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Halloween is almost here! It's the season for ghosts, goblins, witches, vampires, haunted houses and things that go bump in the night.
But at The Law Offices of Kurt M. Young, LLC, we've spent more than three decades dealing with something that can be even scarier than a haunted house or hordes of rampaging zombies:
An Ohio workers' compensation claim gone wrong! đť
We've seen claims turn into nightmares because of missed deadlines, incomplete paperwork, misunderstood rules, misunderstood roles, and mistakes that could have been avoided.
So, in the spirit of Halloween, let's take a tour through the Haunted House of Ohio Workers' Compensation and look at some of the frightening mistakes injured workers should avoid.
đť Ghost #1: The Disappearing Injury Report
âI didn't think it was that serious, so I didn't tell anyone.â
Famous last words. One of the biggest mistakes injured workers make is failing to report an injury promptly.
Maybe you think the pain will go away. Maybe your supervisor tells you to wait a few days. Or maybe you don't want to cause trouble.
But when you finally seek treatment, the employer may question whether the injury happened at work.
This is a fast moving and very busy system that makes some snap judgements. The BWC actually published a list of red and green flags to decide if to allow or deny a claim. Guess what was one of the top red flags, not reporting this to someone and being unable to prove you did.
How to bust this ghost: Report workplace injuries as soon as possible, preferably in writing. Keep a copy of the report and document when, where and how the injury occurred. The copy is key, they tend to disappear faster than a ghost when someone with a camera shows up.
Besides helping your employerâs safety team to prevent injuries to others, it helps you win your claim.
And remember, reporting an injury to your employer is not the same thing as filing a workers' compensation claim with the Ohio Bureau of Workers' Compensation (BWC).
For most Ohio workplace injuries occurring on or after September 29, 2017, the general deadline to file a claim is one year from the date of injury. Certain occupational diseases and other circumstances have different rules.
Don't let the statute of limitations sneak up behind you!
đ§ Zombie #2: The Injury That Keeps Coming Back
âMy back hurts, but I only told the doctor about my shoulder.â
Sometimes a workplace accident injures more than one body part.
Unfortunately, if your medical records only document one injury, getting other conditions recognized later can become much more difficult.
In Ohio workers' compensation, the specific medical conditions allowed in your claim matter.
For example, a claim allowed for a lumbar sprain does not automatically cover every possible back condition.
How to avoid this zombie: Tell your doctor about every body part injured in the accident, describe your symptoms accurately and make sure the medical records reflect what happened.
You are required to put the employer and Bureau on notice within one year of the date of injury on all body parts that you injured. If not we cannot get them added by direct cause or aggravation of a pre-existing condition. That other body part can only be added as a flow through.
Whatâs that? The allowed conditions caused another condition. Weâre not convincing many hearing officers that your shoulder injury caused your back injury.
So, if the medical records have you complaining about a body part and get into the BWC claim within the first year, those body parts have the best chance of being cared for.
If additional conditions are diagnosed later, ask whether they should be requested as additional allowed conditions in your claim.
A workers' compensation claim can have more twists and turns than a zombie movie. Good medical documentation helps keep everyone on the right path.
đ§ Vampire #3: The Doctor Who Doesn't Document How and How Bad You're Hurt
âMy doctor knows I can't work. I don't need anything in writing.â
Oh, yes, you do!
In Ohio, an injured worker's eligibility for temporary total disability compensation generally depends on appropriate medical evidence showing that the allowed conditions prevent a return to the former position of employment.
Your doctor's medical documentation matters.
How to avoid this vampire: Get a BWC Certified Doctor of Your Choice, keep your medical appointments, explain your symptoms and limitations accurately, and make sure your physician completes the appropriate disability documentation, including the Medco-14 when required.
And make sure it is the MD, DO, DC or PhD doing the paperwork. Nurse Practitioners and Physiciansâ Assistants are vital to proper medical care. But Ohio law says once we pass six weeks from the date of injury, their restrictions canât be used to grant or deny Temporary Total or any other benefit.
So, don't assume that because your doctor told you to stay home, the BWC automatically knows about it. They donât and they donât have to pay unless a doctor who sees you fills out the forms right.
Vampires (and doctors) may dislike paperwork, but Ohio workers' compensation certainly doesn't.
đ¸ď¸ Spiderweb #4: The Tangled Web of Missed Appointments
âI forgot about that medical examination.â
Ohio workers' compensation claims can involve appointments with treating physicians, independent medical examiners, specialists and vocational rehabilitation providers.
Missing appointments can delay treatment or benefits. Depending on the circumstances and applicable rules, failing to attend required examinations can also jeopardize compensation.
How to avoid this web: Keep a calendar, open your mail, read notices carefully and communicate promptly if you cannot attend an appointment.
And if you move, make sure the BWC, your employer or self-insured employer's representative, and ESPECIALLY your attorney, have your current contact information.
Sometimes the scariest thing in a workers' compensation claim isn't a monster.
It's an unopened envelope and a not communicated change.
đ§ Witch #5: The Magical Light-Duty Job Offer
âMy employer says I have to come back to work tomorrow, even though I'm still hurt.â
Returning to work after an injury can be complicated.
An employer may offer a light-duty position. Whether that offer affects temporary total disability compensation depends on several factors, including the medical restrictions and whether the job offer satisfies Ohio's legal requirements.
