If you sustain a NEW INJURY at work, you should do the following:
- Notify your supervisor and submit a written incident report as soon as possible. If your employer does not issue a report form, or has not provided one to you, write down a description of your injury, copy it, and provide it to your boss and doctor.
- 2. Obtain medical treatment as soon as possible, and provide an accurate description of the injury to your doctor.
- Contact your lawyer if you have one.
Glossary of Terms
MANAGED CARE ORGANIZATIONS (MCO’s): These are corporations that oversee the payment of medical bills in a Workers’ Compensation claim. They are like insurance companies. All state fund claims are managed by MCO’s. All treatment requests must be approved by the MCO. The name of the MCO is listed on BWC claim identification cards. The physician of record must contact the MCO to obtain treatment authorization. If a treatment request is denied, the worker and/or the physician of records have the right to file an appeal. Most physicians who treat patients with Workers’ Compensation claims are familiar with the MCO appeals procedures.
CLAIMS PROCESSING: This is the system of evaluating a claim for approval, and/or payment. The BWC is a state agency that generally processes claims in a timely manner. However, delays will occur when information is not provided by the employer, the doctor, and/or the hospital. If the employer is contesting your claim, a hearing is normally required, and this will cause further delay. While this might not provide much consolation, it may help to know that many others are in your situation.
INDEPENDENT MEDICAL EXAMINATIONS: Both the employer and the BWC have the right to have a worker examined by a doctor of their choice at certain times. They can do this on a variety of questions concerning a claim. These are called Independent Medical Examinations (“IME’s”). If and when such an examination is set up, a worker should be sure to accurately and completely describe how the injury occurred and tell the examining doctor everything that is painful to them and hurts as a result of your work-related injury. Consult with your attorney before going to an IME. An injured worker should not exaggerate their symptoms as the doctor will pick-up on this easily.
TEMPORARY TOTAL DISABILITY (TT): Temporary Total Disability Compensation (TT), is paid to injured workers’ while they are off work due to their injury. By definition this benefit will not be paid indefinitely, it does stop. Either the worker stops it, or the government stops it for them. A worker can stop T.T. by submitting problematic paperwork in support of disability. Missing or incorrect information almost always causes delays, or termination of T.T. A worker can also stop T.T. by going back to work (to ther job of injury or another job), by settling the claim, or dying. The government stops T.T. by declaring the allowed conditions to have reached maximum medical improvement (“MMI”). Once the allowed conditions are determined to have reached a level of maximum medical improvement (MMI), compensation will stop, even if the worker has not been released to return to work or is still unable to return to work. The allowed conditions are considered to have reached MMI when they have reached a level where no significant additional improvement is expected.
PERMANENT TOTAL DISABILITY (PTD): This is the “grand-daddy” of all Workers’ Compensation benefits. It is a bi-weekly monetary benefit, much like T.T. but it is on a permanent basis. Basically the worker gets a check every 2 weeks for the rest of their life. Since this is such an expensive prospect for the government and the employer, it is not granted very often, and it is very hard to obtain. A worker basically has to prove that they can’t do any work for anyone, anywhere, anytime, forever, and it is based only on the medical conditions allowed in the claim. This is a tough thing to prove in this day and age.
WAGE LOSS COMPENSATION: An injured worker may be entitled to wage loss compensation under two circumstances: (1) if they have found work other than their former position and now receives less pay than they did at the time of the injury; (2) if they cannot find work within allowed medical restrictions. Wage loss compensation is only available for injuries occurring after August 22, 1986.
PERCENTAGE OF PERMANENT PARTIAL DISABILITY: The BWC pays this benefit, also known as a "C-92 award" as compensation for residual impairment that may result from a work-related injury. The BWC determines the percentage of permanent partial impairment based on the recommendation of an independent medical examiner. It is paid in a one-time lump-sum payment. It could be a couple hundred dollars, or a few thousand dollars, or it could be nothing. It all depends on the nature of the injury and the medical examination findings. Many injured workers doe not even know this benefit exists, and/or that they may be entitled to this money, even if they return to work. The issues surrounding this particular benefit are complex, and it would be very wise to consult with an attorney about this one.
PHYSICIAN OF RECORD: The Physician Of Record, or "POR" is the health care provider that is listed as the primary care-giver in your claim. It can be an M.D., a D.O. or a Chiropractor, but they serve as the "gate-keeper" for treatment issues. A worker can choose anyone of their own choosing to be POR, just as long as they accept Ohio Workers' Compensation. In doing so, they agree to abide by BWC Rules concerning paperwork, providing records, and payment issues. Many doctors in Ohio accept workers' compensation but sadly, the number is on the decline because of the very same paperwork and payment issues mentioned in this section.
For information on other types of compensation, visit ohiobw.com, or contact your local BWC employer services specialist.