FAQ about the BWC
The second thing you should do is seek immediate medical attention to document your history of injury and to obtain a diagnosis of the injury sustained. Make sure that you tell all medical personnel that you hurt yourself on the job and describe the incident and every body you injured. If you omit any body part and later need to add it to your claim, you will have a difficult time. If your employer does not direct you to a medical provider you should proceed to the nearest urgent care facility or a hospital ER.
The third thing you should do is contact Gruhin & Gruhin for legal assistance.
As long is your injury is related in some way to the performance of your job, you should be covered by the OhioBWC. You may even be covered if you were injured while traveling for business, running an errand for your place of employment, or even if you were injured at a job-related social event.
Workers’ Compensation provides for replacement of income, payment of medical costs, and sometimes will provide assistance for job placement if vocational rehabilitation is required after recovery from an injury.
Employers and the Bureau of Workers’ Compensation are in a much better position than the injured worker to evaluate the economic value of a claim settlement and will always negotiate to their own advantage. Also, the OhioBWC now sends settlement inquiry letters to all injured workers in order to close out claims to save money. Don’t settle your claim without seeking legal advice. You need to be on an even playing field or you will wind up a loser!
What if my employer tells me not to file a Workers’ Compensation claim or threatens to fire me if I do?
If you were injured on the job but someone else is liable you may be able to collect Workers’ Comp benefits and sue the party responsible for your injury. An attorney who specializes in the field of Workers’ Compensation should be consulted to better understand your rights.
With the representation of a certified specialist, you can be assured that your OhioBWC claim benefits will be maximized.
Don’t wait until a contested issue arises! Get the right advice from the ‘Get-Go’. Gruhin & Gruhin works on a contingency basis. That means that we don’t get paid unless you receive your benefits. once Gruhin & Gruhin gets your claim on the right path, we do not charge any attorney fee on your continuing temporary total disability benefits, unless they stop and we need to file motions or attend hearings to get the benefits started again.
If I was receiving Workers’ Compensation benefits and I return to work are there any Workers’ Compensation benefits I am still entitled to?
When an Injured Worker returns to work with restirctions, whether it is the job on which the injury took place or a return to a new job, and receives wages lower than the Average Weekly Wage set by the OhioBWC, wage loss compensation may be paid. Again, as with all compensation, it must be requested.
A provision in the Ohio Constitution provides that an employee who is injured in the course of his/her employment can request a VSSR award, which is a penalty levied against an employer if it is found that the worker’s injury occurred because of the employer’s violation of some specific safety requirement. These safety requirements are typically found in the Ohio Administrative Code. Some of the cited provisions, among others pertain to overhead protection, safety belts and lifelines, personal protective gear, punch presses, cranes, protective railings on scaffolds, etc.
An injured worker may be entitled to an additional award if the employer violates a specific safety requirement (VSSR) enacted for the protection of the life, health or safety of employees. Article II, Section 35 of the Constitution of the State of Ohio provides the legal authority for the Industrial Commission of Ohio to grant an additional VSSR award.
A VSSR award is in addition to other forms of compensation and is considered to be a ‘penalty’ assessed against the employer. A VSSR award is paid in addition to and concurrently with any other compensation the Injured Worker obtains.
The Industrial Commission has discretion to determine the amount of the award, but the award may not be greater than 50% nor less than 15% of the maximum award established by law for the year of injury.
Should the Injured Worker wish to file the additional violation penalty action against the Employer, Gruhin & Gruhin actively prusues VSSR actions in all applicable claim situations.
If you are employed where you believe you are exposed to dangerous working conditions, you can file a request for investigation with the State of Ohio. However, this is a procedure you should pursue with an experienced workers’ compensation attorney.
Additionally, in a Violation situation, the injured worker should contact OSHA to file a complaint and seek an investigation.
OSHA Complaint Filing Options
You have these options to file your safety and health complaint:
- Online - Go to the Online Complaint Form Written complaints that are signed by workers or their representative and submitted to an OSHA Area or Regional office are more likely to result in onsite OSHA inspections. Complaints received on line from workers in OSHA-approved state plan states will be forwarded to the appropriate state plan for response.
- Download and Fax/Mail - Download the OSHA complaint form* [En Espanol*] (or request a copy from your local OSHA Regional or Area Office), complete it and then fax or mail it back to your local OSHA Regional or Area Office. Written complaints that are signed by a worker or representative and submitted to the closest OSHA Area Office are more likely to result in onsite OSHA inspections. Please include your name, address and telephone number so we can contact you to follow up. This information is confidential.
- Telephone - your local OSHA Regional or Area Office. OSHA staff can discuss your complaint and respond to any questions you have. If there is an emergency or the hazard is immediately life-threatening, call your local OSHA Regional or Area Office or 1-800-321-OSHA.
In order to make sure that your therpay and diagnostic testing is allowed, your physician of records must submit a request for prior authorization to the BWC Medical Care Organization (MCO) on a BWC Form called a C-9 . You should not get the treatment until you know the treatment or diagnostic testing has been approved. You can call your MCO to find out if the mediacl treatment is approved. Find out which MCO is responsible for your BWC claim here.
Some Ohio employers are self-insured. In claims involving a self-insured employer, the request for authorization must be filed first with the employer.
In instances where the MCO or the Self Insured Employer deny the request for authorization, you must file an appeal to the OhioBWC. That will start the administrative appeal process. You will need to obtain medical information from the requesting doctor to support the request for the treatment which has been denied. The appeal issue will then be referred to the Bureau of Workers’ Compensation and the Industrial Commission, where a hearing on the appeal will take place.
If the employer participates in the BWC’s state insurance fund, requests for treatment must be submitted to the employer’s managed care organization (MCO). The The same is true of the Self-Insured Employer, which has its own MCO.