How to avoid this spell: Don't ignore a job offer, and don't assume that every light-duty offer is automatically valid.
Donât say no because no one has ever done that before at my job or that isnât my normal job. That doesnât matter, the employer is allowed to create a temporary or permanent position for you that your doctor deems safe.
Have your treating physician review the proposed duties and restrictions, and seek advice before rejecting an offer or returning to work outside your medical limitations.
And guess what? Medically, an injured worker going back to a safe light duty job is better for your body, your mind and your pocketbook.
There's no magic wand that makes an injured back healthy just because the employer wants you back on Monday.
đ Pumpkin Head #6: The Social Media Monster
âIt's just a picture of me having fun. What's the problem?â
Social media can become an unexpected source of evidence in a workers' compensation dispute.
An injured worker may post pictures or videos that, without context, appear inconsistent with reported medical limitations.
That doesn't mean injured workers must sit in a dark room doing absolutely nothing.
But it does mean that what you post can be misunderstood or used to challenge your credibility.
How to avoid this monster: Be truthful about your limitations, follow your physician's restrictions and think carefully before posting pictures, videos or comments about physical activities.
And remember privacy settings don't necessarily make a social media post private forever. And they can and occasionally follow you around in public.
The Masked Specter #7 â Not Understanding the roles of all who have something to do with your claim.
A staple in funny, like Scooby Doo, or scary like Scream and Friday the 13th movies and TV shows is the masked villain.
Once you know who the man or woman in the mask is, you generally have a better chance of surviving and defeating them.
Well, not understanding who the parties are and who they work for is scarier than any masked villain.
The Ohio Bureau of Workersâ Compensation is not neutral. To use the words of the last three heads of the BWC to a room of lawyers like me, we are a big boy insurance company, and we will fight these claims vigorously.
Donât want to believe me, Google Ohio Revised Code 4123.511 & 512. That is the law on hearings and court appeals. BWC is a required defendant to all claims.
So, treat them like that, have your lawyer talk to them and ask your lawyer not the BWC for advice.
The Managed Care Organization (MCO), if you have one on your claim, self-insured employer claims donât, arenât truly there to help.
They are around to get you back to work with the least cost to the employer.
They get picked by your employer who can change them if they are not happy. And they get paid by the BWC.
And if you want proof of them working together, get BWC website account and go into the notes screen of your claim. You can see what they say to each other and write about you.
The Third Party Administrator (TPA) is the employerâs non-attorney representatives. They do the BWC & MCOâs job in self-insured (or SI) claims. Again, not there for you. In all claims they are there to fight what needs fought and keep the employerâs premiums low. Not all things they do are bad, but their first duty is to your employer.
The HR manager at work is not there for you in this situation. Donât get me wrong, they can be a very helpful person when they are looking out for you. But their primary job is to protect the employer, not you.
Oh, and your doctor, make sure you pick them. Some doctors are wolves wearing a sheep mask. You get to pick.
You are allowed to treat with any Ohio BWC certified doctor. How can you tell instantly if you are with one â the employer, TPA, or MCO listed them. Or the clinic the work at is named Occupational this or Work that.
Now I am not saying Occupational Health doctors are not good physicians, but their training is to reduce workersâ compensation costs to your employer.
Fixing you and getting you back to work can beat that, so they make powerful allies when they side with you.
But wait until an x-ray, MRI, CT scan or the like shows some mild aging issues and watch them throw you under the bus.
đ The Final Fright: Trying to Navigate the Haunted House Alone
Ohio workers' compensation can be confusing. It wasn't meant to be that way. The intent was not to be what we are.
But about 25 years ago the Ohio Supreme Court said it may be a good idea to let lawyers specialize in certain complex areas of law like doctors do. So they contacted the legal organizations of the state of Ohio and said put together a pitch on why it is needed and how you would certify them and we'll consider it.
The first one to get that approval was the Ohio State Bar Association on Ohio Workers' Compensation Law, and Kurt was part of the first class of attorneys to earn that certification.
Between the BWC, managed care organizations, self-insured employers, medical providers, the Industrial Commission, claim forms, deadlines and hearings, it's easy to feel like you've wandered into a haunted maze.
But you don't have to know every rule to protect your rights.
For more than three decades, The Law Offices of Kurt M. Young, LLC has helped Ohio's injured workers navigate the system.
We've handled thousands of hearings, dealt with countless medical and legal issues, and helped working families understand what can sometimes seem like a frighteningly complicated process.
And while we can't promise to keep ghosts, goblins or vampires away from your front porch this Halloween, we can help you understand your rights under Ohio workers' compensation law.
Oh, and the graphic this week? Thatâs Kurt and his wife Cheri, who on behalf of her church went to the first Toledo Area Zombie Crawl and gave out free candy to the zombies and fleeing humans alike.
đŹ Our Halloween Advice?
Enjoy the costumes.
Enjoy the candy.
Enjoy the haunted houses.
But if you're injured at work, don't let a preventable mistake turn your workers' compensation claim into a nightmare.
Happy Halloween from The Law Offices of Kurt M. Young, LLC! đđťâď¸
This article provides general information about Ohio workers' compensation law and is not legal advice. Individual claims depend on their specific facts and applicable law.
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