Workers' compensation (or work-related disability) is a ‘no-fault’ system that compensates employees for work-related injuries or illnesses. Benefits are limited to wage loss, medical and rehabilitation expenses and are payable as long as the disability lasts or medical treatment is reasonably necessary. Workers’ compensation provisions can be found in the Ohio Constitution Article II, Section 35; Ohio Revised Code Chapters 4121 and 4123; and Ohio Administrative Code Chapters 4121, 4123 and 4125.
When an Injury Occurs
Follow your agency's policy on reporting incidents and injuries. Not adhering to agency reporting guidelines or policy may result in denial of employer provided benefits.
Obtain medical care promptly if emergency treatment is required, go immediately to the nearest emergency facility. Otherwise, your Managed Care Organization (MCO) can provide you with names of WILMAPC approved providers in your area who can assist you or visit das.ohio.gov/wilmapc.
Complete an Accident or Illness Report (ADM 4303).
Your agency will forward the completed Accident or Illness Report (ADM 4303) to your Managed Care Organization and the state’s Third Party Administrator.
The Managed Care Organization will file the initial claim information and medical documentation with the Ohio Bureau of Workers’ Compensation.
Your health care provider will forward all medical information regarding your claim to the Managed Care Organization who will contact you to gather additional information regarding your treatment, recovery and claim.
The Bureau of Workers' Compensation will send you a letter informing you of your claim number. This number is to be retained and referenced when contacting your agency, Bureau of Workers' Compensation, the third-party administrator, the managed care organization and your health care provider regarding your claim.
Shortly after you receive your claim number, the Bureau of Workers' Compensation will make an initial decision to allow/approve or disallow/deny your claim and will notify you in writing.
If your medical-only claim is approved, your managed care organization will pay your health care provider for authorized treatments that are directly related to your claim.
If your attending physician determines that your injury or illness will prevent you from working for eight or more calendar days, you may be eligible to receive lost time benefits through the Ohio Bureau of Workers’ Compensation.
If your claim is approved for lost time benefits, the Bureau of Workers' Compensation will begin paying benefits accordingly:
You cannot receive payment from the Bureau of Workers' Compensation for the same period you receive payment from your agency for Disability, Salary Continuation or Occupational Injury Leave benefits. If this occurs, you will be responsible for reimbursing your agency for the benefits you received.
If your claim is approved for lost time, you may receive temporary total compensation at 72 percent of your full weekly wages for up to 12 weeks.
If your injury or illness prevents you from working for more than 12 weeks, your temporary total compensation will be reduced to 66 2/3 percent of your average weekly wage.
These lost time payments are subject to a weekly maximum amount established by the Ohio Bureau of Workers' Compensation and are not taxable.
Should you require prescription medications relative to your work injury, the Ohio Bureau of Workers' Compensation contracts with a pharmacy benefit manager to process pharmacy benefits.
If you require a prescription but have not received your claim number from the Ohio Bureau of Workers' Compensation, you may be required to pay your pharmacy for the cost of the prescription. Once you receive your claim number, give it to your pharmacy, which will then ask the pharmacy benefit manager to reimburse you for your out-of-pocket expenses.
If any party (you or your agency) disagrees with the decision of the Ohio Bureau of Workers' Compensation your workers’ compensation claim, an appeal may be filed with the Industrial Commission.
All appeals must be made in writing and must be filed within 14 calendar days of the date of receipt of the order issued by the Ohio Bureau of Workers' Compensation. The order will inform you of your appeal rights. If you have questions regarding appeal rights, you can contact the Ohio Bureau of Workers' Compensation at 800-OHIO-BWC.
There are three levels in the appeal process, which include the district level, the staff level and the commission level.
If you disagree with a decision during the hearing process, you may appeal your claim to the next level, in the following order:
You may represent yourself, or you may be represented by an attorney. For more detailed information, visit:
To be eligible for salary continuation, you must:
Bargaining unit employees may appeal a denied salary continuation decision claim and should refer to the appeal procedure in the union contract. Appeals should be sent to the Office of Collective Bargaining within 20 days of the denial.
