Warnings to Injured Workers in the Ohio Workers’ Compensation System
Posted on Monday, June 11th, 2018 at 11:31 am
Compensation: When most people hear the word “compensation” they think of monetary recovery. While there is monetary recovery involved in Ohio Worker’s Compensation, it is only one of several benefits available to injured workers. In fact, Ohio Workers’ Compensation provides many forms of recovery that are valuable, but do not come in the form of a check or monetary award. These valuable benefits are unique to Workers’ Compensation and are often times not available in civil lawsuits. However, these added benefits do come as somewhat of a “tradeoff” as some of the monetary recovery received via the Ohio Bureau of Worker’s Compensation is smaller in amount or may seem less significant at first glance when compared to the monetary recovery that can be common in civil litigation. This blog discusses some of the unique aspects of the Ohio Worker’s Compensation system; pointing out both the positives and the negatives for injured workers as compared to more typical civil litigation lawsuits.
In order to receive any Ohio Workers’ Compensation benefits, monetary or otherwise, a claim must first be allowed by the Ohio Bureau of Workers’ Compensation. Before wasting your time, energy, and resources spinning your wheels to see if your claim is allowed you will want to consult with an attorney who specializes in Ohio Workers’ Compensation. What they tell you may surprise you. For example – did you know that Ohio is a “no fault” state? This means that no showing of breach of duty on the part of the employer is required for the allowance of a claim. Unlike commonplace civil litigation the defendant need not do anything wrong, careless, or negligent. If an employee is hurt in the course of, and arising out of, the injured employee’s employment they are covered! The actions the employer took, or failed to take to prevent such an accident are most times irrelevant.
While this no fault system may lead an injured worker to believe it is easy to get their claim allowed and compensation awarded, there are many other hurtles the injured worker may be unaware of that will cause their claim to be denied if not handled correctly. For example, if an employee legitimately gets hurt at work, but hurts a part of their body that has been hurt previously, or may not be perfect to begin with due to the natural aging process, the allowance of such claim may be fought by several other parties at several levels on the basis that it was a preexisting condition. Another situation in which it is nearly impossible to get a claim allowed is for a psychological condition. While Ohio does recognize psychological conditions in certain situations, there are particular procedures and requirements which must be met to receive benefits for psychological injuries. Another quite common scenario is for a claim to be initially allowed for a very minor injury, such as a sprain or strain, but then to not be recognized for the true, but more expensive condition suffered such as radiculopathy or torn muscles and ligaments which will require surgery. Only an experienced Ohio Worker’s Compensation attorney can help overcome these common obstacles in receiving the benefits an Injured Worker may be entitled to.
Where’s the money?
Generally speaking there is a lot less monetary compensation paid to plaintiffs in Ohio Workers’ Compensation than would be recovered for the exact same injury in a Personal Injury lawsuit. The reason for this is twofold: First, there are benefits for plaintiffs hurt at the work place that are not available to plaintiffs in Personal Injury lawsuits; these benefits will be spelled out later on in this blog article. Secondly, as a counter balance to some of those benefits to the injured worker, there are no punitive damages (in other words no pain and suffering) imposed on the employers of a Workers’ Compensation claim, unless there is a special circumstance known as a VSSR.
So, now that we’ve established that plaintiffs tend to recover significantly less money through Workers’ Compensation as compared to other civil litigation, let’s talk about how much money is involved and when an injured worker can expect to receive it. There are usually two situations in which an injured worker can expect to receive monetary compensation in a typical Ohio Workers’ Compensation Claim. The first is known as Temporary Total Disability, or TTD for short. An Injured Worker becomes eligible for TTD when they miss eight or more consecutive days of work and a Doctor has taken them off of work via a form called a MEDCO14. Therefore, plaintiffs who have missed less than eight consecutive days or do not have a MEDCO14 completely filled out and clearly stating that they have work restrictions that prevent them from returning to work will not be eligible for TTD. This is one reason why it pays to have an attorney in your corner. Oftentimes Doctors who are unfamiliar with such required forms will fail to fill them out or fill these forms out riddled with errors. These mistakes can cost injured workers thousands of dollars in TTD, so you will want someone who is familiar with these requirements to advocate on your behalf to your doctor.
The next question you may have is, “how much TTD can I expect to get?”
This number is calculated by statute and is dependent on the wage you were earning prior to your workplace injury. This calculation is set out by the Ohio Revised Code and can be complex and confusing to understand. Therefore it is important to consult with an attorney to ensure you are not being shortchanged on the TTD you receive. One aspect of this type of wage loss recovery that differs from its civil litigation counterparts is that TTD is capped every year by state statute. For example, injured workers receiving TTD in 2018, can receive no more than 902 dollars per week, regardless of what they were earning prior to their injury.
