Who is Qualified to Receive Workers’ Compensation?

Oct 26, 2015

Qualifying for Ohio worker’s compensation payments requires meeting five criteria. It also requires NOT doing two things.

We will focus on these qualifying rules in this blog post. Columbus-based Agee Clymer Mitchell and Portman workers’ compensation attorneys provide much more information on the application process for, benefits of, and deadlines for the state program to compensate injured and ill employees here, here, and here.

DO #1: Your employer must pay into Ohio’s workers’ compensation system.

In its most basic form, Ohio Workers’ Compensation is a disability insurance program. Companies and, in some cases, self-employed individuals pay premiums directly to the program on behalf of employees, who are the beneficiaries.

All private employers must provide workers’ comp coverage to their employees. However, people who work in schools, at state or local government agencies, or for nonprofits may not be entitled to file and collect on workers’ compensation claims. If you do not know whether your employer pays into workers’ comp, ask your manager or human resources person.

DO #2: You must have gotten injured or fallen sick at work.

Job-related injuries, deaths, and illnesses can qualify individuals for workers’ compensation. The single-most important criterion here is “job-related.” A very brief list of situations that could qualify you to receive workers’ comp benefits includes:

  • Having a finger amputated while using equipment to complete a work task
  • Suffering broken bones in a traffic accident while driving from your office to meet with a business client
  • Experiencing a head injury while carrying items from your office building to the trash bin across the parking lot.
  • Developing a persistent lung infection while working in a building suffused with mold

Generally, workers’ comp is not available for stress, mental illness, self-inflicted harms, or health problems that develop while commuting to and from one’s job.

DO NOT #1: You cannot have been committing a crime.

If you get hurt while trespassing or breaking a law, you cannot collect on a workers’ compensation claims. Some leeway does exist for you to succeed with a claim, however, if your boss knew what you were doing and either said it was OK or did nothing to stop you.

DO NOT #2: You cannot have been drunk or stoned.

This kind of disqualification falls under the broader category of self-inflicted harm. Workers’ comp administrators assume that anyone impaired due to intoxication contributed too much to injuring him or herself.

DO #3: You must have a qualifying condition.

A complete catalogue of conditions that could qualify you for workers’ compensation probably does not exist. In general, suffering any of the following while working would make you potentially eligible:

  • Physical injuries, including burns, cuts, fractures, and dislocations
  • Amputation or eye damage
  • Hearing loss
  • Vision loss
  • Sickness requiring hospitalization

To qualify for coverage, the injury or disease must be severe enough to require medical treatment and to keep you out of work for a significant amount of time. “A significant amount of time” typically means at least a month.

DO #4: You must submit each piece of required paperwork by applicable deadlines.

All the forms you need to claim workers’ comp benefits exist on the Ohio Bureau of Workers’ Compensation (BWC) website.

You have two years from the date of the on-the-job incident that injured or sickened you to file an initial workers’ comp claim. This statute of limitations commences from the day the problem developed, not when you discovered the connection. This means that occupational diseases diagnosed years after work-related exposures to toxins or carcinogens do not qualify for workers’ compensation coverage.

Additional deadlines apply to requests for supporting information, appeals, and complaints. Missing just one filing deadline can automatically disqualify your claim.

DO #5: You must provide medical evidence.

Meeting this requirement to qualify for workers’ compensation benefits requires getting extensive documentation from your own doctors, nurses, pharmacists, and other health care providers. You will also need to undergo physical exams and assessments from at least one physician and one occupational specialist chosen by the BWC.

You should work with a Columbus, Ohio workers’ comp attorney.

This last step toward qualifying to receive workers’ compensation benefits in Ohio is technically optional. In reality, though, you should not try to navigate the workers’ comp system all on your own. Meeting the paperwork and medical evidence requirements often proves impossible for individuals who have not run the gauntlet of filings, hearings, and appeals many times.

The Agee Clymer Mitchell and Portman workers’ comp lawyers in Columbus, Ohio, have that experience, and they can answer your questions for free. Contact us before running the risk of losing the compensation you deserve for your work-related injury or illness.

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Worker’s Comp Lawyers Columbus, Ohio - Agee Clymer

140 E. Town St. #1100
Columbus, OH 43215