About Workers’ Comp

The Workers’ Compensation System







The Ohio Workers’ Compensation system is made up of two branches – the Bureau of Workers’ Compensation (BWC), the administrative branch; and the Industrial Commission of Ohio (IC), the claims adjudicative branch. The BWC handles the daily processing of claims, and makes payments as appropriate. It monitors medical treatment, disability and return to work issues, and “medically manages” the claims with the help of outside companies called Managed Care Organizations (or “MCO’s” for short)

 


The Bureau of Workers' Compensation (BWC)

The BWC is the State Agency which has provided injured workers with compensation for work-related injuries, diseases and deaths since 1912. It maintains a central office in Columbus and customer service offices located throughout the state. The BWC manages all claims, initiates workers’ comp insurance coverage, and determines premium rates and manual classifications concerning coverage. The BWC also collects premiums from employers, determines the initial allowance or denial on claim applications, disburses money to pay compensation and manages the state insurance fund.

In addition, the BWC’s Division of Safety & Hygiene performs research to prevent industrial accidents and diseases, and offers employers and their employees safety training and accident-prevention programs.

The BWC Rehab Division and Preferred Rehab Network offer occupational rehabilitation, case-management, and re-employment services to aid injured employees return to work after a job-related injury. The program is strictly voluntary and there is no cost to the disabled worker enrolled in an approved rehabilitation program.

A governor-appointed administrator/chief executive officer and a nine-member Oversight Commission manage the BWC. Of the five voting members, two represent business, two represent workers and one represents the public. Four legislative non-voting members round out the Commission.

Ohio law requires employers with one or more employees to obtain Workers’ Compensation coverage or be granted the privilege of self-insurance for liabilities associated with work-related accidents or occupational diseases.

Employers pay the entire cost of Workers’ Compensation. They are not permitted to “pass on” the costs of their premiums to their employees by charging them, or taking it out of their paychecks. Employers may not exclude employees from benefits based on age, citizenship, gender, race or relationship. According to the law, employees are covered by workers' comp when they receive pay from employers for services performed and when the relationship between the employer and employee is created by a contract of hire – written, oral, expressed, or implied.

The BWC considers corporate officers employees for the purpose of Workers’ Compensation. Corporate offices must report their pay to a maximum limit set each year by Ohio Law. The BWC can change the maximum reportable salary yearly. Domestic workers who earn more than a certain amount set by the BWC or more from one employer during the calendar quarter, also are considered employees for the purpose of Workers’ Compensation. The law also requires independent contractors and subcontractors to carry Workers’ Compensation insurance for their employees. See your local BWC service office for further details as these rules do change frequently.

Workers’ Compensation coverage is optional for ministers, officers of corporations, or family farm corporations, and sole proprietors and partners. All other employees must have coverage.

The Claims Process: top


Immediately after a workplace injury, there are four things an injured worker should do the following:

  1. Seek medical attention.
  2. Tell the employer he or she has been injured. Complete a written accident report if one is available. If not, write down the description of the injury, copy it, and give it to the employer.
  3. Tell the doctor or emergency room the name of the employer’s Managed Care Organization, ("MCO") at the time of service. They will need this information to file the employee’s claim within 24 hours of treatment (and must do so under Ohio law). If the name of the MCO is not known, the health care provider can obtain it from the BWC or the employer.
  4. Ask the doctor or emergency room to file the claim with the MCO, and the BWC. The injured worker’s doctor is required to file the claim with the MCO within 24 hours.

 

MCO’s provide many Ohio employers with MCO identification cards. Employers should distribute these cards to their employees. Note, however, that while these cards do provide some helpful information for identification and other purposes, they are not, in and of themselves, proof of an approved claim, or insurance coverage. These cards only provide information to submit a request for payment for services, which could still be declined. So if you get an ID card from the employer, the MCO, or the BWC itself your are not “in the clear” yet.

Injured workers can assist the MCO with collecting information from his or her health-care provider and the employer. This will speed up the claims decision and payment to him or her. Quickly responding to any inquiries from the BWC or the MCO can help keep the claims process moving.

