In this article, we’ll answer some of the questions that we hear most often.

1. What is a workers’ comp injury?

“An injury whether caused by external or accidental means or accidental in character and result received in the course of and arising out of the employee’s employment.” More simply; an injury that occurred either at your place of employment (on-site or off-site) during your working hours while on a job-related task.

2. How do I file a workers’ compensation claim?

The injured worker or their workers’ comp attorney, as well as employers and medical providers, can all file a claim online at the BWC Website or by manually completing the First Report of Injury (FROI) form and filing it with any BWC office.

3. How long do I have to file a workers’ comp claim?

In Ohio, you have one year from the date of injury or death to file your workers’ compensation claim. However, we recommend you file as soon as possible following the incident.

4. Does every workers’ comp claim require a hearing?

No. Hearings are held only when there is a dispute between the injured worker and the employer.

5. How will I be notified of a hearing?

A notice will be sent to you at least 14 days prior to the scheduled hearing date.

6. How is my weekly rate of pay determined?

The first 12 weeks of disability (if needed for the long) are based on your full weekly wage. This is determined by taking an average of your earnings for the six weeks prior to your injury or the earnings for the week prior to your injury, minus any overtime. The higher of these two figures is considered your full weekly wage. Your weekly rate of pay is determined by taking 72% of that number.

After the first 12 weeks of disability, the weekly rate of pay is based on your average weekly wage. This is determined by the average of the earnings for the entire year prior to your injury. The rate of pay is determined by taking 66.66% of that number.

It is important to note that there are minimum and maximum rates applicable to the year you were injured.

7. What is the difference between an MCO and the BWC?

The BWC is the Ohio agency that is responsible for Ohio’s workers’ compensation system. They make decisions regarding claim allowances and handle any issues with the payment of benefits.

The MCOs are private companies either selected by or assigned to each state-funded employer to medically manage an employer’s workers’ compensation claims, make treatment decisions and coordinate medical care.

8. How do my medical bills get paid if I’m collecting workers’ compensation?

Once your claim is approved, the medical providers who have treated your injury should submit their bills for payment to your MCO, who reviews the bills and then sends them electronically to the BWC, who then disburses payment to the medical providers. If you receive a bill, contact the medical provider and advise them the treatment was for a work-related injury. Give them the name and address of your MCO and ask that they forward the bills there.

9. How do I get reimbursed for medications I’ve paid for?

If the pharmacist sent the bill information to RxNet then you do not need to do anything. You will be reimbursed once your claim is approved. If you paid cash for your prescription and the bill information was not sent to RxNet, you will need to have your pharmacist complete and submit a C-17 form.

10. What happens to my workers’ comp claim if I move out of state?

Although hearings on your claim are only held in Ohio, medical and compensation benefits are paid regardless of where you live.

Have more questions? Contact us. Getting workers’ comp for injuries sustained while working can be a complex process. An experienced workers’ compensation attorney can advise you of your options and protect your legal rights at every stage in the process.

Schedule your free consultation with attorney Thomas Marchese today. Workers’ compensation is all we do.

Just because you received a denial for your workers’ compensation claim, doesn’t mean you’re out of options. You may still be able to file an appeal.

A workers’ compensation denial letter can be a disheartening experience. You were injured on the job and you struggled while waiting for your benefits to come through, and then…nothing. No benefits, and no explanation as to why your claim was denied.

If this sounds familiar, you are not alone. Employers and the BWC routinely deny injured workers’ claims for benefits. Sometimes these denials are legitimate and other times they aren’t, but injured workers who have been denied compensation should promptly evaluate their options for filing an appeal.

Let’s start with the basics.

Why Was I Denied Workers Compensation Benefits?

For now, let’s assume that you’re entitled to workers’ compensation, meaning you’re an employee who was injured on the job.
There are several reasons why your claim may be denied or reduced. Below are some common reasons that can potentially be overcome by filing an appeal:

Your Injury or Illness was (Supposedly) Not Job-Related

Employers and the BWC will often deny workers compensation claims, many times in error, on the basis that the employee’s injury or illness was not job-related. You may have simply failed to present evidence that was available to prove your benefits.

You Missed the Deadline to Report Your Injury or File for Benefits

The deadline for reporting your injury and filing for workers’ compensation is based on the date that your illness or injury occurred. However, this isn’t always as straightforward as it might seem. You should report your injury immediately to your supervisor and the statute of limitations for filing a worker’s compensation claim in Ohio is one year. If you missed a deadline, you should speak with a workers’ compensation attorney to find out if you’re still eligible for benefits.

