by The Bainbridge Firm, LLC | Sep 01, 2020 | General Information
Understanding Workers’ Compensation Claims and What You Need to Do to Pursue Your Claim:
After getting hurt on the job, injured workers often wonder what they need to do to file a workers’ compensation claim and start pursuing the benefits they deserve. This short guide will provide a simple explanation of the steps that every injured worker should take to pursue benefits following a workplace accident.
- What Is A Compensable Injury?
Not all injuries suffered at work are compensable under Ohio law, meaning not every injury in the workplace will lead to a valid workers’ compensation claim. Ohio Revised Code Section 4123.01(C) defines a compensable work injury as those injuries “received in the course of, and arising out of, the injured employee’s employment.” In other words, the injured worker must show that there is a causal connection between the injury suffered and some condition, activity, environment, or requirement of the injured worker’s employment. Workers’ compensation claims do not require the employer or another party to be at “fault,” as it does not matter whether the injury was “caused by external accidental means” or whether the injuries were “accidental in character and result.”
Under Ohio Revised Code Section 4123.01(C) also outlines the specific exceptions to the definition of a compensable workers’ compensation claim and specifically indicates that an “injury” does not include:
- Psychiatric conditions except where the condition(s) arose from an injury or occupational disease sustained by that claimant or where the claimant’s psychiatric conditions have arisen from sexual conduct in which the claimant was forced by threat of physical harm to engage or participate.
- Injury or disability caused primarily by the natural deterioration of tissue, an organ, or part of the body.
- An injury or disability sustained in the course of a work sponsored recreation or fitness activity if the injured worker signed a waiver of rights prior to participation in the program.
- A condition that pre-existed a workplace injury unless the pre-existing condition was substantially aggravated. To prove substantial aggravation, the injured must show objective diagnostic findings, objective clinical findings, or objective test results to substantiate the worsening of their pre-existing conditions. Mere statements from the claimant or their treating physicians that the pre-existing condition is worse following the accident is not enough to satisfy the burden.
An occupational disease, on the other hand, is an illness that is contracted through employment and caused by a specific industrial process. Ohio Revised Code Section 4123.01(F). Common occupational diseases include illness such as poisoning by specific toxins, certain cancers, emphysema, tendinitis, and carpal tunnel syndrome. Typically, occupational disease are caused by workplace exposure to dusts, gases, or fumes; chemicals and toxic substances;’ extreme changes of temperature, noises, or pressure; physical vibration, constant pressure and use; physical movement in constant repetition, or radioactive rays; infections and organisms; and radiation. To prove a compensable claim, the claimant must have a medically diagnosed disease that was caused primarily by workplace exposure to a hazard or toxin.
- Report the Injury or the Occupational Disease to Your Employer.
If you are injured at work, the first thing you should do is report the injury to your employer. This step is critical to your pursuit of workers compensation benefits. Not only does this give your employer notice that a workers’ compensation claim may be filed, but it also creates an opportunity for you to start developing important evidence that may be necessary to prove the compensability of your claim. Once you notify your employer of your accident or injury, your employer may ask you to complete an accident report describing when and how the injury or accident occurred, the nature of your injury, and other relevant information. These accident reports are often filed in your workers’ compensation claim, so it is important that you fill out such accident reports as accurately as possible. The information you provide on the accident report could play a crucial role in proving your case if your employer contests your workplace injury or accident and the validity of your workers’ compensation claim.
Similarly, if you are diagnosed with an occupational disease, you should immediately notify the employer you were working for when you developed the disease. If you were working for multiple employers or are unsure exactly when you developed the disease, you should notify all potential employers, starting with the most recent and working your way backwards in time.
The longer an individual waits to report their injury or occupational disease the greater level of scrutiny they will face upon filing the claim. When you delay the reporting of an injury or occupational disease, the employer, employer’s representatives, and individuals investigating your claim are more likely to assert that the alleged accident did not occur, your injury is not related to your work activity, or your conditions and circumstances surrounding your injury were fabricated for personal gain. This is one of the many reasons why it is extremely important to report an injury or occupational disease as soon as it occurs.
- File a Workers Compensation Claim.
Under Ohio law, an individual who is injured on the job has only one year from the date of the injury to file an application for workers compensation benefits. An individual who contract an occupational disease as a result of their employment have two years from the date they were diagnosed with the condition to file a claim. As with reporting an injury, it is critical that the application for workers’ compensation benefits be made in a timely fashion. The longer one waits to file the claim the higher level of scrutiny they are likely to face upon filing. Furthermore, if you do not file a timely claim, your claim will be barred by the statute of limitations.
You can file a claim by completing a First Report of Injury, Occupational Disease or Death (FROI-1) and submitting it to the Bureau of Workers’ Compensation (BWC) online, by mail, via fax, or in person at your local BWC customer service office. The FROI-1 is often similar to employer accident forms and asks for information about the injured worker, the date and time of the injury, a description of the accident, and the type of injury/disease and boy parts affected. It is important to note that your treating doctor, spouse, employer, or any other interested party can file a claim for you. The BWC will complete an investigation and decide whether to allow or deny your claim within 28 days of receiving your FROI-1. Once an initial determination is made the injured worker will be notified in writing at the address provided on the FROI-1.
- Seek Immediate Medical Attention.
You should seek medical attention if you injured on the job. As with reporting the injury to your employer, seeking medical attention is an important part of proving your claim as valid medical evidence is required to show that you sustained a compensable injury as the result of your workplace injury or accident. If you do not seek medical treatment for days, weeks, or even months after your injury, it is much harder for your doctors to relate your condition to your workplace injury and harder for you or your legal representative to prove your condition was caused by an injury at work.
When you seek medical treatment, it is also very important that you not only explain how you were injured, but also tell the medical providers that your injury happened at work. Injured workers often make the mistake of delaying treatment in the hopes that a workplace injury will resolve on its own, and only report an injury to the employer and seek treatment when they either get worse or go too long without getting better. This mistake not only opens the door for the validity of your injury to be called into questions but has the potential to negatively impact your medical recovery. For these reasons and many more, you should always seek medical treatment immediately following a workplace accident or injury.
- Social Security and Disability Compensation
- Vocational Rehabilitation
- General Information
- Hearing Process
- In the News
- Psychological Conditions
- Workers' Compensation Benefits
- Workplace Accidents and Injuries
- Workers' Compensation in the News
- Workers' Compensation Programs