Self-Insured Workers Compensation

Self-Insured Workers Compensation

What Does It Mean When My Employer Is Self-Insured for Ohio Workers’ Compensation?

The Ohio Bureau of Workers’ Compensation (BWC) permits a small number of companies to self-insure themselves against workers’ comp claims. Such an arrangement can make securing workers’ comp benefits a little tougher, but the basic rules regarding who can apply and which criteria must be used to grant or deny a claim remain the same.

The biggest difference for a worker is that all initial decisions regarding their workers’ comp claim will be handled within the company. This is opposed to in the standard situation, called a “state fund” claim, where an injured or ill worker will spend most of their time dealing with the BWC.

A self-insured employer is completely responsible for

  • Allowing or disallowing claims,
  • Paying compensation and benefits,
  • Keeping all relevant records,
  • Answering questions from the injured or ill employee regarding their claim, and
  • “Assisting employees in filing their applications for benefits and completing the necessary forms for processing a workers’ compensation claim.”

Equally importantly, a self-insured employer has legal duties to clearly inform its employees of this fact. Requiring an employer to disclose its status as self-insured for workers’ comp claims is intended to minimize delays and confusion for workers who have grounds for applying for benefits.

Why Are Some Employers Self-Insured for Workers’ Compensation?

The short and accurate answer is money.

The fees that the BWC charges Ohio employers reflect the number of employees and the value of approved claims. Companies that employ thousands of people end up paying large sums into the state workers’ compensation fund each year. Self-insuring for workers’ comp claims has the potential to reduce employment costs.

But—and this is a big but—companies that opt to self-insure only really save money if they deny a large share of applications for workers’ comp benefits. This means that a self-insured company has a financial incentive to strongly contest and find reasons to reject claims for the coverage of medical bills and the replacement of lost wages.

An initial rejection does not have to stand as a final answer, however. Employees of self-insured employers in Ohio can appeal rejections of workers’ comp claims. Such appeals can be pursued with representation from a lawyer who has experience helping people who suffer work-related injuries or who develop occupational illnesses.

Additionally, a worker whose injury or illness was caused by a negligent third party such as a driver who does not work for the same company or the maker of a defective tool may have grounds for filing a personal injury lawsuit. Speaking with an attorney will clarify whether this a viable option.

A Note on Ohio Workers’ Comp Coverage for Sole Proprietors, Independent Contractors and S-Corps

The BWC makes provisions for individuals who do not work for traditional employers to purchase what the bureau calls elective coverage. Different types of elective coverage policies exist for each of the following people with nontraditional employment arrangements:

  • Sole proprietors,
  • Partners in a partnership.
  • Members in limited liability companies,
  • Family farm corporate officers,
  • Individual who have incorporated but employ moo me but themselves, and
  • Ordained or associate ministers for recognized religious organizations.

Carrying elective coverage is completely voluntary.

When a person who purchases their own Ohio workers’ comp policy has a claim, they apply to the BWC for benefits. The firm that issued the elective coverage policy will also be involved in processing the claim.

Based in Columbus, attorneys with Agee Clymer are available to advise and represent employees all across the state. Whether you are applying to the BWC or dealing with a self-insured employer, you have the right to consult with and hire a dedicated workers’ compensation attorney.

Let us know how we can be of service by reaching out online. If you would prefer to speak with a layer directly, call us at (614) 221-3318 or (800) 678-3318. The first consultation is free.

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Worker’s Comp Lawyers Columbus, Ohio - Agee Clymer

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