You Submitted an Inaccurate or Incomplete Claim Form

If you submit a claim form with incomplete, inaccurate, or inconsistent information, you may be denied benefits. These deficiencies can be overcome, but you cannot expect your employer the BWC to deal with them for you. Speak directly to a workers’ compensation attorney to discuss your options.

You Had Drugs in Your System at the Time of Your Injury

If you had alcohol, prescription medications, or illegal drugs in your system during your medical examination, there is a chance that the employer or BWC will try to use this against you. However, there are points to be argued. Were you under the influence when you were injured, and if so, was this a factor in the injury?

How Can I Appeal My Workers Compensation Denial?

If you’ve been denied workers’ compensation benefits, you have options. To determine the best steps to take, you need to understand why your workers’ compensation claim was denied. Whether due to a simple mistake on your part or the part of your employer or the BWC, appealing your denial may be as simple as straightening things out through a phone call.

However, in many cases, appealing a workers compensation denial means filing a formal appeal. This process usually begins with submitting an appeal to the Industrial Commission. While this is something you can do on your own, it’s a task best handled by an experienced work injury attorney. You may need to present your case to a hearing officer, and if they agree that you are not entitled to benefits, you may need to take your case to court.

Speak with an Attorney about Your Denial
If you need help understanding your rights after a workers compensation denial, call Tom Marchese. We’ll walk you through all of your options and begin appeal proceedings.

With remote work becoming increasingly common, questions about workers’ compensation eligibility for injuries sustained at home are more relevant than ever. If you’re a remote worker in Ohio and get injured during work hours, you might wonder: Am I covered by workers’ comp?

The answer is yes, but proving the injury was work-related can be challenging. Here’s what you need to know to protect your rights.

Workers’ Comp Protects the Worker, Not the Workplace

Under Ohio law, workers’ compensation applies whenever you’re performing job-related tasks, regardless of location. This means your home office is treated the same as a traditional workplace.

Examples of Covered Scenarios:

• Tripping while answering a work-related phone call.
• Injuries sustained while carrying a delivery of work materials into your home.

However, the line between “on duty” and “off duty” can blur, which is where complications arise.

Acting “In Furtherance” vs. Personal Activities

Workers’ compensation claims hinge on whether your actions at the time of the injury were job-related.

• “Acting in Furtherance”: This covers activities directly tied to your job or basic needs to perform it effectively, such as taking a bathroom break or grabbing a drink during your workday. Injuries sustained during these activities are usually compensable.
• Personal Activities: Tasks unrelated to your job, like doing laundry or checking personal mail, likely won’t qualify for workers’ compensation.

Key Factors in Determining Eligibility

To qualify for workers’ compensation while working from home, several criteria must be met:

1. Work-Relatedness:
   The injury must occur while performing tasks within the scope of your employment. Examples include answering work emails or participating in virtual meetings.
2. Course and Scope of Employment:
   The injury must happen during work hours and while actively engaged in job-related duties.
3. Proving the Connection:
   Establishing a clear link between your injury and work is crucial. This often requires documentation like medical records, incident reports, or witness accounts.
4. Employer-Provided Equipment:
   If the injury results from faulty equipment provided by your employer, it strengthens your case for compensation.
5. State-Specific Laws:
   Workers’ comp eligibility for remote workers can vary by state, so it’s important to review Ohio-specific laws or consult an attorney.

Steps to Take if You’re Injured While Working Remotely

If you’re hurt during remote work, follow these steps to ensure the best chance of getting your claim approved:

1. Report the Injury Immediately:
   Notify your supervisor as soon as possible. While you may need to call initially, follow up with an email or written communication to ensure there’s a documented record.
2. Seek Medical Attention:
   Visit a doctor promptly and explain that the injury occurred during work. Detailed medical records will support your claim.
3. Document Everything:
   Keep records of how the injury happened, including photos, timelines, and any correspondence with your employer.
4. Contact a Workers’ Compensation Attorney:
   Navigating a workers’ comp claim as a remote worker can be complex. An experienced attorney can guide you through the process, ensure your claim is filed correctly, and help you appeal if the claim is denied.

Why Choose Thomas Marchese?

