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Workers' compensation (or work-related disability) is a ‘no-fault’ system that compensates employees for work-related injuries or illnesses. Benefits are limited to wage loss, medical and rehabilitation expenses and are payable as long as the disability lasts or medical treatment is reasonably necessary. Workers’ compensation provisions can be found in the Ohio Constitution Article II, Section 35; Ohio Revised Code Chapters 4121 and 4123; and Ohio Administrative Code Chapters 4121, 4123 and 4125

Legal Components

When an Injury Occurs

Claim Processing

Hearing Process

Employer-Provided Benefits

Returning to Work

Partners in Workers’ Compensation

Legal Components

When an Injury Occurs

  • Reporting: Follow your agency's policy on reporting incidents and injuries. Not adhering to agency reporting guidelines/policy may result in denial of benefits.
  • Obtain medical care promptly. Beginning February 1, 2010, your agency or Managed Care Organization (MCO) can provide you with names of Approved Providers in your area who can assist. If emergency treatment is required, go immediately to the nearest emergency facility.
  • Complete an Accident or Illness Report (ADM 4303). 

Claim Processing

  • Your agency will forward the completed Accident or Illness Report (ADM 4303) to your Managed Care Organization (MCO).
  • The TPA will be informed of all information and will keep records regarding your claim, and will file the claim with the Bureau of Workers’ Compensation (BWC).  
  • Your health care provider will forward all medical information to your MCO; your MCO may contact you to gather additional information regarding your claim.
  • The state's third party administrator (TPA) will review all the information received from your MCO and contact your employing agency regarding (certification of rejection) of your claim. Note: Some agencies process their own workers’ compensation claims; you should contact your personnel officer for more information.
  • The MCO will file the initial claim information and medical documentation with the Bureau of Workers’ Compensation (BWC).
  • The BWC will send you a letter informing you of your claim number. This number is to be retained and referenced when contacting your agency, BWC, the TPA, the MCO and your health care provider regarding your claim.
  • Shortly after you receive your claim number, the BWC will make an initial decision to allow or disallow your claim and will notify you.

Claim Approval: Medical-Only Claims

  • You may be eligible for a medical-only claim if you are unable to work for seven days or less.
  • If your medical-only claim is approved, your MCO will pay your health care provider for authorized treatments that are directly related to your claim.

Lost Time Claims

  • If your attending physician determines that your injury or illness will prevent you from working for eight or more consecutive days, you may be eligible to receive lost time benefits.
  • If your claim is approved for lost time benefits, the BWC will begin paying benefits:
    • On the eighth day, if you are off work from eight to 14 days; or
    • From the first day, if you are off work for 15 or more consecutive days;
    • BWC will pay you directly by electronic deposit to you bank account. If you do not have an account, you will receive a debit card that will permit access to benefits.
  • If you are paid by the BWC for the same period you were paid by your agency, you are responsible for reimbursing your agency for the benefit they paid.

Temporary Total Compensation

  • If your claim is approved for lost time, you may receive temporary total compensation at 72 percent of your weekly wages for up to 12 weeks (Note that the weekly wage you receive is subject to a maximum established by the BWC).
  • If your injury or illness prevents you from working for more than 12 weeks, your temporary total compensation will be reduced to two-thirds of your weekly wages, or 66 2/3%.
  • Lost time checks are subject to a weekly maximum amount and are not taxable.

Prescription Medications

  • Should you require prescription medications relative to your work injury, the BWC contracts with a pharmacy benefit manager (PBM) to process pharmacy benefits.
  • You must provide your BWC claim number, your Social Security Number and your date of injury so that your pharmacist can bill the PBM for the cost of your prescriptions.
  • If you require a prescription but have not received your claim number from the BWC, you may be required to pay your pharmacy for the cost of the prescription. Once you receive your claim number, give it to your pharmacy, which will then ask the PBM to reimburse you for your out-of-pocket expenses.

Claim Denial

  • If any party (you or your agency) disagrees with the decision of the BWC on your workers’ compensation claim, an appeal may be filed with the Industrial Commission.
  • All appeals must be made in writing and must be filed within 14 calendar days of the date of receipt of the order issued by the BWC. The order will inform you of your appeal rights. If you have questions regarding appeal rights, you can contact the BWC at 1-800-OHIO-BWC.

Hearing Process

There are three levels in the appeal process, which include the district officer level, the staff hearing officer level and the commission level.

If you disagree with a decision during the hearing process, you may appeal your claim to the next level, in the following order:

  • District Hearing Officer
  • Staff Hearing Officer
  • Industrial Commission
  • Common Pleas Court

You may represent yourself, or you may be represented by an attorney. For more detailed information, please visit https://www.ohioic.com/appeals/appeals.html or click here (https://www.ohiobwc.com/downloads/blankpdf/hearpro.pdf) for information from the Ohio BWC.

