Workers’ Compensation Claims Process
Workers Compensation Claims Process
What is Workers’ Compensation?
Workers’ compensation is a system that provides benefits to employees who have been injured or become ill as a result of their job. These benefits typically include medical expenses, lost wages, and disability payments. In exchange for receiving workers compensation benefits, employees give up their right to sue their employer for damages related to the injury or illness.
How to File a Workers’ Compensation Claim
If you have been injured or become ill on the job, follow these steps to file a workers’ comp claim:
Step 1: Report the Injury
Notify your employer immediately after the work injury or illness occurs. If you fail to report the injury in a timely manner, you may lose your right to receive workers’ comp benefits.
If you choose to file an Ohio workers’ compensation claim without the help of an attorney:
Online: You can file a claim online via the Ohio Bureau of Workers’ Compensation (BWC) website. Simply visit https://info.bwc.ohio.gov/ and click on the “File a Claim” button on the homepage. Follow the prompts to complete and submit the form.
Phone: Another option is to call the BWC at 800-644-6292 from 7:30 a.m. to 5:30 p.m. (EST) or a local BWC customer service office. A customer service representative will ask the questions needed to complete the form, and to start the claims process.
Mail: If you prefer to submit the form by mail, you can download and print the workers’ comp claim form directly from the BWC website, and mail the necessary paperwork to the BWC office at the address provided on the form.
Step 2: Seek Medical Treatment
If the injury is serious, seek immediate medical attention. Make sure to inform your healthcare provider that your injury is work-related.
If you’ve been injured on the job and need medical treatment for an Ohio workers’ compensation claim, there are a few things you should know.
First and foremost, as an injured worker, it is important to get a medical report as soon as possible. Depending on the severity of the injury, you may need to go to an emergency room or urgent care. If your injury is not an emergency, you should make an appointment with a doctor who is authorized and familiar with the workers compensation claims process.
In Ohio, injured workers generally have the right to choose their own doctor for workers’ comp treatment. However, there are some restrictions. For example, if your employer is part of a managed care organization (MCO), you may be required to choose a doctor within the MCO network.
Once you have selected a doctor, make sure to inform him/her that your injury is work-related, and you are seeking treatment for a workers’ comp claim. Your doctor will need to document your injury and treatment in order to support your claim for benefits.
Step 3: Complete the Claim Form
Your employer will provide you with a workers’ compensation claim form. Complete the form as soon as possible, and submit it to your employer.
Completing an Ohio workers’ compensation claim form is a crucial step in the process of securing benefits for a work-related injury or illness. Here are the steps to complete a claim form:
Obtain a claim form: The Ohio Bureau of Workers’ Compensation (BWC) provides a First Report of an Injury (FROI) form that you can download and print from their website, or you can request a form from your employer.
Complete the claim form: The FROI form requires you to provide detailed information about your work injuries, including the date and time of the incident, a description of the injury or illness, and information about your medical care. You will also need to provide personal information, such as your name, address, and employer information.
Submit the claim form: Once you have completed the FROI form, you can submit it to the BWC by mail, fax, phone, or online. You can also submit the form to a local BWC customer service office.
It is important to note that mailing a claim form can slow down the workers’ compensation claims process time, so submitting your claim online or over the phone is typically the fastest option.
If you have questions or need assistance completing the FROI form, you can contact the BWC for guidance, or work directly with my staff at Misny Law. Additionally, it’s always in your best interest to hire a workers’ comp attorney, like myself, to ensure your rights are protected and you receive the benefits you are entitled to.
Step 4: Wait for the Decision
After you have submitted your claim, your employer’s workers’ comp insurance policy carrier will investigate the claim and decide whether to approve or deny it. This part of the workers comp process may take several weeks.
Here is an overview of what to expect:
Investigation: The claims administrator will typically speak to you and your employer, review medical records, accident reports, and other documents related to your claim. This investigation is to determine whether your injured workers claim is eligible for benefits under Ohio’s workers’ comp laws.
Decision: The investigation into your Ohio workers compensation claims must come to a decision within a reasonable period. This decision can take a few weeks to several months, depending on the complexity of your claim and the backlog of cases.
Notification: Once a decision is made, you’ll be notified of the outcome. If your claim is approved, you can receive benefits for your medical bills, lost wages, and disability payments. If the workers compensation insurance is denied, you have the right to appeal the decision.
During the waiting period, it is important to keep all medical documentation about your injuries and subsequent treatment, and cooperate with the insurance company’s reasonable requests for information and documentation. If you have any questions or concerns about the status of your claim, you can contact the Ohio Bureau of Workers’ Compensation for assistance.
Step 5: Appeal the Decision (if necessary)
If your workers’ comp claim was denied, you have the right to appeal the decision via the Ohio workers compensation system. It is also very important to retain me as your workers’ comp attorney, so I can represent you during the appeal process.
