How Long Do You Have to Be Out of Work to Get Workers’ Comp in Ohio?

Many people worry about how they can afford to miss work after an on-the-job injury. Workers should know that, generally speaking, workers’ compensation benefits should cover all medical expenses for a job-related injury, no matter how much time is missed from work. These benefits also cover a portion of the workers’ lost wages if they miss more than seven days of work.

The most important factor is immediate reporting of the injury to jumpstart the workers’ compensation process. Contact our dedicated Ohio injury attorneys today to learn how the workers’ compensation process works.

What Is the Timeframe for Workers’ Compensation Claims in Ohio?

There are several steps to complete in the workers’ compensation process in Ohio. As outlined by the Ohio Bureau of Workers’ Compensation (BWC), the first step in the process involves the filing of a First Report of Injury (FROI) to any BWC office in Ohio. Applicants can file the FROI by mail or online.

It is important to note that many workers’ compensation claims are filed on behalf of the injured worker. In certain cases, the first medical care provider may file the workers’ compensation claim. In other cases, the employer may file the workers’ compensation claim. Either way, injured workers are encouraged to check with the BWC to see whether an FROI is on file before submitting an application.

In terms of processing time, the BWC maintains a 28-day turnaround time for all Ohio workers’ compensation claims. Within that 28-day period, the BWC will review the FROI and make a decision as to approval or denial of the underlying claim.

On a related note, there is a statute of limitations for workers’ compensation claims in Ohio. Injured workers have a maximum of two years to file a claim for workers’ compensation with an injury date prior to September 30, 2017. This was changed to one year to file the claim for injuries after September 29, 2017.  If the injured worker waits longer than the one or two years (depending on date of injury), he or she loses the ability to file a claim for workers’ compensation in Ohio for that injury.

How Does Workers’ Compensation Cover Medical Bills?

After the BWC approves a claim for workers’ compensation, there is a simple process to ensure payment of medical expenses. Essentially, the health care providers involved in treatment submit relevant bills and expenses to the managed care organization (MCO).

After the MCO receives the bills and expenses, there is an evaluation process. Upon conclusion of the evaluation process, the MCO forwards the bills and expenses to the BWC. Upon approval of the bills and expenses, the BWC submits payment to the MCO. Then the MCO submits payment to the health care providers.

What Happens If Health Care Providers Send Bills to Injured Workers?

Once the injured worker obtains approval for the workers’ compensation claim, he or she should not receive medical bills from health care providers. If the injured worker does receive such a bill:

• He should follow up with the health care provider and alert the provider of the nature of the work-related injury.
• The injured worker should also provide the name and contact information for the MCO, requesting that the health care provider redirect the bills in question.
• Contact our office immediately to be sure the medical bill is properly filed.

Do Injured Workers Receive Benefits for the Entire Period of Disability?

Injured workers can receive lost time benefits if they miss more than seven working days. However, injured workers cannot receive compensation for the first seven days until they miss 14 consecutive working days.

Otherwise, injured workers are generally compensated for the entirety of missed days for a work-related injury. If the injured worker misses 90 days or more of work, he or she may be required to take a medical examination. The results of the medical examination will be used to determine whether benefits continue.

Is There an Appeals Process for Denied Workers’ Compensation Claims in Ohio?

Thankfully, a denied or rejected workers’ compensation claim is not the end of the road. As detailed by the Ohio Industrial Commission, there is a procedure in place to challenge denied or rejected claims.

As explained above, the BWC reviews all claims for workers’ compensation in Ohio. After reviewing the claim, the BWC decides whether to award or deny workers’ compensation benefits. Once the BWC makes a final decision, the employee or the employer can appeal if the decision is adverse to them.  .

Typically, an employee would challenge the denial of benefits, whereas an employer might challenge the award of benefits. In either case, the appealing party must file Form IC-12 – Notice of Appeal with the Industrial Commission. Once the appealing party files Form IC-12, the claim will be transferred to the Ohio Industrial Commission.  By law, the Industrial Commission must schedule the hearing within 45 days of the time the Industrial Commission receives the claim.  The initial hearing would be to a District Hearing Officer.  Either party can appeal the decision of the District Hearing Officer to a Staff Hearing Officer and that again will be set within 45 days.  If the claim is approved at the District Hearing Officer lever, benefits must be paid.  If the staff Hearing Officer denies the claim, there is a chance the claim may go to a hearing before the Industrial Commission in Columbus.  However, these hearings are few and far between.  .

Finally, even if an injured worker exhausts all appeals within the Industrial Commission, he or she can appeal it to the Court of Common Pleas of the County in which they were injured..

Let Us Help You Today

If you are dealing with a workers’ compensation claim or related considerations, there is a complicated network of bureaucratic procedure to take into account. With overlapping timelines and complex regulations, it can be a challenge to file workers’ compensation claims properly. In order to maximize the chance of success for your claim, it can be valuable to retain the services of a trusted workers’ compensation attorney.

The law firm of Heller, Maas, Moro & Magill Co., L.P.A., has built a reputation of trust and has demonstrated capabilities for successfully handling workers’ compensation cases. The lawyers at our firm have a proven track record of success in Northeastern Ohio, helping clients in Youngstown, Akron, Warren, Salem, Ravenna, Kent, Alliance, and elsewhere. If you have legal questions, please feel free to contact us today for a free case evaluation.