefits directly. Injured workers receive workers’ compensation benefits from the state insurance fund if their employer is state funded.
- State fund claims are initially processed by the BWC. No payment can be made in state fund claims without an order from the BWC or IC, as outlined below.
- Self-insured employers do not pay premiums into the state insurance fund. Instead, they fund their own insurance and pay all compensation and benefits directly to the injured worker.
- Self-insured claims are processed differently from state fund claims. Because self-insurers pay compensation directly, they can pay compensation or benefits without an order from the BWC or IC. Self-insurers make the initial decision on whether to accept or deny a claim. If a self-insurer chooses to deny a claim, then the issue will be referred for a hearing with the IC.
Types Of Claims
Three types of claims may be filed — injury claims, occupational disease claims and death claims.
An injury occurs when a worker suffers a physical injury on the job or in conjunction with a physical injury suffers a psychiatric condition. There is no need for a specific incident or event, and an injury that gradually develops over a defined period of time may be compensable.
An occupational disease is a disease resulting from exposure during employment to conditions or substances that are detrimental to health. The workers’ compensation statute lists a schedule of diseases, and any disease that meets the requirements of the schedule is compensable as an occupational disease. There is also a general occupational disease definition set forth in the statute, and any disease that meets the requirements of this definition is also compensable as an occupational disease. Common examples of these types of injuries include carpal tunnel syndrome, mesothelioma and asbestosis.
Death claims are filed when a worker has died due to his or her employment or recognized workplace injuries. Eligible dependents are entitled to an award known as death benefits.
Filing A Claim
For an injured worker to receive benefits under the Ohio workers’ compensation system, the injured worker must file a workers’ compensation claim with the BWC. A claim can be filed by using the First Report of Injury form (FROI-1). This and all other forms can be found at www.ohiobwc.com. It is the injured worker’s responsibility to ensure that a claim is filed.
If a claim has been filed, the injured worker will receive a BWC claim number. This should be sent to you by the BWC or your employer. It often comes as a card in the mail. If you have not received a claim number, check to ensure that a claim has actually been filed.
There are strict time limits for filing workers’ compensation claims. Generally, a claim must be filed within two years from the injury date. If a claim is not filed within the time limits, it will be forever barred. Because the issue of time limits is important and potentially confusing, you should contact an attorney to discuss questions regarding this issue.
Initial Decision On A Claim
- The initial decision in state fund claims is made by the BWC. The BWC investigates a claim and within approximately 28 days issues an order allowing or denying the claim. If an injured worker or an employer disagrees with the decision, either can file an appeal to the IC.
- In self-insured claims, the initial decision is made by the employer. The self-insured employer has approximately 30 days to investigate and make a decision on a claim. If the self-insured employer does not make a decision within 30 days, the claim will be referred to the IC for a hearing.
If a claim is referred for hearing, it is first heard by a district hearing officer (DHO) of the IC. Either party to the claim can appeal the decision of the DHO. This will result in a second hearing before a different hearing officer, called a staff hearing officer (SHO). Any party to a claim may appeal the decision of the SHO to the full Industrial Commission in Columbus. The third-level appeal is discretionary, meaning the Industrial Commission may accept or refuse the claim for a third-level hearing.
Following the Industrial Commission hearings, the injured worker or employer has the option to appeal the final decision to a Court of Common Pleas or a Court of Appeals, depending upon the issues involved. Questions dealing with an injury itself or additional conditions requested in your claim will go to the Court of Common Pleas. These are called right to participate issues. Decisions of the IC dealing with treatment for your injuries or benefits will usually require the filing of a case in the 10th District Court of Appeals in Columbus seeking a writ of mandamus. These are called extent of disability questions.
Benefits In Workers’ Compensation
Here is a list of the most basic types of workers’ compensation benefits:
- Medical benefits are paid for specific medical conditions resulting from the work injury/occupational disease recognized in your claim.
- Temporary total disability is compensation paid to an injured worker who misses seven or more days of work as a result of an injury/occupational disease. The temporary total award provides compensation for the injured worker’s loss of earnings while healing from the injury. The weekly amount of temporary total compensation paid is based upon the injured worker’s earnings in the year prior to injury, with a maximum amount set by law. An injured worker is eligible for temporary total disability if they are not capable of performing the work they were doing when injured. An injured worker may not work in any capacity while receiving temporary total disability compensation.
- Wage loss compensation provides compensation for the injured workers’ loss of earnings resulting from an injury. An injured worker is eligible for wage loss if he or she returns to work in a light duty capacity and makes less money than that earned at the time of injury.
- An injured worker may also be entitled to nonworking wage loss benefits, which provide compensation for an injured worker who is looking for work within any restrictions that have resulted from the work injury. There are limits to the amount of wage loss and nonworking wage loss that can be paid in a claim.
- Permanent partial disability compensation is an award to pay for permanent residuals, problems or limitations suffered by an injured worker as a result of injury. The permanent partial award is not a settlement and the claim remains open after receipt of a permanent partial award. An injured worker must wait a certain number of weeks (which varies depending upon the date of injury) before applying for this compensation.
- Permanent total disability compensation is an award given to an injured worker who is not capable of sustained remunerative employment as a result of the injury/occupational disease. Before an application for permanent total disability compensation can be filed, an injured worker must participate in a vocational rehabilitation program or make other significant efforts to return to work. 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.
- An injured worker may apply for a violation of a specific safety requirement (VSSR) if his or her employer violated safety rules and the violation resulted in injury. Applications for these awards must be filed within two years from the date of injury or death. Applications are investigated by the Industrial Commission and referred to a hearing before a staff hearing officer.
- A loss of use award is a one-time award to an injured worker who loses a limb through amputation or as a result of condition(s) that make it useless. There are also loss of use injuries for loss of vision and total loss of hearing.