My Employer is Self-Insured. Does That Mean I Can’t Get Workers’ Compensation Benefits?
You’ve been injured or gotten sick at work, but your employer has not paid into the Ohio workers’ compensation fund. Will that affect your workers’ compensation benefits?
The short answer is no, not really. The Ohio Bureau of Workers’ Compensation (BWC) categorizes employers into two categories: State-Funded and Self-Insured.
A State-Funded employer pays a premium to the BWC, similar to a typical insurance policy. The employer, as part of its participation in the workers’ compensation fund, also picks a Managed Care Organization (MCO). Your employer’s MCO is not the same as a health insurance provider that you may get through your employer, though. An MCO is just for employees participating in the BWC’s workers’ compensation fund. Your MCO takes care of all things medical, such as:
- Paying medical bills
- Approving treatment
- Referring to specialists
- Deciding what benefits to pay to you, the injured employee
A Self-Insured employer is different. Instead of paying the BWC, which then would pay you through your employer’s MCO, a Self-Insured employer pays workers’ compensation benefits directly to you, the injured employee, through its own workers’ compensation insurance policy. If you have a Self-Insured employer and get hurt on the job, you and your medical providers have to submit documentation directly to your employer, which then decides:
- If medical services are allowed
- What treatments will be paid for
- What benefits it will pay you
Basically, your employer or its workers’ compensation insurance provider acts like an MCO. That does not mean government agencies are completely left out of the process. If you do not agree with your Self-Insured employer’s decisions, you can always file a C-86 motion with the Ohio Industrial Commission to force your employer to change its decision via a government order.
The Key Differences
State-Funded and Self-Insured employers essentially work the same way, but who makes the decisions on your benefits and medical treatment is different. What does this mean for you? It means you submit documents, requests for treatment, and requests for benefits to either your employer’s MCO or your employer directly.
Get Help Navigating the Workers’ Compensation Process
Working with your employer for your workers’ compensation benefits can be confusing, but knowing the BWC’s categorization of your employer can help de-mystify the process. Having a trusted attorney at your side is even better. After handling thousands of workers’ compensation cases, Agee Clymer has the answers to your questions and can help you get through the worker’s compensation process with ease. Call us at (614) 221-3318 or contact us today for a consultation.