Workers Compensation Law in Ohio
The Ohio workers’ compensation law system was created by state law in 1911 as a no-fault and exclusive insurance system for workplace injuries. Prior to the law, injured workers could sue their employers, but employers had multiple defenses that usually left their injured employees empty-handed. When an injured worker’s claim did prevail, the court award could bankrupt the company.
Ohio Workers’ Comp Law a ‘No Fault, Exclusive Remedy’
The no-fault provision, meaning injured workers did not have to show that their employers caused their injury, is a trade off. Almost any injured worker can obtain workers’ compensation for medical bills and a portion of lost wages if they are hurt on the job. In exchange for coverage that is guaranteed, workers give up the right to sue their employer for negligence in most cases, and do not receive money for pain and suffering or as punitive damages.
The exclusivity means all such claims must go through the state system, the Bureau of Workers’ Compensation (BWC) or Industrial Commission (IC). Only after every level of the BWC and IC has been exhausted may the injured worker appeal a disputed claim in Ohio’s court system.
The law seems pretty straightforward, but as with any program that has to address any eventuality, it gets more complicated once you apply specifics. And, if an employer is determined to not pay benefits to an allegedly injured worker, they can dispute the claim. That’s when you need an experienced Heller, Maas, Moro & Magill, Co., LPA, workers’ compensation lawyer on your side.
Our Ohio workers compensation attorneys have been assisting injured workers in Northeastern Ohio with workers’ compensation claims for more than 30 years. We know the Ohio workers’ compensation system. We can make it work for you.
Four Requirements for an Ohio Workers’ Compensation Claim
Ohio workers’ compensation law requires an injured worker to prove four factors for their claim to be valid. If their employer can disprove any one of them, the claim fails, it is considered invalid.
The four elements are:
- The employer / employee relationship: A relatively recent trend is that employers will claim a worker is actually a contractor, not an employee, and therefore not covered by workers’ compensation. This occurs often in the construction and trucking industries. In addition to falsely classifying employees as contractors, companies disputing claims may contest applications by workers attached to the company through labor leasing or professional employer organizations, or as temps or interns.Legally, such workers would not qualify for benefits, but often the classification of the employee as a contractor, intern, temp, etc., is incorrect. An attorney who understands can help to compile work records that prove the worker’s status as an employee.
- Injury is “accidental in character and result”: This phrase from state workers’ compensation statutes seems to place a qualifier on the no-fault nature of the program. However, courts have continued to say employers may not cite the workers’ contributory negligence as reason to deny a claim.In other words, lack of common sense, failure to follow work rules, inattention to detail, and other similar discrepancies on the part of the employee will not invalidate a claim.In most cases, a description of the accident that caused the employee’s injury is sufficient to meet this legal qualification.
- Injury occurred “in the course of employment”: For a workers’ compensation claim to be allowed in Ohio, the injury must have occurred “in the course of employment,” or while on the job. In most cases, work records and witness statements make this easy to prove. However, an employer may object if an accident occurred while the worker was on a break, for example, or not yet on the job and in the parking lot, or while combining personal activities and business. The so-called “Coming and Going Rule” says that an employee’s commute to a fixed worksite does not count as “on the job.”There are exceptions to the Coming and Going Rule, one of which sets the rule aside if an accident happens in a parking lot the employer owns and controls, and the employee was required to park there, for example.
- Injury occurred “arising out of the employment”: This portion of the law requires the worker to show that a risk or hazard directly related to their employment was the actual cause of the workplace injury. Disputes over this factor typically relate to:
- Heart attack or stroke: Many lifestyle, genetic and general health factors may contribute to a heart attack or stroke, even if it occurs in the workplace
- Repetitive motion injury (e.g., carpal tunnel syndrome or rotator cuff syndrome): Any kind of cumulative injury is subject to being questioned, with the employer pointing to previous employment or other activities as its cause.
- Toxic exposure: Diseases caused by toxic exposure, such as silicosis or asbestosis, have lengthy periods before they show symptoms. Again, this allows employers to point at other potential causes.
Strong documentation of the worker’s medical condition is necessary to overcome an objection to the“arising out of employment” claim, should one arise.
Heller, Maas, Moro & Magill, Co., LPA can help at any point in your workers’ compensation claim to ensure that your benefits application is clear and complete as it sets out the valid reasons you deserve benefits.
