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The Ohio workers’ compensation program is a state managed workers’ compensation system that provides compensation and medical benefits to employees who are injured at work. The Ohio Bureau of Workers’ Compensation (Ohio BWC) administrates Ohio workers’ compensation claims. If a dispute arises, the claim is set for a hearing which is adjudicated by the Industrial Commission of Ohio.
FILING A CLAIM:
Claims are filed on an FROI-1 form. (First Report of Occupational Injury form) The FROI form is filed at the Ohio BWC. The form can be downloaded from the Ohio BWC website. Once the claim is filed, the claim will be assigned a claim number. There are time limits on when a claim must be filed. Generally, a claim must be filed within two years from the date of injury. In an occupational disease claim the required filing date is more complicated and the advice of counsel is recommended to ensure the claim is timely filed.
NO FAULT SYSTEM:
Ohio’s workers’ compensation system is a no-fault system. This means that the fault, or negligence of the worker or the employer is not an issue in the allowance of the claim and the injured worker will be paid compensation and medical benefits regardless as to any party’s negligence. An exception to the no fault rule is that injuries resulting from horseplay, intoxication or injuries that are self-inflicted are not covered. As part of the no fault system, unless the employer “intentionally” injured the injured worker, the employer is immune from any other type of lawsuit and the injured worker’s sole means of recovery is the Ohio workers’ compensation claim. (See O.R.C. § 4123.74) Co-workers also have immunity and cannot be held liable for lawsuits resulting from the injury. (See O.R.C. § 4123.741)
STATE FUND AND SELF-INSURED EMPLOYERS:
Employers in Ohio can either be state-funded or self-insured. If the employer is state-funded, the workers’ compensation claim is managed by the Ohio BWC. The Ohio BWC makes the initial decisions regarding the allowance of claims and payment of compensation. Payments for lost time compensation are made to the injured worker by the Ohio BWC rather than the employer.
State fund employers also have managed care organizations that oversee the approval and payment of medical treatment and medical bills. Disputes regarding medical treatment are referred to the alternative dispute resolution program and later to the Ohio BWC and Industrial Commission if a disagreement remains.
If the claim is self-insured, it is managed by the self-insured employer or their representative. In self-insured claims, initial decisions to allow the claim, pay compensation, and approve medical treatment are made by the self-insured employer. The self-insured employer does not pay premiums to the Ohio BWC like a state fund employer. (although some assessment is paid) The self-insured employer makes payments of compensation directly to the injured worker. The self-insured employer manages approval and payment of treatment without a managed care organization. (see self-insured employer claim guide)
In either case, when there is a dispute, the issue is referred to the Industrial Commission of Ohio for a hearing.
If either party is dissatisfied with an Industrial Commission order regarding the allowance of the claim or any additional condition, an appeal can be filed into the Common Pleas court in the county where the injury occurred. Other issues are appealed by filing a mandamus action in the Tenth District Court in Franklin County. (See O.R.C. § 4123.512)