Employer Responsibility for Work Injury Claims

Ohio employers have specific responsibilities when it comes to work-related injuries and workers compensation benefits. If you are an injured employee, it will be beneficial for you to understand the workers comp employer obligations. You should understand workers compensation laws and your employer’s workers comp coverage. Workplace injuries are common, and it is very important that injured employees understand the claims process is their employer obligation.

You first priority after you’ve been hurt at work, is to seek proper care and get better! Next, it is very important to document your injuries and medical care. Documentation of your injuries and medical care is a requirement of your workers’ compensation claim’s process. Then call me, or call me as you gather your documentation. My experience with workers’ comp claims and Ohio’s workers compensation laws will help you obtain maximum benefits for your medical expenses and lost income. There are also workers comp employer obligations you need to thoroughly understand. I know, work injuries are difficult on you and your family. Let me make the process easier by dealing with your employer’s workers compensation insurance carrier, so you don’t have to.

Who has to carry Workers Compensation Coverage?

In Ohio, all employers are required to carry workers comp insurance or be self-insured, even for part-time workers. This requirement applies to employers with one or more employees. The only exceptions to this rule are workers who work in the employer’s home, such as babysitters or house cleaners, who earn less than $160 per calendar quarter. Employers with more than 50 employees can choose to self-insure.

Employer Responsibilities for Safety

Employers are responsible for the safety of their workers while on the clock. This includes providing the following:

Active insurance coverage

The Ohio Bureau of Workers’ Compensation (BWC) is the exclusive provider of workers’ compensation insurance in Ohio. Employers with one or more employees must have workers’ compensation coverage and keep their policy information updated.

Filing the claim with the insurance provider or BWC

According to the Ohio Bureau of Workers’ Compensation (BWC), injured workers, their employers, or a medical provider can file a claim. Also, their employer’s managed care organization, or a legal representative can file a workers’ comp claim. Claims can be submitted online, by phone, fax, mail, or in person. The BWC classifies claims into two categories: medical only, or lost time.

Advising the injured worker to seek medical attention

The employer should encourage the employee to seek medical care as soon as possible to address any injuries and ensure a prompt recovery. If the injury is severe, the employer should call 911 or an ambulance to take the employee to the hospital. The employee should also keep detailed records of their treatment and any medical bills incurred during the process.

Selecting a managed care organization (MCO) to medically manage the claims for injured employees—an MCO is required in the state of Ohio

The Ohio Bureau of Workers’ Compensation states, Ohio employers with state-funded workers’ compensation coverage can choose a managed care organization (MCO) to help manage the medical portion of their employees’ workers’ compensation claims. The MCO assists with the management of claims and ensures that injured workers receive the appropriate medical care to return to work as quickly and safely as possible.

Ohio employers are required to choose an MCO within 30 days of receiving their Certificate of Ohio Workers’ Compensation. They can either use an online MCO selection form or a PDF form to select an MCO that best suits their company’s needs.

Two types of Workers Compensation Coverage

State Funded Employers

In Ohio, state-funded workers’ compensation coverage is available to private and public employers, with the exception of state agencies. Employers pay an insurance premium to the state’s workers compensation board to purchase a workers’ compensation policy. This coverage provides compensation benefits directly to the worker for any work-related injury. Ohio law requires all employers with one or more employees to have workers’ compensation insurance. Coverage becomes effective when Bureau of Workers Compensation receives a completed application and a $120 non-refundable fee. BWC pays medical benefits and lost wages to employees who are injured, or contract an occupational disease while on the job. Death benefits can also be paid to survivors when a death results from a work-related injury or disease.

Self-Insured Employers

Self-insured employers in Ohio have the privilege of directly paying compensation and medical costs for work-related injuries to their employees. Self-insured employers must meet certain requirements. Having authorization from the Ohio Secretary of State to do business in Ohio is a must. They must have at least two years of experience with the Ohio State Insurance Fund, demonstrating strong financial stability, and possessing the ability to administer a self-insured program. Self-insured employers are not using an insurance company for their workers’ compensation claims, but are rather handling the claims themselves.

Employers are given the opportunity to directly pay compensation and medical costs for their employees rather than paying premiums to the state board).

Self-insured employers who are approved by the Ohio Bureau of Workers’ Compensation must demonstrate sufficient financial strength. They must have administrative ability to ensure prompt payment of workers’ compensation benefits to their employees.

Difference in Workers Comp Benefits

Ohio workers have the same rights whether it is through a state-funded employer or a self-insured employer. The process, however, will be slightly different for self insured employers, so they will need to uphold specific obligations to an injured worker.

Workers comp employer obligations include the following:

• Must make arrangements for medical care within reason during workplace hours.

• Assist the injured employee in filling out workers comp claim applications and benefit forms.

• Review workers’ compensation claims in a timely manner.

• Issue payment in a timely manner.

• Must keep an office in the state of Ohio that has 1+ employees capable of administering a WC program (may also use a third-party administrator to assist).

• Retain claim files within the state at one of their locations with approval from the BWC

Employer Steps after Workers Compensation Claim is Filed

In Ohio, employers must take the following steps after an employee files a workers’ compensation claim:

1. Ensure that the claim is properly filed with the Managed Care Organization (MCO) within 24 hours by the employee’s doctor if medical treatment is needed. If the employer is self-insured, file the claim with the Ohio Bureau of Workers’ Compensation (BWC).

2. Report any work-related injuries or illnesses resulting in death or hospitalization to the Occupational Safety and Health Administration (OSHA) within eight hours.

3. Cooperate with any investigations conducted by the BWC or other state agencies.

It is very important for the employer to maintain communication with the employee and the MCO regarding the progress of the claim. Also, they must provide necessary documentation or information related to the claim. Employers should ensure they are properly withholding Ohio income tax on the employee compensation.

Length of time for a Workers Comp Claim to be Resolved

The state workers’ compensation board must make a decision to allow or deny a claim within 28 days of receiving the First Report of Injury. The duration of a workers’ compensation claim in Ohio can vary depending on factors such as the complexity of the case. Workplace accidents vary in the extent of the injury. The BWC offers two types of claims: medical-only and lost-time claims. A medical-only claim is when the injured worker misses seven or fewer days of work due to the work injury. The worker can still report to work while receiving treatment and/or benefits for the injury. In contrast, a lost-time claim is when the injured worker has missed more than eight days of work due to the injury.

If you were hurt at work, you need to know and protect your rights. The best way to do so is to call me at 1 (877) 944.4383. As your Ohio workers’ compensation lawyer, I’ll be there for you, and I’ll Make Them Pay!®