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How Do Ohio Workers’ Comp Claims Work?

How Does Workers’ Comp Work?

When an Ohio workers’ compensation claim has been denied, it can be because of a number of different reasons. Our lawyers and support staff can help overturn the denial of your claim. We have the knowledge and experience to help you to turn a negative into a positive!

Unlike in other states, many Ohio employers contract with the state for workers’ compensation insurance. This increases the size of the state workers comp bureaucracy. In Ohio, you will need to fight a system that is complicated and layered with delays for someone who doesn’t know how to work through it.

That fight will go easier if you understand how an Ohio workers’ compensation claim works. Below we discuss the claims process and what to expect if you seek benefits. Heller, Maas, Moro & Magill Co., LPA, helps workers in northeastern Ohio get the workers’ compensation they deserve. We know the Ohio workers’ compensation system. We can make the system work for you.

How To File A Workers’ Compensation Claim In Ohio

If you have been injured while at work, your first obligation is to yourself. Get medical help. Follow all of your company’s policies and procedures for reporting workplace accidents and work-related injuries or illness, and keep copies of all forms you complete or correspondence you create throughout your injury and recovery.

To file a workers’ compensation claim in Ohio, fill out the First Report of Injury Occupational Disease or Death (FROI). It requires:

  • Injured employee name
  • Gender
  • Social Security number
  • Date of birth
  • Occupation or job title
  • Injured worker’s mailing address
  • Injured worker’s home or work phone number
  • Date of injury or illness
  • Type of injury or illness and part(s) of body affected
  • Description of workplace accident
  • Employer policy number (can look up online)

You will also need to complete an Authorization to Release Medical Information form. These forms are available online from the BWC and can be downloaded, completed and mailed, or filed online.

After you file for benefits, the BWC will issue you a claim card with your claim number, which is used as your claim ID from here on out. You can also look up claim information with your Social Security number.

Within 28 days from the date your initial claim is filed, BWC will decide whether to allow or deny it. During this period, you should answer any questions from the BWC or your employer’s managed care organization (MCO).

How Ohio Examines Workers’ Compensation Claims

Once the BWC receives a claim, it is assigned to a claims service specialist (CSS). Your claim card should have contact information for the CSS assigned to your case. The CSS will begin by requesting more information from you:

  • Medical records from all medical providers who treated the alleged injury
  • Documentation from your medical provider if he or she suggests any restrictions in work activities
  • Your request for Temporary Total Compensation (Form C-84) if your injury has or will keep you out of work for more than seven calendar days
  • Wage documentation from any of your employers for the 52 weeks prior to the date of your injury. This is the Injured Worker Earnings Statement.

The CSS will also contact your employer. This is your employer’s first opportunity to certify that you have a valid claim or to challenge it. A challenge from your employer is considered at this point but, according to the BWC, is not a determining factor.

It should also be noted that the medical providers who treated you and who provide documentation of your injuries to the CSS must be registered as Ohio BWC certified providers.

Within 28 days, you should receive written notice of the CSS’s decision. You may be told your claim has been:

  • Allowed. Be sure to read the details of the order to ensure you are in total agreement with the decision.
  • Denied. If you or your employer disagree with the decision, either of you may file an appeal within 14 days of the date the decision is received.
  • Dismissed. If you voluntarily withdraw the application before the CSS issues the order (or during an appeal period), the CSS will dismiss the claim.

“Allowed” means you have been granted the “right to participate,” which means you may request medical treatment and compensation benefits through the Bureau of Workers’ Compensation. This requires additional forms and medical documentation of your injury status.

If you have withdrawn your claim, you may refile at any time for up to two years from the date of your injury. After that date, you will not be able to claim workers’ compensation benefits related to that particular date of injury.

If your claim has been denied, the notice from your CSS should provide a specific reason. In many cases, the information your application has provided to the CSS is simply not enough to allow the claim.

If you disagree with the CSS’s decision, you have 14 days to file an appeal. File a notice of appeal with form IC-12 or with a letter to your assigned CSS. Either must include:

  • Your and your employer’s names
  • Your claim number
  • The date of the order you’re appealing
  • The reason you’re appealing
  • Your signature and date of the appeal.

Once an appeal is filed to a BWC order, the matter will be referred to the Ohio Industrial Commission for a hearing on the merits of your request. At this point, the matter will be heard before a hearing officer (also an attorney) who will weigh the evidence and make a decision. There are three levels of appeal for a denied workers’ compensation claim:

  • District level: A hearing before a district hearing officer (DHO) is held at the Industrial Commission office closest to the injured worker’s home. Any of the parties may present information.
  • Staff level: This is a second hearing before a staff hearing officer (SHO), which any party may request if the DHO decision is not satisfactory.
  • Commission level: At this point, Industrial Commission members may refuse to hear the appeal, or may agree to a hearing.

After a hearing at the commission level, the employee or employer may pursue the matter by appealing it to the appropriate County Court of Common Pleas where the injury occurred.

Let Our Workers’ Compensation Lawyers Compile Your Workers’ Comp Claim

As you can see, a workers’ compensation claim requires a variety of information, which you may not have at your fingertips. If you are still recovering from your injuries, that can make it harder to round up the records necessary for a complete claim application.

Heller, Maas, Moro & Magill Co., LPA, can help you compile your claim and ensure that it is accurate and complete. We can step in at any point of your case to assist you. The complexity of the Ohio workers’ compensation system can easily work against you. But our workers’ compensation lawyers bring the advantage back to you. You are no longer alone.

We work with workers’ compensation claims like yours in northeastern Ohio every day, and have done so for many years. We know the system. We know what the BWC wants in a claim. We stand up for what’s right when injured workers seek the workers’ compensation benefits they have been promised by Ohio state law.

Don’t go it alone. Call Heller, Maas, Moro & Magill Co., LPA, today.