The second major situation an injured worker is typically eligible for monetary compensation is much later on in their claim when they have been determined by a doctor to have reached Maximum Medical Improvement, or MMI. MMI is defined by Ohio statute as “a treatment plateau (static or well-stabilized) at which no fundamental functional or physiological change can be expected within reasonable medical probability in spite of continuing medical or rehabilitative procedures.” However, reaching MMI does not necessarily mean the injured worker is %100 recovered. Again the monetary compensation is set out by the Ohio Revised Code, which provides a calculation that is based on the Permanent Partial Disability the injured worker has sustained. By way of example, if an injured worker reaches MMI, but is determined to only be 90% recovered, their compensation will be based on the remaining 10% Permanent Partial Disability. Much like TTD, this calculation is confusing and the process for obtaining this award is complex. This is another component of Workers’ Compensation in which an attorney who specializes in Ohio Workers’ Compensation will add tremendous value to your claim.
Other possible, but far less common Workers’ Compensation monetary benefits can include: working wage loss, VSSR, death benefits, and living maintenance. Only an attorney with experience in Ohio Workers’ Compensation will be able to identify if these special benefits are entitled to a particular injury or claim.
Other than monetary compensation, Ohio Workers’ Compensation provides injured workers with medical treatment and rehabilitation that can often times far outweigh the value of compensation paid via TTD and Permanent Partial Disability. The Ohio Workers’ Compensation system is designed to enable Injured Workers to be treated and get back to work as soon as possible. Therefore if an injury or disease is determined to be work related, treatment for such aliment is covered through the Workers’ Compensation System. Such treatment can include, but is not limited to surgeries, diagnostic tests such as MRIs and x-rays, physical therapy, chiropractic treatment, and pain management. However, for this valuable treatment to be covered through your Workers’ Compensation claim, the treatment must be deemed reasonable and necessary to treat a condition that has been formally allowed in the claim. Again, getting both conditions and treatments allowed is confusing and time consuming. If a condition or treatment is denied an injured worker may only have a short amount of time to figure out how to appeal it. This is when an attorney with Ohio Workers’ Compensation experience can make a remarkable difference in your claim.
Due to the fact that so many of these benefits are received by the injured worker before the end of their claim, the payout at the end in the form of Permanent Partial Disability, is much less than what would be recovered for the same injury in civil litigation. In other words, if a person were to recover for an accident through a personal injury lawsuit, that person would have to front all of their own medical treatment, and come up with income during time missed from work, then at the end of their treatment they would recover all of the money spent on medical bills, lost on missed wages, and even be compensated for their pain and suffering. In Ohio Workers’ Compensation however, the Injured Worker will be receiving most of these benefits as they work through the claim, and because the Ohio Workers’ Compensation system is set up to get workers back to work rather than to punish employers the monetary sum at the end will almost always be quite less than the same injury would result in through a Personal Injury claim.
Many injured workers are surprised to find out that even after reaching MMI and getting a Permanent Partial Disability award, there may be further benefits an injured worker is entitled to, that only an attorney with Ohio Workers’ Compensation experience will be able to identify. These can include maintenance treatment, vocational rehabilitation, and even future increases in Permanent Partial Disability.
So the next question you might be asking yourself is, “Yes I can see that having an attorney who understands the complexities of the Ohio Workers’ Compensation system is important. But I am out of work and how am I supposed to pay an attorney?”
The good news is that most Workers’ Compensation Attorneys work on a contingency basis. Meaning, the attorney only gets paid a percentage of money they recover for you. Therefore, just as most injured workers are eligible for monetary awards twice during their claim, so also attorneys get paid for their work most commonly at these two junctures as well: when back due TTD is awarded, and at the resolution of the case upon reaching MMI. “What about when my attorney wins additional conditions, diagnostic tests, or treatment for me?” You might ask. Most attorneys will only charge a very small and nominal fee for this type of service if that attorney feels that the Injured Worker is not likely eligible for any of the monetary compensation to which they would collect a typical fee for. If the attorney is certain that there is lost time at issue in the claim, or a Permanent Partial Disability has been suffered by the injured worker, any work done to get treatment allowed will be done at no additional charge.
Last, but certainly not least are some time frames that injured workers should be well aware of. The first is that of a short 14 day appeal deadline. Oftentimes when an aspect of a claim, or a claim in its entirety is not allowed an Injured Worker may have only 14 days to appeal such a decision. Additionally, disputes over the allowance of benefits necessitate Injured Workers to appear at various hearings and medical exams on quite little notice. Thus, an injured worker does not want to delay in getting an attorney. In order to make sure you have representation at such hearings, and to ensure you do not miss appeal deadlines, it is in your own best interest to retain an attorney as early as possible.
In sum, Ohio Workers’ Compensation is a complex area of the law. Attorneys and non-attorneys alike may has some understanding of what to expect in a run of the mill civil lawsuit, but these understandings and expectations cannot be applied in the same way to Ohio Workers’ Compensation claims. Before you find yourself in over your head, or facing a deadline that you do not understand come in for a free consultation with one of our attorneys who specializes in Ohio Workers’ Compensation.