Workers’ Compensation is to Protect Injured Workers
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 claim for compensation. A Toledo workers’ compensation attorney 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; and
- In the event of denials, to either represent yourself or hire a lawyer
Though there are many different variations of workers’ comp benefits, they basically fall into four categories:
- Medical expenses;
- Wage loss compensation;
- Disability, which can be awarded in a negotiated lump sum; and
- Wrongful death, which is also subject to a negotiated lump sum.
Filing a Workers’ Compensation Claim
If you suffer a workplace injury – even a minor one – report it to your employer and seek timely medical attention. The claims process begins when the injured worker, medical provider or employer files a First Report of Injury (FROI) with the BWC, either online or by mail. This “first contact” has an overwhelming impact on the final disposition of your claim. So it’s important to contact an experienced Toledo workers’ compensation lawyer to assist you before you submit your FROI. This assures a properly completed submission, which significantly lessens the chances of errors on the form or other improprieties, any of which could lead to your claim being denied.
The BWC will inform you whether your claim is approved or denied within 28 days. Contrary to popular perception, the BWC is a government administration agency. It is NOT your advocate. Think of the BWC as a state-run health insurance company (even if it only manages the compensation that comes from your employer’s private accident insurer). So like the private insurer, its interests often lie more in the employer’s favor than yours.
When Your Workers’ Compensation is Denied
Because it is financially advantageous to your employer (and its insurer) for your claim to be denied, your employer may dispute it. More claims awarded mean more compensation going out and possibly higher premiums for your employer to pay the insurer. So disputing claims means the BWC has to play the referee to two opposing stories. And that slows the “administrative process,” which any governmental bureaucracy dislikes.
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 of 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.
Robert Fiedler explains the options you have if your Workers’ Compensation claim has been denied.
You may be entitled to a permanent partial loss, wage loss or a settlement. FInd out all the details here and contact us if you have further questions or need assistance.
Gallon, Takacs & Boissoneault Can Help
Being injured at work is stressful. Working through the paperwork of Workers’ Compensation is even more stressful. Let us help make the process easier for you and help you get the compensation you deserve. Call us at 419-843-6663 or contact us online. Our attorneys are experienced in fighting for injured workers. Call us. We can help.