If you’ve been injured while working from home, you need an advocate who understands the nuances of workers’ compensation law. Thomas Marchese has extensive experience helping employees secure the benefits they deserve, no matter where their workplace is.

Schedule a free consultation today to protect your rights and get the support you need.

For anyone injured on the job, workers’ compensation can serve as a lifeline.  If you find yourself in this situation, you probably feel stressed about the uncertainty of the future, wondering how you will pay medical bills along with other daily expenses.

Filing a workers’ comp claim can help you and your family with these expenses so that you can focus on your recovery. However, workers’ comp claims are often complex and those who are unexpectedly hurt and unable to work often don’t know how to properly file a claim. That is what we’ll discuss in this article, so you can ease some of the uncertainty that comes along with a work injury.

Is my injury eligible for workers comp?

You are eligible to receive workers’ compensation if you are injured while acting within the normal scope of your job.

Exceptions:

• You may not be able to receive workers’ compensation if your injury can be remedied by basic first aid, such as small cuts or scrapes, and does not require treatment by a medical professional.
• If you are doing something illegal while at work and you’re injured as a result, you will not be eligible to receive worker’s compensation payments.
  If you are an independently contracted worker, you may not qualify.

Do I have to be at work when I’m injured to receive workers comp?

No. As long as you were performing a work-related duty when you were injured, you are eligible for workers comp regardless of your physical location at the time the injury took place.

Exceptions: 

• Commuting to work is generally considered outside of the scope of your employment, and an injury that happens during your commute will not qualify for workers’ comp.

How do I report a workplace injury?

Before filing a worker’s compensation claim, you should first report your injury to your employer. It’s important to do this as soon as possible. If you wait too long, it could negatively impact your claim.

It’s a sad fact that there are those who are looking to defraud the system and file a workers’ comp simply for financial gain. The longer you wait to file a claim, the less likely that you’ll maximize your benefits. Waiting to file allows too many opportunities and questions as to the true extent and severity of your injury.

For this same reason, it’s important to also seek medical treatment as soon as possible. This allows your recovery to begin while also adding to the legitimacy of your claim.

What happens after I report my injury to my employer?

A first report of injury filed (FROI) with the BWC will begin your formal claim. This can be done by either your employer or your doctor, however, if neither party reports your injury to the BWC, then you will have to report it yourself.

You can do that here: File a workers comp claim with BWC

Next, the BWC will review your claim by speaking with you, your doctor, and your employer. It’s important to be honest and thorough with officials. If you are approved, you will begin receiving benefits. However, if you are denied, your workers’ comp lawyer can help you prepare an appeal, which must be filed within 14 days. Even if you are approved for your claim, the BWC may pay you insufficient benefits. 

Your next step is to hire a workers comp lawyer. Workers’ comp claims can be very complex. The best chance at getting the compensation you deserve is to have an experienced workers comp lawyer to ensure nothing is overlooked. As a workers comp lawyer, I’ve helped over 3,400 people get the benefits they deserve. I understand every part of the workers’ compensation process in Ohio, and I can help you make sure that you get the help you and your family need during this difficult time. Contact me for a free case evaluation.

Slip-and-fall injuries can happen to anyone, especially in physically demanding environments like factories or warehouses. At first, you might dismiss the injury as minor—until days later, you realize it’s more serious than you thought. If this happens, it’s crucial to know your rights and the steps to take to secure workers’ compensation for medical expenses and lost wages.

Here’s a guide to help you navigate the workers’ compensation process in Ohio.

Step 1: Report the Injury to Your Employer

The first step after any workplace injury, no matter how minor it seems, is to notify your employer as soon as possible.

• Why It’s Important: Timely reporting ensures that your injury is documented, which is critical for a successful claim.
• How to Do It: Provide written notice of the incident, detailing what happened and the injury sustained.

Pro Tip: Even if you initially feel fine, report the incident. Some injuries, like back strains or sprains, may not show symptoms immediately.

Step 2: Consult a Workers’ Comp Lawyer

Ohio workers’ compensation laws can be complex, and mistakes in filing could lead to a denied claim or reduced benefits. Hiring an experienced workers’ comp attorney ensures that your claim is filed correctly and that you receive the full range of benefits you’re entitled to, such as:

• Medical benefits
• Temporary or permanent disability benefits
• Lost wages
• Vocational rehabilitation

Why It Matters: An attorney can guide you through the paperwork and help you fight a denied claim if necessary.