Here is an overview of the appeals process:
District level: Your first stage of appeal is heard by a district hearing officer (DHO). You may present more information, further detailing how the injury occurred and the resulting financial burden.
Staff level: If you are dissatisfied with the district hearing officer’s decision, you can appeal to the staff level. A staff hearing officer (SHO) will hear the appeal.
Commission level: If you are still not satisfied with the SHO’s decision, you can appeal to the Industrial Commission of Ohio (IC). This is the final level of appeal for workers’ comp claims in Ohio. The IC will review your case and issue a final decision.
It is important to note, that as an injured worker you must file an appeal with the IC within 14 days of receiving the denial of your claim by the Ohio Bureau of Workers’ Compensation. It is also imperative to hire me, as your workers’ comp attorney, so I can help you navigate the workers comp process and protect your rights.
Common Workers’ Compensation Claims
Workers’ comp claims can be filed by an injured worker for a variety of injuries and illnesses that occur in the workplace. Listed below are some of the most common types of workers’ compensation claims:
Repetitive Motion Injuries
Repetitive motion injuries are injuries that result from repeated motions over time. Here are some examples of common repetitive motion injuries:
Tendinitis: This is a condition in which the tendons, which connect muscles to bones, become inflamed due to repeated use. It often affects the shoulders, elbows, wrists, and knees.
Bursitis: This is a condition in which the bursae, which are small fluid-filled sacs that cushion the joints and help reduce friction, become inflamed due to overuse. It often affects the shoulders, elbows, hips, and knees.
Carpal tunnel syndrome: This is a condition in which the median nerve, which runs from the forearm into the hand, becomes compressed at the wrist due to repetitive hand and wrist movements. It often affects people who use computers or perform assembly line work.
Tennis elbow: This is a condition in which the outer part of the elbow becomes painful and tender due to repeated twisting and gripping motions of the forearm muscles. It often affects people who play tennis or perform manual labor.
Trigger finger: This is a condition in which the finger or thumb catches or locks in a bent position due to inflammation of the tendon sheath. It often affects people who perform repetitive gripping motions with their hands.
Slip and Fall Work Injuries
Slip and fall injuries occur when a worker slips or trips and falls, often resulting in broken bones or head injuries.
Slip and fall injuries are a common cause for workers’ comp claims. Here are some examples of slip and fall injuries that could be covered by a workers compensation claim:
Broken bones, such as a broken arm or wrist, which can result from falling on a hard surface. The cost of treatment for broken bones can range from $2,500 to $18,000 or more, depending on the severity of the injury and the required treatment plan.
Soft tissue injuries, such as sprains and strains, can result from slipping or tripping and falling. These injuries can be painful, limit a person’s ability to work, and may require physical therapy or other treatments.
Head injuries, such as a traumatic brain injury, can occur if a person hits their head during a fall. These injuries can be serious and may require extensive medical treatment, including hospitalization and rehabilitation. Slip and fall accidents are a leading cause of traumatic brain injury.
Overall, slip and fall injuries can have a significant impact on a worker’s health and on his/her ability to work. Medical treatment many necessitate time off from work. If you have been injured in a slip and fall accident at work, you may be eligible for workers compensation benefits to cover your medical bills and lost wages.
Occupational illnesses occur as a result of exposure to hazardous materials, such as asbestos or toxic chemicals.
Occupational illnesses are conditions that develop over time, as a result of exposure to certain substances or working conditions. Here are some examples of occupational illnesses that may qualify for workers compensation benefits:
Mesothelioma: a type of cancer caused by exposure to asbestos fibers, commonly found in construction, shipyards, and other industries.
Repetitive Motion injuries: damage to muscles, tendons or nerves caused by repetitive motion, such as carpal tunnel syndrome or tennis elbow.
Pneumoconiosis: a group of lung diseases caused by inhaling dust particles over a prolonged period of time, such as silicosis from inhaling silica dust in mining or construction.
Lead poisoning: a condition caused by exposure to lead, commonly found in certain industries like construction, plumbing, and painting.
Hearing loss: a condition caused by prolonged exposure to loud noise, commonly found in industries like construction, manufacturing, and agriculture.
It’s important to note that each state has its own requirements for what illnesses and conditions are covered by workers compensation. Be sure to call me to discuss your case, and I can determine if your specific condition may qualify for benefits.
Back injuries can occur due to heavy lifting, improper lifting techniques, or other work-related activities.
Examples of back injuries that may be covered under workers’ compensation claims include lumbar spine injuries, herniated discs, strains, sprains, and fractures. It’s important to report any back pain or injury to a supervisor or human resources department as soon as possible and seek medical attention to document the injury for a workers compensation claim.
Navigating the workers’ compensation claims process can be a daunting task. However, by following the steps outlined in this guide, you can ensure that your claim is properly filed and you receive the benefits you are entitled to. Remember, if you are unsure about any aspect of the claims process, call me, so I can ensure your rights are protected and I’ll Make Them Pay!®