Employer-Provided Benefits

Salary Continuation

  • Provides the injured employee with 100 percent of his/her regular rate of pay in lieu of workers’ compensation temporary total benefits.
  • Benefits are not to exceed 480 hours.
  • Once salary continuation benefits are exhausted, you may be eligible to receive lost time benefits from the Bureau of Workers’ Compensation (BWC). You and your attending physician will need to file a Request for Temporary Total Compensation (Form C-84).
  • Payments for salary continuation are included in your bi-weekly pay.
  • Filing a Claim

Occupational Injury Leave

  • Provides the injured employee with 100 percent of his/her regular rate of pay in lieu of workers’ compensation benefits.
  • Available to employees who are injured in the line of duty as a result of a bodily injury sustained by an inmate, client, patient, resident, youth or student, and is limited to specific agencies. You may refer to the Ohio Revised Code, the Ohio Administrative Code or your union contract for specific information.
  • Benefits are limited to a maximum number of hours determined by your bargaining unit, or for non-bargaining unit employees, 960 hours.
  • If your occupational injury leave benefits are exhausted, you may be eligible to receive lost time benefits from the Bureau of Workers' Compensation (BWC). You and your attending physician will need to file a Request for Temporary Total Compensation (Form C-84).
  • Bargaining unit employees may appeal a denied OIL decision claim and should refer to the appeal procedure in the union contract.
  • Appeals should be sent to the Office of Collective Bargaining within 20 days of the denial.
  • Non-bargaining unit employees do not have grievance rights. They may appeal a denied OIL decision using the appeal form, however, the decision by DAS Benefits is final. The appeal should be sent to the Office of Collective Bargaining.
  • Payments for occupational injury leave are included in your bi-weekly pay.

    Filing a Claim

  • You must file an Accident or Illness Report, ADM 4303 and check the benefit being requested.
  • Note that there are submission deadlines; non-bargaining unit employees have 20 days, bargaining unit employees should refer to their bargaining contract.
  • If there is not enough information to approve your claim, you may be asked for additional information either by your agency or the third party administrator. This information should be submitted to your personnel officer.

Disability Advancement

  • Available only if the BWC denies your claim for workers’ compensation benefits and you are appealing the decision. If you do not intend to appeal, you may file for disability benefits within 20 days of the denial order.
  • To file for disability advancement, complete the disability application and submit it and your denial order to your personnel office within 20 days of notification of denial.
  • Payments are subject to the same two-week waiting period as disability leave benefits.
  • You may receive the advancement for a maximum of 12 weeks.
  • If your workers’ compensation claim is approved through the appeal process or by a settlement, you will be required to pay back all of the money that has been advanced, regardless of the amount received from the BWC or the settlement.

Leave Buy Back

  • Some bargaining unit employees have the option of buying back leave time that was used while waiting for a workers’ compensation claim to be approved. See your bargaining unit contract to determine your eligibility.
  • A wage advancement agreement is a contract between you and your employer that states the amount of leave time that you will buy back.
  • You may buy leave time back either with or without a wage advancement agreement.

With a Wage Advancement Agreement

If you complete an agreement, you will be permitted to use your leave time (including sick leave) while waiting for your workers’ compensation claim to be approved. Under this agreement, you must use your BWC payments to buy back the leave up to the amount you receive from the BWC. The maximum amount of time that you can buy back is 12 weeks.

Without a Wage Advancement Agreement

If you do not file a wage advancement agreement, you may use leave time while you are waiting for your workers’ compensation claim to be approved; however, the BWC will not pay over any period in which you used sick leave to receive wages. Buy backs include vacation, personal and compensatory time and are limited to a maximum of 12 weeks.

Returning to Work

Step Increases and Leave Restoration
When you return to work from a disabling illness or injury, you may be eligible for a pay increase and/or restoration of your leave balances. Vacation leave, however, is not restored. Refer to your bargaining unit contract for more information, or ask your personnel officer.

Transitional Work
If you have been off work due to a workers’ compensation claim and still have temporary work restrictions, the state may provide you with a program to help you transition back to work. Transitional work provides injured employees with the opportunity to resume employment as soon as possible following a job-related injury or illness.

In many cases, the resumption of work will require some form of job modification. The modifications are based on medical restrictions provided by the employee’s medical provider which are directly attributable to the injury or illness. Most job modifications will be temporary in nature and will be handled on its own merits. Any accommodation made will be temporary and will be monitored periodically with the goal of assisting the employee to resume his or her regular assignment as soon as medically possible.

  • Pay

While participating in a transitional work program, you will receive your normal pay for the hours you work. You may be eligible to receive OIL, salary continuation, or workers’ compensation benefits for the time you are not working.

  • Duration

Most state agencies have developed their own transitional work program, which is typically approved for 30 days, but may be extended based on your attending physician’s recommendation. Most programs do not exceed 90 days. Your agency personnel officer will assist you with specific requirements.

Partners in Workers' Compensation

Bureau of Workers' Compensation 1.800.OHIO.BWC
Industrial Commission 1.800.521.2691
CompManagement, a Sedgwick CMS Company, Third Party Administrator 1.800.825.6755
CompManagement Health Systems, Managed Care Organization 1.888.268.4369
CareWorks, Managed Care Organization 1.888.627.7586


 

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