Ohio BWC: Basics For Injured Workers

February 9, 2015 | Mark Newman, Ohio Certified Workers’ Compensation Specialist

Work injury claimInjured in the workplace?

Here are some basic things you should know to help you navigate the workers’ compensation system.

Know Your Rights:

Injured workers in Ohio, have the right to workers’ compensation benefits and high quality health care. Ohio laws require employers to provide workers’ compensation insurance for all employees. Your employer’s workers’ compensation insurance is state funded or self-insured. If your employer is state funded the claim will be managed by the Ohio Bureau of Workers’ Compensation and the managed care organizations that determine medical and return-to-work services. A self-insured employer manages its own claims and will pay worker’s compensation benefits directly to its employees.

Filing a Claim:

If you are injured on the job, you can simply fill out the First Report of Injury form and mail it in to any BWC office. You can also file your claim online or with your Managed Care Organization. In most cases, if you receive medical treatment at a hospital or urgent care, the facility will file a claim for you. You can check with the BWC to see if a claim has been filed. Your employer can notify the MCO to file a claim and your health care provider can also notify your MCO to file a claim. It is your responsibility to make sure a claim is filed.

Medical Process:

Injured workers have the right to receive medical treatment from a doctor of your choice as long as the doctor is a BWC certified physician. If your employer is state funded, you can choose from a list of pre-approved physicians provided by your managed care organization. If your employer is self-insured, you can contact your employer to obtain information about choosing the right physician for you. You can also select a doctor on you own.

Do I Pay For My Medical Bills?

After the claim has been approved, your health care provider should submit their bills to your managed care organization. The MCO will review and pay the medial bills if the treatment is necessary and appropriate. If you receive a bill in the mail contact your health care provider and notify them the treatment was related to a workplace injury. Give the health care provider the name and billing address of your managed care organization.

Compensation:

If you are unable to work for more than seven days due to your work injury you will be entitled to temporary total disability compensation. The first seven days of lost time are not payable until you lose 14 consecutive days. Your compensation is based on your earnings during the year prior to the injury. Temporary total is paid bi-weekly. You will receive temporary total until you return to work or reach maximum medical improvement. If you miss more than 90 days of work a medical exam may be scheduled.

 

Mark L. Newman, Attorney at Law | Twitter  | LinkedIn  If you have any questions about any of the information contained in this blog, contact Mark Newman via phone: 513-533-2009  or by email at mln@bpbslaw.com.  Advertisement Only

OHIO BWC Changes it’s Premium Collection Period

October, 2014 By: Mark L Newman, Cincinnati Workers’ Compensation Lawyer

Ohio BWCProspective Payment Timeline Announced for 2015!

Currently, Ohio employers pay their workers’ compensation premium for the previous six months of coverage (Example: Private employers paid in February 2013 for the July 1, 2012 to December 31, 2012 coverage period.)

This will soon change, as the BWC is transitioning to a prospective billing system that will provide more flexibility for employers while reducing overall system costs. Prospective billing is a national industry standard and builds upon ongoing efforts by BWC to modernize its operation. Under prospective billing, BWC will, like most insurance companies, collect employer premiums at the beginning of and throughout the policy period.

According to BWC the benefits of changing to the prospective payment process for Ohio employers will include:

  • More flexible payment options (e.g., monthly, quarterly, semi-annually and annually) with possible discounts for those who pay in advance.
  • Better ability to anticipate budgetary impacts of workers’ compensation program cost changes.
  • Better opportunities for BWC to provide quotes online or via phone.
  • Lower mutualized costs from employers who don’t pay premiums timely or have workers injured without coverage for employers in good standing.
  • Increases BWC’s ability to detect employer non-compliance and fraud.

The biggest benefit will be the savings. The BWC is providing Ohio employees a one-time transition credit of nearly $1.2 billion. The credit is being issued so the switch from the retrospective billing system to the prospective system will not cost the Ohio employers additional funds.

The transition is expected to become effective July 1, 2015 for private employers and January 1, 2016 for public employers.

For more information about Ohio Workers’ Compensation, contact Mark Newman, Ohio Certified Specialist Workers’ Compensation Lawyer.

 

Workers’ Compensation Benefits and Social Security Disability Benefits – How do they work together?

By Mark L. Newman, Workers’ Compensation and SSD attorneyImgae WC and SSD

If  you, as an employee, have a debilitating accident at work, there are insurance and government benefits available to you and your family. These include:

  • Workers’ Compensation
  • Social Security Disability Insurance
  • Supplemental Security Income
  • Medicare coverage

Even though the sources of these benefits differ (federal vs. state), they are interrelated and you may not be able to receive all benefits at their maximum amount. This is referred to as “offsetting.” The interrelationship with Social Security disability and Workers’ Compensation happens more frequently.

