Ohio Bureau of Workers' Compensation honored the men and women who had been killed as the result of a workplace injury during the Fallen Workers Memorial 2018. To the family and friends of these dedicated workers, we wish you peace to bring comfort, courage to face the days ahead and loving memories to forever hold in your heart
Well yes and no. Pronounced “dwarf" the benefit is actually DWRF (Disabled Workers Relief Fund). DWRF is a type of Ohio workers’ compensation benefits provided to injured workers currently receiving permanent and total disability benefits.
“Permanent and total disability (PTD) benefits pay a worker when that person can’t perform sustained, paid employment due to their work related injury.” Info.bwc.ohio.gov
PTD benefits are problematic because amount paid to the injured worker is fixed. Yet PTD compensation is paid for life. Remember how much gas cost 20 years ago? Less. A lot less. Actually, probably less than half of what it costs today. Things get more expensive. The cost of living goes up every year. That is a big concern for people on a fixed disability income. Huge!
Established in 1953, the DWRF is a special fund to supplement the PTD benefits. Prior to this, injured workers were unfavorably affected by rising inflation and cost of living.
So what’s the problem?
This sounds great right? No application, automatic reviews, and just like that another check in the mail! Well it can be great, but for a few self-insured employees, this can be very misleading.
Self-Insured Employer failed to pay PTD yet Injured Worker received DWRF.
In one situation, an injured worker was awarded PTD. However, the self-insured employer wasn’t actually paying the PTD. The injured worker was receiving DWRF payments, but that is obviously a lot less. Thankfully, an experienced workers’ comp attorney became involved and the man was re-paid what was owed.
The Ohio BWC is a complex system wrought with errors, omissions, unnecessary denials, and other actions harmful to injured workers. An experienced attorney is a necessity to traverse the intricate processes and procedures. Call Garson Johnson today if you have questions about PTD, DWRF payments or other workers’ comp related concerns.
Will the Ohio Workers’ Comp pay for my prescriptions for a work related injury?
If your workers’ comp accident and injury were approved and allowed by Ohio BWC, then yes, workers’ comp will pay for your prescriptions prescribed by your comp doctor.
I originally paid for the prescription. How can I be reimbursed?
The pharmacist needs to submit the bill information to the BWC’s Pharmacy Benefits Manager (PBM). If the pharmacy does this, you will automatically be reimbursed once your claim is allowed. If you paid as a “cash customer” and the bill information was not submitted to the PBM, ask the pharmacy to complete the Outpatient Medication Invoice (C-17).
Important things to remember
Can I be reimbursed for co-pay if my health insurance originally paid for the script?
That’s a no. Any scripts related to a work injury need to be submitted to the BWC’s Pharmacy Benefits Manager (PBM). BWC will not reimburse you for any co-pays.
My medication was denied for requiring a prior authorization. How do I get prior authorization?
The medical professional prescribing your meds should contact BWC's Pharmacy Benefits Manager, ACS State Healthcare at 1-800-644-6292. Or, the prescriber should complete a Medco-31 or Medco-32 (for non-preferred medication). Basically, you need to call your doctor and ask them to make sure your meds are authorized. They should be able to manage this for you.
If you have any questions about your prescriptions or other workers’ comp claim related concerts, don’t hesitate to reach out to experienced and dedicated attorneys at Garson Johnson. We have decades of experience focusing on the Ohio workers’ comp law and BWC system.
***BWC will only reimburse medications that are listed on the BWC medication formulary.
ATTENTION: Clients with hearings scheduled at the Cleveland Industrial Commission Office.
Please be aware of the ongoing construction around the state building. Expect parking and walking delays because of the repairs and replacements.
Industrial Commission- Cleveland
615 Superior Ave. NW
Cleveland, OH 44113-1898
In January 2017, the NEW OHIO WORKERS COMP LAW SIGNED TO HELP FIRE FIGHTERS WITH CANCER revealed a new law to help Ohio firefighters with cancer to receive workers' compensation benefits. Then in November 2017, OHIO BWC INITIATES FIREFIGHTER EXPOSURE GRANT PROGRAM discussed grants available to fire departments to improve safety.
This month, Middleburg Heights is joining the list of fire departments utilizing the Ohio BWC grant. Cancer is proven to be a job hazard for firefighters. We applaud the Ohio BWC for providing grants and attempting to reduce the exposure to toxic chemicals in any job environment.
