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)

Maximum medical improvement

The BWC has the authority to make initial determinations on all claim actions, including determining whether to continue or terminate temporary total compensation based on evidence of maximum medical improvement (MMI). As mentioned elsewhere in this site, Temporary Total Disability is just that, TEMPORARY, it does stop. Either a worker stops it, or the government stops it for them. The main was that the government stops this benefit is by declaring the allowed conditions in a claim to have reached maximum medical improvement. This is a bad thing for an injured worker, and a good thing for an employer. MMI is bad for the worker because it means the end of their weekly disability payments. It is good for the employer because claim costs will go down significantly when disability payments cease. MMI can be reached as early as 90 days from the date of injury, or as late as "never" (that is, an injury may never be deemed MMI because of a return back to work, settlemetn of a claim, or the ultimate denial of a claim).

MMI occurs when an individual’s medical condition has stabilized to the point that no fundamental functional or physiological change can be expected in the condition, despite continued medical treatment and/or rehabilitation. This means your medical condition is not going to get any better and you are “as good as you’re going to get” when it comes to recovering from your work injury.

So how are the benefits actually "terminated". The BWC (or self-insured employer) are limited to unilaterally terminating temporary total disability benefits only in instances where there is no contradicting medical evidence that the injured worker has reached MMI. This is usually when the injured worker’s own doctor finds that all of the allowed conditions have reached MMI. The treating doctor must state so in writing, and provide an effective date as to when MMI has been reached. In all other situations, the BWC schedules the worker for an Independent Medical Examination (an "IME") by a BWC-paid doctor. Almost always the doctor finds that the conditions in the claim have reached MMI. The BWC then refers the claim to the Industrial Commission for determination of MMI through an administrative hearing. In self-insured employer claims, the doctor examination is set up by the employer rather than the BWC, but the same procedures are followed.

If the Inudstrial Commission decides an injured worker has reached MMI, Temporary total Disability benefits will be ordered terminated usually as of the date of the first hearing on the issue. Although MMI means that temporary total disability will be terminated, a worker may still be entitled to other forms of Workers’ Compensation benefits.