Let’s walk through what this means to you and how your benefits are re-calculated if you collect Workers’ Compensation benefits and file for Social Security Disability (SSD) benefits.

How and why would your Social Security benefit be reduced?  This is due to a law that says you can only receive up to 80% of your average current earnings (ACE) when receiving both workers’ compensation and Social Security disability benefits.  Simply stated:

If (Workers’ Comp benefit $ + SSD benefit $) > Average Current Earnings, your Social Security benefit will be reduced

So how do you calculate your average current earnings, or ACE? Your ACE is the average of either your highest consecutive 5 years of earnings at anytime during your work history, or the highest year of earnings within the 5 years prior to your disability.

For example: If you earned:

$45,000 in 2005
$47,000 in 2006
$48,000 in 2007
$50,000 in 2008
$46,000 in 2009

And you became disabled in 2010, $50,000 is the highest earnings for the 5 years before you became disabled.  To calculate your ACE, which is 80% of this number:

$50,000/12 mns = $4,166.66/mn * 80% = $3,333.33

Your monthly ACE = $3,333.33

Now, determine your monthly workers’ compensation amount.

For example: You receive $400.00 weekly in workers’ compensation benefits.  Multiply this by 4.3333333 (which is the formula Social Security uses to determine your monthly workers’ compensation benefit).

$400.00 x 4.3333333 = $1,733.33 is your monthly workers’ comp benefit in this example.

Lastly, calculate your offset or the highest SSD benefit you can receive (using this example.)

Subtract the workers’ compensation from your ACE to determine your offset.

$3,333.33 – $1,733.33 = $1,600.00

$1,600.00 represents the highest SSD benefit you could receive under this example.

Every case presents different facts.   It is crucial, however, that you report any and all changes (reductions and increases) to your workers’ compensation benefits to Social Security if you receive workers’ compensation and SSD, because each change can affect your benefit.  Keep good records of all communications regarding changes.

Since the benefits and qualifications can differ from case-to-case and state-to-state, it can be difficult to figure out the bottom line without a lawyer.

 

By Mark L. Newman, Attorney at Law | Twitter  | LinkedIn

If you have any questions about any of the information contained in this blog, contact Mark Newman via phone: 513-533-2009  or by email at mln@bpbslaw.com.  Advertisement Only

Mark L. Newman, Workers’ Compensation and SSD Newsletter

June 2014 Mark Newman Nwesletter

In my June newsletter, I discuss the following topics:

Enjoy reading and please feel free to contact me if you have any additional questions.

Contact Mark Newman for any questions you may have regarding social security disability. (513) 533-2009 | mln@bpbslaw.com | @MarkLNewmanAtty

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Thinking about filing for social security disability?

Social Security AdminBy Mark L. Newman, Cincinnati Lawyer Social Security Disability

Filing for and receiving Social Security disability is a long process, made more so by the fact that you have medical problems and may not be not working. Although some cases are approved at the initial level, many claims end up at hearing, and the time from the initial application to hearing can extend over two years.

In this recent article there were some interesting and current statistics about the Social Security Disability program. The article focuses on the Social Security’s disability program as it edges toward the brink of insolvency. The trust fund that supports the disability program is projected to run out of money in 2016.

So if you are thinking about filing for social security disability, here are a few facts:

  1. The amount you receive each month will be based on your average lifetime earnings before your disability began. It is not based on how severe your disability is or how much income you have.
  2. In 2007, the average processing time for a hearing was 512 days. It was reduced to less than 365 days in 2012 but has since crept back up above 400 days.
  3. There are 937,600 cases pending before administrative law judges, according agency statistics.
  4. Social Security employs a little more than 1,400 administrative law judges.
  5. By the time disability cases reach an administrative law judge, the claims have been rejected at least once and often twice by workers in state offices.
  6. Nearly 11 million disabled workers, spouses and children get Social Security disability benefits. That’s a 45 percent increase from a decade ago. The average monthly benefit for a disabled worker is $1,146.
  7. Nationwide, approval rates among judges have declined in recent years. In 2013, judges approved 56 percent of the cases they decided, down from 72 percent in 2005.

Contact Mark Newman for any questions you may have regarding social security disability. (513) 533-2009 | mln@bpbslaw.com | @MarkLNewmanAtty

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Ratings and Reviews

Mark L. Newman, a Fabulous Workman’s Compensation Lawyer!

In November 2006, I was injured on a field trip to a bowling alley that another teacher and I had taken our high school students on. I began medical care for my injury with my family doctor, but then after long delays on the submission of the necessary paperwork, and not being satisfied with the…

- (5 star review)