The Bainbridge Firm, LLC
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Toll Free: 800-762-1612

Columbus : 614-545-9990

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January 2015 Archives

Outpatient medications paid for prior to a claim being allowed by the BWC takes effect February 1, 2015

The BWC's Board of Directors adopted O.A.C. 4123-6-21.6, which provides for first fill of outpatient medications.  This rule, expected to take effect on February 1, 2015, permits the BWC to approve payment for prescription medication for certain drugs (listed in an appendix to the rule) before the administrator makes the initial determination whether to allow the claim.  The rule also permits the BWC to provide first fill reimbursement for prescription medication not included in the appendix "in cases of medical necessity supported by clinical documentation and evidence of need." Under this plan, the BWC will pay for no more than ten days worth of prescription medication, with no refills permitted.

How am I most likely to suffer an injury on the job?

As frequent readers of our blog know employers in Ohio are required by law to provide their employees with workers' compensation benefits that can be used in the event of a work-related injury. On top of this, employers are also required to take the steps necessary to provide a safe working environment free from hazards that could lead to such accidents.

What does subrogation provide?

Subrogation provides for the BWC or self-insured employer to receive reimbursement of workers' compensation benefits paid where the injured worker has a third party action because 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 and also gives them a right to sue someone in tort.

How can I get my medical bills paid?

Revised Code § 4123.54 provides that every employee who is injured or who contracts an occupational disease is entilted to receive such medical, nursing, and hospital services as are auhtorized under chapter 4123 of the Revised Code. Section 4123.66 authorizes the Administrator of the Bureau of Workers' Compensation to pay such amounts from the State Insurance Fund for such medical services, nursing services, hospital services, and medicine as the Administrator "deems proper." The Bureau and the Industrial Commission retain broad discretion in deciding whether to approve or disapprove payments for medical benefits. 

Forty Individuals Arrested and Indicted for Social Security Fraud

Department of Justice
Office of Public Affairs

FOR IMMEDIATE RELEASE
Thursday, January 15, 2015
Forty Individuals Arrested and Indicted for Social Security Fraud

On Jan. 12 and 13, 2015, a federal grand jury in the District of Puerto Rico returned 39 separate indictments charging one doctor, Luis Escabi-Pérez, and 39 other individuals for fraud in the application process for Social Security Administration (SSA) disability insurance benefits in Puerto Rico, announced U.S. Attorney Rosa Emilia Rodríguez Vélez for the District of Puerto Rico.

Ohio Workers' Compensation Rates

Year1Temporary Total Max. & Wage Loss Max.2Amputation Award3& Death Max.4Temporary Total Min. & Permanent Partial Max.Permanent Total Max.5
2015 $862.00 $862.00 $287.33 $862.00
$574.67
2014 $849.00 $849.00 $283.00 $849.00
$566.00
2013 $838.00 $838.00 $279.33 $838.00
$558.67
2012 $809.00 $809.00 $269.67 $809.00
$539.33
2011 $783.00 $783.00 $261.00 $783.00
$522.00
2010 $775.00 $775.00 $258.33 $775.00
$516.67
2009 $767.00 $767.00 $255.67 $767.00
$511.33
2008 $751.00 $751.00 $250.33 $751.00
$500.67
2007 $730.00 $730.00 $243.33 $730.00
$486.67
2006 $704.00 $704.00 $234.67 $704.00
$469.33
2005 $678.00 $678.00 $226.00 $678.00
$452.00
2004 $662.00 $662.00 $220.67 $662.00
$441.33
2003 $644.00 $644.00 $214.67 $644.00
$429.33
2002 $628.00 $628.00 $209.33 $628.00
$418.67
2001 $618.00 $618.00 $206.00 $618.00
$412.00
2000 $589.00 $589.00 $196.33 $589.00
$392.67
1999 $567.00 $567.00 $189.00 $567.00
$378.00
1998 $541.00 $541.00 $180.33 $541.00
$360.67
1997 $521.00 $521.00 $173.67 $521.00
$347.33
1996 $511.00 $511.00 $170.33 $511.00
$340.67
1995 $493.00 $493.00 $164.33 $493.00
$328.67
1994 $482.00 $482.00 $160.67 $482.00
$321.33
1993 $460.00 $460.00 $153.33 $460.00
$306.67
1992 $443.00 $443.00 $147.67 $443.00
$295.33
1991 $428.00 $428.00 $142.67 $428.00
$285.33
1990 $419.00 $419.00 $139.67 $419.00
$279.33
1989 $400.00 $400.00 $133.33 $400.00
$266.67
1988 $385.00 $385.00 $128.33 $385.00
$256.67
1987 $376.00 $376.00 $125.33 $376.00
$250.67


Notes

House rule could set up explosive battle over Social Security

WASHINGTON - Buried in new rules that will govern the House for the next two years is a provision that could force an explosive battle over Social Security's finances on the eve of the 2016 presidential election.

Am I covered by the fund if I am an apprentice?

The General Assembly extended workers' compensation coverage to apprentices engaged in formal training programs in 1961. The coverage was extended beyond apprentices in 1975 to cover persons engaged in pre-apprenticeship training programs, entry-level trainees, and journeyman trainees. 

Actions by Ohio BWC that made 2014 a good year for workers

Compared to other years, did you notice anything different about 2014 in relation to workers' compensation and workplace safety? If you didn't, you're not alone. Most people here in Ohio don't follow actions made by the Ohio Bureau of Workers' Compensation. News outlets don't help either, oftentimes failing to report changes that have a huge impact on workers across the state.