The MCO assigned to your claim is responsible for determining whether the requested treatment initially will be approved or denied. Appeals from the MCO’s initial denial are filed with the BWC for further evaluation. Should the BWC uphold the denial, the Injured Worker must appeal that denial to the Industrial Commission for hearing on the merits.
ICD-9 Codes and How They Affect Your Claim
ICD-9 Codes are three, four or five-digit numeric codes that represents a uniform, international classification system of coding disease and injury diagnoses and are used to report allowed, non-allowed or disallowed/denied conditions. ICD-9 is an acronym for International Classification of Diseases, 9th Revision. ICD-9 coding is a statistical classification system that arranges diseases and injuries into code categories according to established criteria. For example, an injury such as a broken arm could be classified and coded as follows: fractured radius, 813.81 Using the broken arm example; the left, right, or bilateral (both) arms would be identified. In addition, an injury site may also be listed if necessary. Site locations apply to injuries to the fingers, teeth, and toes.
How does BWC use ICD-9 codes?
Since ICD-9 codes identify the type and nature of the injury sustained, they are also used to determine what medical treatment is appropriate for an injured worker. For example, if a claim were allowed for a torn medial meniscus, a serious knee injury, surgery would likely be an appropriate type of treatment. However, if the claim were allowed for a sprained knee, a less serious injury, surgical intervention would not be appropriate and authorization would not be granted.
In addition, when medical providers bill BWC for services, the ICD-9 code is listed on the billing forms. All bills that are submitted are reviewed to determine if the medical provider is treating the allowed injuries in the claim. If bills are submitted for injuries that are allowed within the claim they will be paid. If bills are submitted for injuries that are not allowed within the claim the bill will be denied.
What is an invalid ICD-9 code?
BWC has defined the following information as an invalid ICD-9 code:
- A code for an injury/condition that is not causally related to an industrial injury or occupational disease;
- The proper application of coding principles (Code assignment requires the highest level of specificity, i.e., must assign the maximum number of digits for a code.) BWC has identified all three and four digit codes that require a fourth and fifth digits respectively;
- An unspecified injury/condition or site code therefore a more specific code exists;
- A symptom code;
- A multiple injury/site code. Reported injury/condition with more than one injury/site are assigned individual codes for each.
Subrogation may apply where the injured worker has a “third party action” as a result of the injury.
A “third party action” exists when a worker suffers an injury in the course of their employment which gives them a right to workers’ compensation benefits and also gives them a right to sue a third party for a personal injury, in addition to the workers’ compensation claim. The personal injury claim is referred to as the “third-party action”.
Subrogation means that the Bureau of Workers’ Compensation or Self-Insured Employer is entitled to seek reimbursement from the “third party action” against any workers’ compensation benefits paid to the injured worker. In Ohio, the State Legislature has determined that there should be no “double” recovery and therefore permits the BWC claim to be subrogated to the “third party action”.
The concern employers have faced is when do they have to file a subrogation claim. Recently, in Corn v. Whitmere, the 2nd App. Dist. Ct. determined an employer is not bound by the two-year statute of limitations of R.C. 4123.931(H), but rather by the six-year statute of limitations for oral contracts and actions arising upon a liability created by statute. The result is that self-insured employers no longer have to file their own cases against tortfeasors within the two-year statute of limitations and no longer must coordinate with the employee’s counsel to ensure that the employer is added as a party to the lawsuit.
Practically speaking, R.C. 4123.931(G) requires a claimant to notify a self-insured employer of the identity of all third parties against whom the claimant has or may have a right of recovery. No settlement, compromise, judgment, award, or other recovery in any action or claim by a claimant is final unless the claimant provides the self-insured employer with prior notice and a reasonable opportunity to assert its subrogation rights. If a self-insured employer is not given notice, or if a settlement or compromise excludes any amount paid by the self-insured employer, the third party and the claimant shall be jointly and severally liable to pay the self-insured employer the full amount of the subrogation interest.
However, on January 14, 2011, the Ohio Sixth Appellate Division issued a decision in the case of State of Ohio Bureau of Workers’ Compensation v. Dernier, Court of Appeals No: L-10-1126, in which it held that a 3rd party tort claim which is settled before the filing of an Ohio Workers’ Compensation claim is not subject to subrogation by the OhioBWC (which would also be the same if the injured worker was employed by a self-insured employer).So, if it is at all possible, should you be the victim of a 3rd party negligence action while you were on the job, you should seek settlement of the 3rd party tort claim prior to filing a claim for OhioBWC benefits.
There are time limits, so you should consult with a Board Certified Ohio Workers’ Compensation Specialist Attorney before you say or do the wrong thing. Mike Gruhin is a Board Certified Ohio BWC Specialist Attorney. Call now for a free, no obligation consultation. Have your Ohio Workers’ Compensation Claim questions answered by n OhioBWC specialist lawyer.
Often, errors are made in the calculation of your AWW. It is important to make certain your rate is properly calculated because you are paid 2/3 of your AWW from the 13th week and onward while you are unable to work (as certified by your doctor of record for allowed conditions). If your rate is wrong, your compensations payments will also be incorrect.
There is a simple formula to calculate the AWW but in many instances certain statutory exceptions may apply.
For example, if you were unable to work a full 52 weeks prior to your injury due to illness, layoff, or other reasons beyond your control, you may be entitled to a higher AWW. If you are injured on your first job and are of a young age, you may qualify for a special AWW rate.
If you fall under the above exceptions, you should consult with a workers’ compensation lawyer for the preparation of a wage affidavit seeking a higher AWW, based upon the special circumstances statutes. This may entail a hearing before the Industrial Commission.