After obtaining information and investigating the facts within the time period set forth by Ohio Law, the BWC will then issue its decision to allow or deny the claim, based in large part, whether or not the employer has certified or rejected the claim. Decisions of the BWC as to the initial allowance or denial of a claim are set forth in a determination called the “BWC Order.” This is a white-colored, letter-sized priece of paper with the words “BWC Order" emblazoned diagonally on the paper itself. Under Ohio Law, within 28 days of getting notice of an injury, the BWC must determine whether or not the injured worker has a valid claim.

If the injured worker or employer disagree with the decision, either party may file an appeal with the IC within 14 days of receipt of the BWC Order. For more information about the appeals process, see IC Hearings and Appeals link on this web-site, log on to the I.C.’s web-site at OhioIC.com, or call the IC at 1-800-521-2691 or 614-466-6136.

The BWC pays compensation on allowed claims either after the 14-day appeal period expires or sooner if the employer certified the claim, or both parties waive the appeal period. This is rare, however, and a waiat is the norm.

If the BWC allows the claim, the MCO will reimburse the injured worker or their provider for medical expenses. The MCO will only pay for medical services directly related to an allowed workplace injury or occupational disease. Accordingly, in order to be paid for its services, a provider must establish to the satisfaction of the MCO, that the services are medically necessary, and are the direct and proximate result of the work place injury, or the medical conditions for which the claim has been allowed.

If an injured worker cannot return to work for eight or more days, the BWC will pay a percent of lost wages. The amount of compensation paid each week ranges from 72% to 66% depending on the length of time off work. The first 12 weeks of disability are paid at 72% of the “full weekly wage” which is the average of 6-weeks of wages prior to the date of injury. From the 13th week onward, workers are paid at 66% of the average weekly wage, which is an averaging of all of the wages for the year prior to the date of injury. Thus is it always a good idea to hang on to your pay-check stubs, or keep wage/tax information handy if you are injured. You will eventually need it.

After the BWC approves the claim, it reports subsequent payments to the employer. Employers should review these payments carefully and contact the local BWC customer service office with any questions. Claim pay-outs do have an affect on an employer's premium rates, and it operates much like car insurance. If a person has a lot of speeding tickets or accidents, their car insurance rates will go up. Similarly, workers' comp claim pay-outs for medical treatmentor disbility compensation will often result in an increase in the employer's workers' comp insurance premiums.

After an injured worker has received compensation payments for 90 consecutive days or more, the BWC will schedule a medical examination with an independent, BWC-certified physician to evaluate progress. This examination ensures the injured worker is getting the proper treatment, determines whether they can return to work, and rehabilitation potential. For further information on what to expect in a BWC medical examination, see the link marked as such on this web-site.

The BWC and employer both have an interest in returning the injured worker to work as soon as possible. In doing so they may offer services under the BWC's rehabilitation Division. These services will help the worker make a safe return to work, and the MCO will help. The MCO will provide the assistance of vocational rehabilitation professionals who understand work injuries and the type of work the worker does. For example, the worker may receive services that let them use tools and equipment to increase their ability to do the job. If the worker is changing jobs, the MCO may provide them with help in writing a resume, interviewing skills, or job leads.

Industrial Commission (IC) top

The Ohio Industrial Commission (the "IC") hears and decides contested claims and determines permanent total disability. The Governor appoints the three-member Industrial Commission itself and the Ohio Senate confirms it. One member represents labor, one represents industry and one represents the public. The Commissioners set hearing policy, and the rules/regulations on how contested claims are decided. The Commissioners also conduct Third-level administrative hearings in certain instances.

The Industrial Commissioners in turn select and appoint Hearing Officers (the Judges on workers’ comp claims) who conduct first and second-level hearings. The District Hearing Officer ("DHO") conducts first-level hearings, and the Staff Hearing Officer ("SHO") presides over second-level hearings. There are nearly 100 hearing officers assigned to local offices throughout the State of Ohio.

 

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Main Office: 545 Helke Road, Vandalia, Ohio 45377 | Phone: (937) 264-1122 | Fax: (937) 264-0888
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