In Ohio, when an employee is injured within the course and scope of employment, he or she is not allowed to sue the employer for personal injury. Instead, the injured employee's recourse is to file a workers' compensation claim with a special administrative agency – the Ohio Bureau of Workers' Compensation (BWC).
The good news is that workers' compensation benefits are available even in cases where the employee through his/her own mistake causes his/her own injury. Workers' compensation law does not attempt to determine if someone's fault caused the injury. Instead, the focus is on whether the injury was caused as a result of employment, the nature and extent of the injury, and the available remedies under the administrative law system.
One of the first things that will happen after a claim is filed is that the BWC assigns it a number. This "claim number" is merely a reference number. It is how the BWC keeps track of activities in the claim. It does not mean your claim has been "allowed."
A variety of elements must be established to allow a claim. For example, the claim must be timely filed; the diagnosis your doctor gives must be recognized as an injury in Ohio; the injury must have happened within the course and scope of employment; and your doctor must explain how your injury caused the diagnosis. These are only some of the elements that need to be established. The BWC or your employer may challenge whether all of the required elements to establish the allowance of a claim have been established.
Once a claim has been allowed it gives an injured employee a "right to participate." Participation includes the right to ask for benefits related to the diagnoses allowed in the claim. Benefits available include, among others, medical care, payment for lost wages, rehabilitation and retraining, and a range of awards for permanent disability and death.
A right to participate does not mean that you automatically get the benefits you ask for. It only means you can ask. Just as with the allowance of your claim, the BWC or your employer may challenge whether you have substantiated the appropriateness of what you have asked for, whether it is causally related to the allowance of your claim, or whether the benefits were asked for in a proper manner.
If the BWC or your employer decides to challenge your participation in the workers' compensation system, you have an opportunity to have the Industrial Commission decide who is right. Those issues are brought before the Commission's administrative law judge called a Hearing Officer. The employer will usually have its own lawyer or adjusters present to argue its case. The BWC will usually have its attorney present to argue its case.
In limited cases, an injured worker can sue his/her employer outside of the workers' compensation system. Such cases usually involve an employer that intentionally injured the employee or knowingly allowed the employee to work in an environment that was known to the employer to be hazardous to the employee. There are also additional benefits within the workers' compensation system that are available when an employer violates certain safety rules.
The attorneys at Heller, Maas, Moro & Magill Co., L.P.A. have several years of experience in sorting through the red tape of the workers' compensation system and fighting for the benefits its clients are due.
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