Non-bargaining unit employees do not have grievance rights. They may appeal a denied salary continuation decision using the appeal form; however, the decision by the Ohio Department of Administrative Services' Office of Benefits Administration Services is final. The appeal should be sent to the Office of Collective Bargaining.
Occupational Injury Leave is a state of Ohio employee benefit that provides the injured worker with 100 percent of his/her regular rate of pay in lieu of workers’ compensation temporary total benefits.
To be eligible for Occupational Injury Leave, you must:
Bargaining unit employees may appeal a denied Occupational Injury Leave decision claim and should refer to the appeal procedure in the union contract. Appeals should be sent to the Office of Collective Bargaining within 20 days of the denial.
Non-bargaining unit employees do not have grievance rights. They may appeal a denied Occupational Injury Leave decision using the appeal form, however, the decision by the Ohio Department of Administrative Services' Office of Benefits Administration Services is final. The appeal should be sent to the Office of Collective Bargaining.
Disability Advancement is available only if the Bureau of Workers' Compensation denies your claim for workers’ compensation benefits and you are appealing the decision. If you do not intend to appeal, you may file for disability benefits within 20 days of the denial order.
To file for disability advancement, complete the disability application and submit it and your denial order to your personnel office within 20 days of notification of denial.
Payments are subject to the same two-week waiting period as disability leave benefits.
You may receive the advancement for a maximum of 12 weeks.
If your workers’ compensation claim is approved through the appeal process or by a settlement, you will be required to pay back all of the money that has been advanced, regardless of the amount received from the Bureau of Workers' Compensation or the settlement.
Some bargaining unit employees have the option of buying back leave time that was used while waiting for a workers’ compensation claim to be approved. See your bargaining unit contract to determine your eligibility.
A wage advancement agreement is a contract between you and your employer that states the amount of leave time that you will buy back. https://www.bwc.ohio.gov/downloads/blankpdf/C-18.pdf.
You may buy leave time back either with or without a wage advancement agreement.
With a Wage Advancement Agreement
If you complete an agreement, you will be permitted to use your leave time (including sick leave) while waiting for your workers’ compensation claim to be approved. Under this agreement, you must use your Bureau of Workers' Compensation payments to buy back the leave up to the amount you receive from the Bureau of Workers' Compensation. The maximum amount of time that you can buy back is 12 weeks.
Without a Wage Advancement Agreement
If you do not file a wage advancement agreement, you may use leave time while you are waiting for your workers’ compensation claim to be approved; however, the Bureau of Workers' Compensation will not pay over any period in which you used sick leave to receive wages. Buy backs include vacation, personal and compensatory time and are limited to a maximum of 12 weeks.
Returning to Work
Step Increases and Leave Restoration
When you return to work from a disabling illness or injury, you may be eligible for a pay increase and/or restoration of your leave balances. Vacation leave, however, is not restored. Refer to your bargaining unit contract for more information, or ask your personnel officer.
If you have been off work due to a workers’ compensation claim and still have temporary work restrictions, the state may provide you with a program to help you transition back to work. Transitional work provides injured employees with the opportunity to resume employment as soon as possible following a job-related injury or illness.
In many cases, the resumption of work will require some form of job modification. The modifications are based on medical restrictions provided by the employee’s medical provider which are directly attributable to the injury or illness. Most job modifications will be temporary in nature and will be handled on its own merits. Any accommodation made will be temporary and will be monitored periodically with the goal of assisting the employee to resume his or her regular assignment as soon as medically possible.
While participating in a transitional work program, you will receive your normal pay for the hours you work. You may be eligible to receive OIL, salary continuation, or workers’ compensation benefits for the time you are not working.
Most state agencies have developed their own transitional work program, which is typically approved for 30 days, but may be extended based on your attending physician’s recommendation. Most programs do not exceed 90 days. Your agency personnel officer will assist you with specific requirements.
Workers' Compensation Partners
Ohio Bureau of Workers' Compensation
CompManagement, a Sedgwick CMS Company, Third-Party Administrator
CompManagement Health Systems, Managed Care Organization
CareWorks, Managed Care Organization
Department of Administrative Services
30 East Broad Street, 27th Floor
Columbus, Ohio 43215
800-409-1205 Toll Free
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