WHAT DOES IT MEAN TO HAVE A WORKERS’ COMPENSATION CLAIM?
By Laura Wilson
Gallon, Takacs, Boissoneault & Schaffer Co., L.P.A.
You were injured on the job. The Bureau of Workers’ Compensation or the Self-Insured Employer has
acknowledged your injuries. So, what does that mean exactly?
Logically, one would think it means you can get the treatment you need, that it would be covered, and
that you would be compensated accordingly for your injuries. Makes sense, doesn’t it?
But, having an established claim does not guarantee treatment or compensation without a fight. In fact,
all it means is that your injuries have been acknowledged as having occurred on the job. It does not
guarantee treatment or compensation for your injuries. For every treatment request, for every
condition requested, for every request of compensation, the Bureau of Workers’ Compensation, the
Managed Care Organization and/or the Self-Insured Employer have the ability to make an initial
decision. In a state funded claim, the Bureau of Workers’ Compensation will make the initial decision on
the claim. Once the claim is established, the Managed Care Organization will make the initial
determination on any treatment requests that are submitted. The Bureau will address compensation
and any additional conditions that are diagnosed. In self-insured claims, it is the self-insured employer
that addresses all requests. While it certainly does not make sense, there are times where injured
workers will find themselves with an established workers’ compensation claim and yet still not able to
get the treatment or compensation they are rightfully entitled to and desperately need.
There is good news, however. While the Bureau, the MCO and the Self-Insured Employers have the
initial decision making ability, none of them have the final say. You have the right to appeal a denial and
request a hearing before the Industrial Commission of Ohio.
To say that maneuvering through the workers’ compensation system in Ohio is difficult is an
understatement. That is why we are here to help. If you have been injured on the job, do not hesitate
to contact the attorneys at Gallon, Takacs, Boissoneault & Schaffer Co., L.P.A. We will fight for you to
get the benefits you deserve.