"Last Injurious Exposure" Principle

The restrictive statutes governing occupational disease require an injurious exposure in Ohio to support a finding that the claim is compensable. "Injurious exposure" can be defined as an exposure which proximately causes the disease, or an exposure which augments or aggravates a pre-existing disease.

Workers' Compensation Fraudsters Caught in the Act

COLUMBUS (Brooks Jarosz) -- New undercover video exposes workers faking injuries, finding loopholes, and ultimately defrauding the Ohio Bureau of Workers' Compensation.ABC 6 Investigators are targeting those stealing from the state, finding that just last month there were nine who were convicted of ripping off the state insurance fund.Those convicted claimed they couldn't work, but bank statements, records, and surveillance video proved otherwise.Samuel Jarrell claimed he hurt himself and was getting total disability benefits. However, he's seen carrying parts, operating a forklift, and even unloading wheels and tires from a pickup truck. Agents caught him on camera day after day running the family truck and auto repair shop in Marion."It's amazing what goes on out there," Special Agent Scott Lape said. "People are just so blatant in the way the commit fraud."Scott Lape is special agent in charge with at least 200 open cases where people like Jarrell are faking injuries. Bank records show Jarrell was getting paid for working at the repair shop.Investigators say they showed the undercover video to Jarrell's doctors who were surprised and sided with agents, getting a conviction against Jarrell. He was sentenced to 90 days in jail and ordered to pay more than $6,000 in restitution.In another case, a tip to investigators lead them to a job site near Mansfield. That's where Charles Mattox, of Newark, was seen working on a roof and removing shingles. It's against the law because Mattox is getting workers' compensation benefits.Mattox claims to be hurt, however, he was caught on camera climbing ladders, walking on the roof, removing and replacing it all while investigators say he was getting paid under the table.When agents confronted Mattox about the work, he swore under oath in a written statement saying at no time did he do any work, supervise, or get paid. Mattox claims he stayed in the house but the video exposes him day after day on the roof.Mattox was convicted and ordered to pay nearly $3,000 in restitution. He was also sentenced to 90 days in jail.Agents says they want to send a message to anyone trying to scam the system."We hope it's a deterrent," Agent Lape said. "We want them to know that we are watching and we investigate every allegation we receive."Thousands of allegations means across the state, agents are watching for fraudsters who can't keep their hands out of the state's pockets.Just in 2014, the Bureau of Workers' Compensation found $60 million in fraud. In total, nearly 150 indictments and 130 convictions for workers stealing from the state. 

Workplace injuries aren't simply injuries

When most workers hear the phrase "workplace injury," they immediately think of a single accident. Slipping on material littering the factory floor, crush injuries in a machine press, scaffolding collapse or an item falling from a high shelf striking their head and neck -- these are all situations that could lead to a serious bodily injury. However, workers are encouraged to consider other types of injuries when thinking about their workers' compensation claim.

Self-inflicted injuries are not compensable

An employee's self-inflicted injuries are excluded from coverage under the workers' compensation fund. Deliberate self-injuries are highly unlikely to be motivated by the prospect of entitlement to workers' compensation benefits, because compensation law provides for an award based upon only a percentage of a workers' wages. 

Workplace injuries aren't simply injuries

When most workers hear the phrase "workplace injury," they immediately think of a single accident. Slipping on material littering the factory floor, crush injuries in a machine press, scaffolding collapse or an item falling from a high shelf striking their head and neck -- these are all situations that could lead to a serious bodily injury. However, workers are encouraged to consider other types of injuries when thinking about their workers' compensation claim.

Workplace injuries aren't simply injuries

When most workers hear the phrase "workplace injury," they immediately think of a single accident. Slipping on material littering the factory floor, crush injuries in a machine press, scaffolding collapse or an item falling from a high shelf striking their head and neck -- these are all situations that could lead to a serious bodily injury. However, workers are encouraged to consider other types of injuries when thinking about their workers' compensation claim.

Could your Facebook post hurt your workers' comp claim?

In the last few decades, the use of social media has exploded. This has created a new generation of Internet users who are not only able to maintain long-distance relationships with people worlds away but are able to upload just about every aspect of their life to the web, giving everyone a snapshot of who they are and what they're doing.

Personal Risks Concurring With Employment

Injuries arising out of risks personal to the claimant generally do not arise out of the employment. The injury may arise out of employment, however, if the employment increases the risk or aggravates the injury. For example, an injury sustained in a fall attributable to a personal risk is compensable if the employment placed the employee in a position that increased the danger of such a fall, such as atop a tall structure, near machinery or sharp corners, or in a moving vehicle. 

Is an injury compensable if the employee was engaging in recreational or social activity during the time of the injury?

The type of activities conducted on the employment premises is often determinative of the course of employment issue. Injuries sustained during recreational and social activities on the employer's premises have generally been held to be compensable. However, to be compensable, the injury must have been sustained while engaing in activities that were customary, either in the industry or in the particular place, in order for the activities to qualify as a regular incident of employment. 

Are elected officials covered "employees" under the fund?

Elected officials were initially excluded from coverage under the workers' compensation law because they occupied a status similar to that of employers. However, an amendment to Ohio Revised Code § 4123.01(A)(1), effective since 1959, enables elected officials to be covered as employees under the workers' compensation law. 

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The Bainbridge Firm, LLC

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Columbus, OH 43215

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