State Funded Employers? The Ohio BWC
In Ohio, the majority of businesses pay for workers’ compensation insurance to the Ohio Bureau of Workers’ Compensation. Most likely, your employer is one of these businesses and is considered to be state funded. In those situations, the Ohio BWC will pay for your medical expenses and benefits of your workers compensation injury. Ohio Managed Care Organizations (MCO) assist the Ohio BWC by medically managing your workers’ compensation case. The MCO will approve treatment, process paperwork, and process payment for medical providers. The Ohio BWC, however, is the entity actually paying for workers’ comp benefits as well as paying the MCO for their administrative functions.
Self-Insured Employers? The Employer
Some very large Ohio businesses may qualify to be self-insured employers. Which means, the business would administer and pay for the workers’ compensation claims against them. To qualify, an employer must meet several requirements including:
What can the injured worker do to get the best results from a workers comp injury?
Engaging and hiring an experienced and successful workers comp attorney is extremely important to ensure the injured worker receives the best treatment and benefits available. It is common knowledge but rarely spoken that injured workers without an attorney receive less benefits, less treatment and overall inferior results.
At Garson Johnson, we represent many employees of nursing homes that have been injured because they are required to manually lift their patients. This nursing home in Sandusky, Ohio invested in technology that has prevented countless work place injuries. Unfortunately, they are in the minority in the State of Ohio. Injuries to nursing home staff continue to be the highest rate of injury of any occupations in Ohio.
Researchers and government reports make clear that working as a nurse's assistant is among the jobs with the highest reported rates of injury in Ohio and the country. Nursing assistants are hurt three times more often than the average worker, according to the U.S. Bureau of Labor Statistics.
Your attorney recommends filing a C92 to determine a percentage for your permanent partial disability. You attend the doctor’s exam. Great news! The BWC approved and determined the percentage. Congratulations, you’ve been awarded permanent partial disability benefits!
But wait, does this mean your workers’ comp claim is closed? Absolutely Not!
Sometimes when an injured worker received permanent partial disability (PPD) award, they believe this settles or closes the claim. A PPD award does not close a workers’ compensation claim. ***If you want to keep your claim open and active, it is extremely important that you continue to follow up with your physician of record at least once a year after a PPD award is paid.***
ABOUT C92/ PPD:
ABOUT WORKERS’ COMP CLAIM EXPIRATION (STATUTE OF LIMITATIONS)
Are you trying to get medical treatment approved through the Ohio Bureau of Workers' Compensation?
If you have a claim with the Ohio Bureau of Workers' Compensation, you probably already know this is a complex and often confusing system. When you get injured at work, often times the workplace injuries will require treatment. It should be as simple as getting to the doctor and getting the treatment, right? Well, it's not always that easy.
Here are steps to getting treatment approved through the Ohio BWC system for state-funded cases:
(Hopefully, you will be successful with step 1! If not, read more to get the scoop.)
STEP 1: Your Physician of Record (POR) completes a C-9 form and submits it to your employer's Managed Care Organization (MCO).
-If the MCO approves it, congratulation! You can begin treatment!*
STEP 2: If the MCO denies the C-9, your physician or attorney must appeal the denial within 14 days to the Ohio BWC.
-If the BWC approves it, congratulations! You can begin treatment!*
STEP 3: If the BWC denies it, your attorney will appeal to the Industrial Commission for a hearing in front of a District Hearing Officer. (DHO) Don't be intimidated about the actual hearing, read more to learn everything you need to know.
-If the DHO approves the treatment for your workplace injury, congratulations! You can begin treatment!*
STEP 4: If the DHO at Ohio's Industrial Commission denies the recommended medical treatment at a hearing, your attorney will appeal again. This time you will be referred to a Staff Hearing Officer (SHO) at the Industrial Commission. This hearing is much like the hearing at the DHO level.
-If the SHO approves it, congratulations! You can begin treatment!*
STEP 5: If the SHO denies the medial treatment for your workers' comp injury, call your attorney, schedule a phone consult or in office consultation, and discuss the next steps for your claim. Experienced workers' comp attorneys will be able to work with your physician and guide you on the best possible actions moving forward.
When dealing with the Ohio BWC, you are much better positioned and prepared if you have an experienced, strategic and compassionate lawyer on your side. Contact us at Garson Johnson LLC with any questions about your workers comp medical treatment.
*Side Note! Your employer can appeal any approval of treatment during steps 1-3. If this happens, rely on your attorney to help you!
