This page provides answers to the following questions:
- I had an accident at work. How do I file a workers compensation claim in my state?
- Should my employer have workers compensation insurance? How do I know I am covered?
- What are the conditions that enable me or prevent me from claiming benefits under my state's law?
- What benefits might I be eligible to receive?
- How much time do I have to file my claim? What are the stages of the claim process? What should I expect?
- If I'm not happy with the determination, how do I appeal?
1. I had an accident at work. How do I file a workers compensation claim in my state?
If you are injured while on the job, report the injury or circumstances of the accident to your employer as soon as possible, if not immediately. Your employer is expected to assist you in filing a claim with the employer's insurance provider. There are many options for filing your claim- you can do so online, through your employer's insurance provider, or by completing a First Report of An Injury, Occupational Disease or Death application. As of September 29, 2017, the filing time has been decreased to one year therefore claims must be filed within this time frame.
2. Should my employer have workers compensation insurance? How do I know if I am covered?
Ohio employers are expected to provide workers compensation coverage but may elect to become self-insured or to participate in a coverage program with an authorized insurance provider. It is important for there to be clear communication about the expectations and procedures involved in filing a claim with your employer. Make sure to speak with your employer and ask questions about what steps you should take to deal with the outcomes of your workplace accident.
3. What are the conditions that enable me or prevent me from claiming benefits under my state's law?
The best way to ensure the receipt of benefits is follow the procedures and filing requirements specified by your employer or your employer's insurance provider. Clear communication and proper documentation will always serve you throughout this process, especially in the event of a dispute.
4. What benefits might I be eligible to receive?
The state workers compensation system works to supplement medical expenses and wage-losses caused by a work-related injury or illness. The state's main benefit is to help mitigate these kinds of expenses. However, the Bureau of Workers' Compensation also provides vocational training and return-to-work programs to help assist you in returning to gainful employment or re-learning skills.
There are several forms of workers' compensation offered through your workers' compensation coverage program, classified by state law and the Bureau of Workers' Compensation. What you may be entitled to receive will depend largely on the extent of your injuries. Below is a short description of each benefit you may be entitled to, depending on your claim:
- Temporary total compensation: Compensation paid to you if you are unable to return to work for eight (8) days or more. These are benefits paid to you for those days you are unable to return to work, but your injury is more temporary in nature. Compensation is calculated based on you average wage earnings at the time of your injury. The amount can fluctuate depending on how long you are considered disabled within this category (between 67-72% of average weekly earnings).
- Living maintenance wage loss: Compensation paid to you for agreeing to comply with an approved rehabilitation plan that aims to help you return to work. This is considered to be payments for the difference between your wages pre-injury or if you are unable to find a job within your medical restriction.
- Permanent total disability or statutory permanent total disability: You must be declared permanently disabled to be eligible for this kind of benefit. If you are considered permanently disabled, you may only receive payments so long as you are unable to return to work.
- Disabled Workers' Relief Fund: A fund paid out to individuals receiving temporary or permanent disability benefits but can't meet the average standard of living. The fund supplements these benefits packages.
- Percentage of permanent partial disability as residual impairment: Compensation for residual impairment that stems from a work-related injury.
- Permanent partial disability: Compensation paid for the loss of or loss of use of a specific body part as a result of a work-related injury.
- Facial disfigurement: A one-time award given to you for a facial or head disfigurement that may prevent you from obtaining employment in the future.
- Death awards: An award provided when death is the result of a work-related injury or illness. Dependents or survivors of the deceased may be eligible for these payments. The new law prohibits the payment or compensation benefits to incarcerated dependents.
- Lump sum advancement: This is a one-time lump sum paid out to you or your surviving dependents (in case of death). A separate application process is available for individuals interested in receiving a lump sum advancement.
5. How much time do I have to file my claim? What are the stages of the claims process? What should I expect?
Remember to report the circumstances of your accident to your employer as soon as possible, if not immediately. If you receive medical treatment before speaking with your employer, your medical provider should contact your employer or employer's insurance provider within twenty-four (24) hours of treatment. Clear communication is key- if you have worked with a medical care provider and you later inform your employer, make sure to share the information with your employer that a claim may already be underway.
After filing a claim, you will receive a packet of information and a claim identification card with all the information regarding your claim and your designated Bureau of Workers' Compensation claims service specialist. Your claims specialist will assist you throughout the claims process and keeps track of your progress throughout. For example, if you miss more than eight (8) days of work your claims specialist will call you within one week of when your claim is filed.
Your claim will be evaluated within twenty-eight (28) days of being filed, at which time you will learn whether your claim is to be accepted or denied. If either you or your employer disagrees with the determination, both parties are entitled to appeal the decision within fourteen (14) days.
The appeals process has three levels:
- District Level Hearings: this is the first level of appeal after receiving the initial determination of your claim. Your claim is heard by a district hearing officer and one of the district offices. The district hearing officer's decision will be made within seven days of the hearing. Each party is then entitled to appeal the determination within fourteen (14) days of the determination.
- Staff Level Hearings: After potentially filing an appeal from the district level hearing, a staff level hearing is scheduled forty-five (45) days later. The same time frames apply- the decision at this level is made within seven days to which each respective party has fourteen days to appeal.
- Commission Level Hearings: If you choose to appeal to this level, the Commission Staff either decides to accept or deny the appeal. If the appeal is accepted, a hearing is scheduled within forty-five (45) days and a decision will be issued within seven.
6. If I am not happy with the determination, how do I appeal?
If you have exhausted all appellate procedures within the Bureau of Workers' Compensation, depending on the issues unresolved or disputed, you may be able to appeal the decision to the state court system within sixty (60) days. All applicable court rules and procedures will apply.