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.
When an Injury Occurs
Follow your agency's policy on reporting incidents and injuries. Not adhering to agency reporting guidelines or policy may result in denial of employer provided benefits.
Obtain medical care promptly if emergency treatment is required, go immediately to the nearest emergency facility. Otherwise, your Managed Care Organization (MCO) can provide you with names of WILMAPC approved providers in your area who can assist you or visit das.ohio.gov/wilmapc.
Complete an Accident or Illness Report (ADM 4303).
Your agency will forward the completed Accident or Illness Report (ADM 4303) to your Managed Care Organization and the state’s Third Party Administrator.
The Managed Care Organization will file the initial claim information and medical documentation with the Ohio Bureau of Workers’ Compensation.
Your health care provider will forward all medical information regarding your claim to the Managed Care Organization who will contact you to gather additional information regarding your treatment, recovery and claim.
The Bureau of Workers' Compensation will send you a letter informing you of your claim number. This number is to be retained and referenced when contacting your agency, Bureau of Workers' Compensation, the third-party administrator, the managed care organization and your health care provider regarding your claim.
Shortly after you receive your claim number, the Bureau of Workers' Compensation will make an initial decision to allow/approve or disallow/deny your claim and will notify you in writing.
You may be eligible for a medical-only claim if you are unable to work for seven calendar days or less.
If your medical-only claim is approved, your managed care organization will pay your health care provider for authorized treatments that are directly related to your claim.
If your attending physician determines that your injury or illness will prevent you from working for eight or more calendar days, you may be eligible to receive lost time benefits through the Ohio Bureau of Workers’ Compensation.
If your claim is approved for lost time benefits, the Bureau of Workers' Compensation will begin paying benefits accordingly:
You cannot receive payment from the Bureau of Workers' Compensation for the same period you receive payment from your agency for Disability, Salary Continuation or Occupational Injury Leave benefits. If this occurs, you will be responsible for reimbursing your agency for the benefits you received.
If your claim is approved for lost time, you may receive temporary total compensation at 72 percent of your full weekly wages for up to 12 weeks.
If your injury or illness prevents you from working for more than 12 weeks, your temporary total compensation will be reduced to 66 2/3 percent of your average weekly wage.
These lost time payments are subject to a weekly maximum amount established by the Ohio Bureau of Workers' Compensation and are not taxable.
Should you require prescription medications relative to your work injury, the Ohio Bureau of Workers' Compensation contracts with a pharmacy benefit manager to process pharmacy benefits.
If you require a prescription but have not received your claim number from the Ohio Bureau of Workers' Compensation, 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 pharmacy benefit manager to reimburse you for your out-of-pocket expenses.