Governor John Kasich signed House Bill 27 changing 7 areas of Ohio workers' compensation law effective September 29, 2017. Here are the details you should know:
Deadline to File a Claim (Statute of Limitations)
Before 9/29/17:::::24 months (2 years) from Date of Injury (DOI)
After 9/29/17::::::::12 months (1 year) from Date of Injury (DOI)
Prior to September 29, 2017, injured workers had 2 years from the date of injury to file a claim with the Ohio Bureau of Workers Compensation. Now, you must file within 1 year. People in Ohio that are hurt on the job sometimes hesitate to file a workers comp claim for many reasons. With this new change, the employee should not "wait and see" how it goes. They need to file quickly to ensure the injury has been recorded and documented with their employer and Ohio BWC.
Need to file a workers' comp claim? Visit Ohio BWC website to complete a First Report of Injury.
Time to File Appeals
Before 9/29/17::::: Within 60 days from final decision
After 9/29/17:::::::: Within 150 days from final decision
House Bill 27 extends the time period to file a claim from 60 days from final decision of the Industrial Commission to 150 days. However, this only applies if the injured worker or the employer files a notice of intent to settle the claim AND the other party does not object.
To learn more about appeals and the industrial commission, visit Ohio BWC- Basics.
Before 9/29/17:::::Types and amounts of controlled substances did not comply with Code of Federal Regulations
After 9/29/17::::::::Types and amounts of controlled substances COMPLY with Code of Federal Regulations (CFR)
While this is a minor change to the law, it is important that employees know and understand their employers drug and alcohol policy. Many Ohio employers participate in the Drug Free Safety Program offered by the Bureau of Workers' Compensation. In addition, employers can seek to disallow a claim that involves a positive test for alcohol or certain controlled substances.
Did you fail a drug test after a workplace accident? Contact an experienced attorney today to discuss your options.
Permanent Partial Disability Applications
Before 9/29/17::::: Suspends PPD Application if IW Does Not Attend Exam Scheduled by BWC
After 9/29/17:::::::: Provides BWC Right to Dismiss Application Completely
When filing for Permanent Partial Disability (PPD), the injured worker is not always available and/or able to make the scheduled exam. Prior to the new rule, BWC would suspend the application until the injured worker could re-schedule and attend a state medical examination. However, this new rule allows the BWC to completely dismiss the application if the injured worker is a "no-show" or misses the state doctor's examination. Apparently, this change is going to increase BWC ability to operate more efficiently and effectively. That is yet to be determined and very doubtful. However, the new rule will unfairly create a lengthier, more tedious process for the injured worker and his/her attorney causing delays in compensation.
Receiving Workers Compensation Benefits while Incarcerated
Before 9/29/17:::::Dependents awarded workers comp benefits received $ regardless of confinement status
After 9/29/17::::::::Incarcerated dependents cannot receive compensation
For many years, injured workers could not receive any workers' comp benefits while imprisoned. Now, the new rule applies this rule to dependents as well. In some workplace death cases, dependents are awarded compensation also known as death benefits. The revised statute suspends any death benefits paid to a dependent while that dependent is incarcerated.
Waiver of 90 Day Exam
Before 9/29/17::::: Statute required BWC to schedule 90 day exam
After 9/29/17:::::::: Provides BWC right to waive 90 day exam with good cause
When an injured worker received Temporary Total Disability (TT) for 90 days, the BWC was required to schedule a 90 day exam with a state doctor. According to the Ohio BWC website, "This exam addresses a number of issues, including continuing compensation, return-to-work barriers and potential solutions, the need for further medical treatment or supportive care and the potential for rehabilitation."
After 9/29/17, the HB 27 allows the BWC to waive the 90-day exam for good cause. However, the employer has the right to object, and then the exam will be scheduled.
Calculations of Full Weekly Wage
Before 9/29/17:::::BWC would not pay Temporary Total without wage documentation
After 9/29/17::::::::BWC will set rate at 33 1/3% of statewide average weekly wage
If an injured worker is awarded Temporary Total (TT) benefits due to a workplace injury, the BWC needs wage verification to determine the amount of weekly benefits. The benefits are calculated by determining the injured worker's full weekly wage (FWW). Sometimes, it is difficult and time consuming to collect documents, verify prior earnings and calculate the amount. The new statute allows the BWC to set the FWW at 33 1/3% of statewide average weekly wage. Once the actual FWW is determined, Ohio Revised Code 4123.56(E) allows for the amount to be adjusted.
To learn more about Temporary Total and the calculations visit, Ohio BWC.