8 Common Legal Issues for Employees and Workers’ Comp Claims Law
In addition to the four elements an injured worker must prove for a workers’ compensation claim to advance, the application must overcome any other objections the employer raises. Here are eight common legal issues that injured workers, as well as the BWC, IC and Ohio courts, have repeatedly had to examine:
- Intoxication. While workers’ compensation is a no-fault program, Ohio courts have found that an accident caused by the injured person’s use of drugs or alcohol in the workplace is a bridge too far. However, it is up to the employer or the IC to prove that an injured worker’s intoxication was the proximate (i.e., most closely responsible) cause of the workplace injury for the claim to be denied.
- Horseplay. A worker who is injured in a fight, scuffle, or similar horseplay that the injured worker instigated is generally not eligible for workers’ compensation. However, Ohio courts have also ruled that in workplaces where horseplay is common and tolerated by the employer, an injury that occurs during horseplay may be considered “arising out of the employment.” Therefore the claim would be valid.
- Recreational activity. Many workplaces sponsor recreational activities for employees, from softball games or teams, to bike rides, or confidence-building adventure outings. But there’s a difference between company-sponsored activity, at which injuries would be covered by worker’s comp, and informal employee gatherings, which would not.
- Out-of-state accidents. Here in Ohio’s Mahoning Valley, it is not unheard of for a worker who lives in West Virginia and works for a company headquartered here to be injured at a job site in Pennsylvania. How does their workers’ compensation claim work? Ohio courts have ruled that to determine whether employment is located in Ohio for purposes of workers’ compensation coverage, the following should be considered:
- The location of the contract for hire
- The location of the employee’s supervisor
- The physical location of the work-related injury
- The state in which workers’ compensation premiums were paid
- The location of the employee’s home
- Any language in contracts or other documents that indicate the intent of the employer and employee.
- Mental health injuries: Ohio workers’ compensation pays for mental health counseling and other treatment of psychological issues, but only if the mental health injury is related to a physical injury that occurred while on the job. In other words, a psychiatric issue arising from workplace conditions does not qualify for workers’ comp benefits on its own.
- Business travel injuries: Many jobs require travel among multiple offices or job sites, some of which is before or after the workday. It is a mistake to think that if an accident occurs while you are “off the clock” it cannot be the basis of a workers’ comp claim. In most cases, if your employer is paying your expenses (such as “mileage”) and controls and benefits from your travel, a business travel injury would be eligible for workers’ compensation.
- Union member activity: Injuries that occur while engaged in union activities may be ineligible for workers’ compensation. In one case, an employee was injured while walking a picket line on company property. The court decided the employee was on strike and receiving union pay, not company wages, and was on the picket line at the union’s direction. When injured, the employee was engaged in activity to benefit the union, not his employer, and was therefore not eligible for compensation.
- Intentional torts: Despite the no-fault/exclusive remedy intention of Ohio workers’ compensation, if an employer intentionally or through gross negligence causes an employee’s injury, they may be sued for compensation outside of the workers’ comp system. To establish intentional tort, the employee must prove:
- The employer knew of the specific risk caused by a specific task
- The employer knew the employee was subject to this known specific risk
- The employer, despite such knowledge, required the employee to continue to perform this dangerous task.
In addition, it should be understood that Ohio workers compensation law clearly prohibits an employer from discriminating against an employee who has filed a workers’ compensation claim. Illegal activities by the employer would include firings, warnings, demotions, suspensions, and/or pay cuts.
The presence of any of the issues above will complicate a workers’ compensation claim, regardless of who raises it and who would seem to benefit. A Heller, Maas, Moro & Magill. workers’ compensation attorney would be able to help you compile and present evidence as required to make or defend your workers’ comp claim. Our assistance can make your claim go smoother and faster. We can make the system work for you.
Lawyers Experienced with Ohio Workers’ Compensation Claim Law & Legal Issues
The Ohio workers’ compensation system continually changes as legal decisions, legislation, policy and procedure change how the law is applied to workers’ claims for benefits. Heller, Maas, Moro & Magill has worked with Ohio workers’ compensation since 1985, and our attorneys have shaped some of those legal decisions.
We stand up for what’s right when injured and disabled workers seek workers’ compensation benefits in Northeastern Ohio. We know the Ohio Bureau of Workers’ Compensation and Industrial Commission, and the key rules, regulations and players in each. We know the Ohio system. We know how to fight effectively for you.
Over 30-plus years protecting the rights of injured workers, injury victims and the disabled in the Mahoning Valley, we have developed a solid reputation for the assistance we provide to our clients. Don’t go it alone. We make the system work. Contact us today.