Step 3: Complete and Submit the Necessary Paperwork

In Ohio, most workers’ comp claims involve the Bureau of Workers’ Compensation (BWC). However, if your employer is self-insured, they may manage claims independently.

• How to File:
  • Complete a First Report of Injury (FROI) through the BWC website or submit a paper form.
  • Your employer, treating physician, or a representative (like your attorney) can also file on your behalf.

Pro Tip: Double-check all forms for accuracy. Any errors could delay the processing of your claim.

Step 4: Wait for Claim Approval or Denial

Once your claim is submitted, the insurance carrier or BWC will review it and either approve or deny the claim.

• If Approved:

  • You’ll receive details on payment for medical bills, disability benefits, and a portion of lost wages.
  • You and your attorney can negotiate for a larger settlement if needed.

• If Denied:

  • Request a reconsideration from the insurance carrier.
  • File a formal appeal with the state workers’ comp board, with your attorney’s assistance.

Step 5: Returning to Work

When you’re ready to go back to work, notify both your employer and the insurance company in writing.

• Modified Duties: If your injury prevents you from resuming your previous role, your employer may offer a modified role or alternate tasks through a formal return-to-work program.
• Permanent Disability: If your injury leads to permanent limitations, you may qualify for additional disability benefits.

Common Questions About Workers’ Comp in Ohio

1. Can I get workers’ comp even if the accident was my fault?
Yes. Ohio is a no-fault state for workers’ compensation, meaning you don’t need to prove fault to file a claim.

2. How long do I have to file a claim?
You have one year from the date of injury to file a workers’ compensation claim in Ohio.

3. What if my employer disputes my claim?
If your employer contests the claim, you can appeal through the Ohio Industrial Commission with the help of an attorney.

Why You Shouldn’t Handle This Alone

Filing a workers’ comp claim can be overwhelming, especially when you’re recovering from an injury. An experienced workers’ compensation attorney ensures:

• Your claim is filed correctly.
• You receive all eligible benefits.
• You have a strong advocate if your claim is denied.

If you’ve been injured on the job, don’t wait. Contact workers’ comp attorney Thomas Marchese today to get started on your case and focus on what matters most: your recovery.

Workers who have needlessly suffered a workplace injury deserve to be compensated for their medical bills and lost wages. While workers’ compensation laws try to make that a clear and attainable objective, pitfalls can limit or even undermine your claim, including getting it outright denied.

Let’s discuss some steps you can take to maximize your workers’ comp claim.

Don’t Handle This Alone.

The simplest way to maximize your claim is to hire an experienced workers’ comp attorney. Submitting your initial paperwork is crucial to setting up the relief and reimbursement you may receive. Once you have filed your claim, workers’ comp carriers can push anxious and injured workers to make hasty decisions regarding their case. A lot of times, claimants may not be aware of all the options that may be available to them.

However, a skilled lawyer can ensure the initial paperwork is strong and present a clear case for compensation, and advise injured workers of their rights and full options, including the level of risk versus return for each. Don’t be pressured to accept an unfair settlement or agree to a lower disability percentage. If you find the terms unacceptable, we are prepared to demonstrate at a hearing our evidence why your case for reimbursement should be increased.

Follow Your Employer’s Guidelines for Filing a Claim

The longer you wait to file a claim, the less likely that you’ll maximize your benefits. Waiting to file allows too many opportunities and questions as to the true extent and severity of your injury. This is often viewed as a red flag that many carriers look out to help weed out improper, invalid, or untimely claims.

That is why it’s essential that you file a claim as soon as possible and follow all of the requirements and requests for information regarding your claim. Failure to do so could not only limit the compensation you receive but could also result in your claim being denied.

Stay Organized.

A lot of workers’ comp claims revolve around your medical records. So, not only should you ensure that you have all of your medical records from all of your providers, but you should keep them organized. This allows a workers’ comp carrier to find the relevant information to help support your claim, and it also can highlight how your injury may not have healed and progressed as the doctor believes it should have.

Having your medical records in a neat and orderly fashion can help provide a clearer medical chronology to help the examiner and judge determine your true disability level.

Bottom line

Although these tips are the best ways to maximize your workers’ compensation claim, with over 40 years of experience, workers’ comp lawyer Thomas Marchese has other skills and proven litigation tactics to further maximize what you may be entitled to.

If you’ve been injured on the job, call me today. We’ll get started on your case so you can focus on healing.