What is Workers’ Compensation?
Workers’ compensation, also known as workman’s comp or workers’ comp, is a system designed to provide financial compensation for workers who are injured or become ill due to events in the workplace or as a result of their job. This program aims to cover all medical expenses and also compensates for lost wages due to the inability to work or reduced work capacity. This compensation is contingent upon verification that the injury or illness was sustained while the employee was involved in work-related activities.
Understanding Workers’ Compensation Rights in Ohio
With a few exceptions, Ohio State Law requires every employer to purchase insurance (or provide documentation that it is self-insured) to pay workers’ compensation benefits to employees who suffer a work-related illness or injury. Injured workers have the following rights when they are injured and must file a workers’ compensation claim. A Toledo workers’ compensation lawyer at Gallon, Takacs & Boissoneault, can ensure fair compensation and due process, such as:
- A quality, independent medical exam and treatment
- Payment by your employer’s insurer of all appropriate medical bills
- Access to all of your records
- Appeal of any denial by your employer’s insurer to the Ohio Bureau of Workers’ Compensation (BWC), Ohio Managed Care Organizations (MCO), or the Industrial Commission of Ohio (IC)
- Receive timely payments for all allowed claims
- In the event of denials, either represent yourself or hire a lawyer
Types of Workers Compensation Benefits
Though there are many different variations of workers’ comp benefits, they fall into four categories:
- Medical expenses
- Wage loss compensation
- Disability, which can be awarded in a negotiated lump sum
- Wrongful death, which is also subject to a negotiated lump sum
Filing a Workers’ Compensation Claim
If you suffer a workplace injury, report it to your employer and seek medical attention promptly. The claims process starts with filing a First Report of Injury (FROI) with the BWC, either online or by mail, by the injured worker, medical provider, or employer. The outcome of your claim depends on this initial contact, so it’s crucial to consult with an experienced Toledo workers’ compensation lawyer before submitting your FROI. This ensures proper submission, reducing the chances of form errors or other issues that could lead to claim denial.
The BWC will notify you of claim approval or denial within 28 days. Contrary to popular belief, the BWC is a government administrative agency and not your advocate. Think of the BWC as a state-run health insurance company that handles compensation from your employer’s private accident insurer. Hence, its interests often align more with the employer’s rather than yours.
When Your Workers’ Compensation Claim is Denied
Your employer (and its insurer) have a financial incentive to deny your claim, as more awarded claims result in increased compensation and potentially higher premiums. Therefore, they may dispute it, making the BWC the referee in conflicting stories. This slows down the administrative process, which governmental bureaucracies generally dislike.
Often the denial is based on technical grounds such as:
- Your claim was not filed on time;
- The claim and the medical records are inconsistent;
- Your account of the events of the injury is unclear or incomplete;
- The injury happened outside of your job description (or happened someplace else); and
- Your employer claims you are not an actual “employee.”
If denied, you have the right to appeal, but an appeal must be filed no later than 14 days from your receipt of that denial. A hearing is scheduled before the Industrial Commission (IC), which is supposed to hear you and your employer make your respective cases. This is where your attorney becomes a clear asset to deflect your employer’s claims. It is also likely that after hearing both sides of the matter, the IC will order you to undergo another medical exam before rendering its decision.
What to Do When Your Workers’ Compensation Claim Is Rejected
Filing a workers’ compensation claim can be complex, and claims being denied or disputed are not uncommon. If your claim gets rejected, it’s crucial to understand your options and take steps to appeal. Seeking assistance from a workers’ compensation attorney who can help navigate the legal system and secure the benefits needed for recovery is important. If you need help with your claim, contact Gallon, Takacs & Boissoneault today for a free consultation. Call 419-843-6663 or reach out to us online.
