Ohio Workers’ Compensation Guide

Ohio Workers' Compensation Guide

• Administrative Agencies
• Type of Employer
• Type of Claim
• Filing a Claim
• Hearings and Appeals
• Compensation and Benefits
• The Law
• Forms
• The Ombuds System
• Additional Information

Administrative Agencies

What agencies administer the workers' compensation system and what do they do?

Two administrative agencies run the Ohio workers' compensation system: the Ohio Bureau of Workers' Compensation and the Ohio Industrial Commission.

The Ohio Bureau of Workers' Compensation handles the administrative functions of the Ohio workers' compensation system. The BWC has limited decision making powers, mainly related to the initial allowance of a claim. The BWC handles the processing of claims and the payment of money. An administrator, appointed by the Governor, heads the BWC.

The Industrial Commission handles the majority of the decision-making functions in the workers'  compensation system. The Industrial Commission makes decisions about contested issues.

The Industrial Commission has three levels of decision-making: District Hearing Officers (DHO), Staff Hearing Officers (SHO), and a three member board called the Industrial Commission. The three-member Industrial Commission also sets policy for the Commission.

Any party unsatisfied with a decision can appeal. Appeals from a DHO go to an SHO. Appeals from an SHO go to the three-member Industrial Commission, but the three-member Commission has discretion whether to take such appeals and hears very few appeals.

Type of Employer

What different types of employers exist? How does the type of employer affect a workers'  compensation claim?

Two different types of employer exist in the Ohio workers' compensation system: state fund employers and self-insured employers. Although an injured worker should receive the same compensation and benefits regardless of the type of employer, the way the system works differs.

State fund employers participate in the state insurance fund. They pay a premium, and do not pay workers' compensation benefits directly. The state insurance fund pays workers' compensation benefits for state fund employers.

The BWC processes state fund claims. An injured worker who has a state fund employer cannot receive payment without a Bureau or Commission order.

Self-insured employers do not pay premiums. They pay all compensation and benefits directly to the injured worker.

Because self-insurers pay compensation directly, they can pay compensation or benefits directly, without any order. Self-insurers make the initial decision on whether or not to pay a claim.

If the self-insurer chooses not to pay, then the issue can be contested through the hearings process. To get a hearing you must file a motion after the self-insurer refuses payment.

Another difference between state fund and self-insurers involves the application of the managed care medical system, for payment of benefits. This is explained in our Guide to Ohio Workers' Compensation Medical Benefits.

Type of Claim

What are the different types of workers' compensation claimst?

The type of claim depends on what happened to the worker.

An injured worker may have an injury claim. R.C. 4123.01(C) defines injury as

Any injury, whether caused by external accidental means or accidental in character and result, received in the course of, and arising out of, the injured employee's employment.

Injury has a very broad definition. The definition does not require a specific incident or event. An injured worker can also receive workers' compensation for a gradually developing injury, an injury which has occurred over a period of time.

An injured worker may have an occupational disease claim if they have a disease which either satisfies the R.C. 4123.01(F) occupational disease definition or meets the requirements of the R.C. 4123.68 occupational disease schedule.

If a worker died due to their employment, eligible dependents may have an R.C. 4123.59 death claim.

Filing a Claim

What does an injured worker file to receive Ohio workers' compensation benefits?

An injured worker must file a workers' compensation claim to receive Ohio workers' compensation benefits. The injured worker must ensure that a claim has been filed. Use the FROI-1 form to file an initial workers' compensation claim. Many claims are electronically filed by the managed care organization, when an injured worker seeks medical treatment.

The BWC will send a claim number once it receives a claim. Make sure that the claim number is a BWC claim number. BWC claim numbers currently begin with the last two digits of the year of injury (for example, an 2010 injury claim would begin "10-"). If you have not received a BWC claim number for your claim, check with the BWC to ensure that they have received the claim.

The claim number identifies the claim. Put the claim number on all documents filed with the BWC or Industrial Commission.

You must file the workers' compensation within before the time limit expires or the claim will be forever barred. Because the issue of time limits is important and potentially confusing, if you have a specific question about the time limits for filing a claim, you should contact an attorney.

Hearings and Appeals

What happens when the employer or BWC contest an issue?

The Industrial Commission holds hearings on disputed claims issues.

The Bureau of Workers' Compensation makes the initial decision in state fund claims. Sometimes the BWC refers an issue to the Industrial Commission for a hearing without making a decision. In self-insured employer claims, the self-insurer makes the initial decision.

Any party can appeal an unfavorable decision.  For most matters, a District Hearing Officer (DHO) holds the initial hearing. The next hearing level, the Staff Hearing Officer, hears appeals from DHO orders.  The final level of administrative hearings involves a discretionary appeal from the SHO to the Industrial Commission.

Note that  strict time deadlines apply to filing appeals. If you miss the time limit for filing an appeal you will lose the right to appeal.

Compensation and Benefits

What types of compensation and benefits can an injured worker receive?

The amount of workers' compensation benefits paid in a claim depends on the type of compensation being paid and the year of injury. Our rates chart lists maximum and minimum amounts of compensation for injuries from the year 1987 to the present.

The most basic types of workers' compensation benefits are:

• medical benefits;
• temporary total compensation;
• wage loss compensation;
• permanent partial compensation;
• permanent total compensation; and
• violation of the specific safety requirement (VSSR) award.

The Law

What law governs the Ohio workers' compensation system?

Ohio Constitution Article II, Section 35 provides for Ohio's workers' compensation system.

Ohio Revised Code, Chapters 4121 and 4123 contain the statutes which govern the Ohio workers' compensation system. Ohio Administrative Code, Chapters 4121, 4123 and 4125 contain rules the BWC and Industrial Commission adopted which further govern the system.

Court decisions on workers' compensation cases apply the law and may may affect whether an injured worker receives benefits. Our case index has summaries of Ohio workers' compensation decisions.

Forms

What forms do I need to file? What do these forms do?

Although much information is now filed electronically, the Ohio workers' compensation system still uses forms to gather information. You can view forms on the BWC or the Industrial Commission web site.  You can fill out some forms on-line.

Tips:

1. Always put your claim number in the upper right hand corner of every page of the form (or any other document you file), before filing.
2. Have an extra copy of the form time-stamped and keep the copy for your records so you have proof that you filed the form.  If you file a form electronically keep a copy of the receipt.
3. If you want to highlight information, circle it or draw an arrow.  Don't use a highlighter, because it may make the information appear as a black line when the BWC scans the document.

The Ombuds System

Can anyone in the system help me with my claim?

The ombuds system is designed to cut through red tape in the Ohio workers' compensation system and help injured workers. An injured worker having trouble with the workers' compensation system can contact the Ombudsperson by calling (800) 335-0996, or emailing [email protected].

Additional Information

For additional information about Ohio workers' compensation, see:

• Common Ohio workers' compensation terms;
• Ohio Workers' Compensation basics; or
• History of Ohio workers' compensation timeline.