Cincinnati Workers compensation Blog by Cincinnati Attorney
Many times injured workers do not know the full extent of their benefits. Often they want to sue their employer. An employee normally can not sue their employer unless the employer intended to hurt them. However there are many benefits available to the injured worker. But injured workers need to be careful because often no one tells them what benefits they are entitled to.
In Ohio Lawyers can become certified as specialists in Ohio worker's compensation.
Employees can seek the help of these attorneys normally on a contingency fee basis so that they do not have to fight the system by themselves in the dark.
I have listed below the benefits available, in addition to payment of medical bills and prescription medications.
Compensation Types
BWC offers a variety of compensation types. If your claim has been allowed you may qualify for compensation even if you have not lost time from work as a result of your injury. Some of the types of compensation are:
Temporary Total Compensation (TT)
TT compensation is provided to compensate an injured worker who is totally disabled from work on a temporary basis or a short period of time due to the work related injury or occupational disease. TT is generally the initial award of compensation paid to an injured worker to compensate for lost wages. Be careful because they will try to cut you off of this award even if you can not go back to your regular job.
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Percentage of Permanent Partial Award (%PP)
A certain amount of permanent damage (called residual damage) may remain as a result of the injury. %PP is commonly referred to as C-92 awards and is compensation awarded for residual impairment resulting from an allowed injury or occupational disease according to ORC 4123.57. For example, if an injured worker sustains a broken arm and can no longer extend it to the full degree, he would be eligible for an award based upon the residual loss. The permanent impairment may be physical, psychological or psychiatric.
%PP is not payable for any psychiatric condition(s) unless there is an allowed accompanying medical condition in the claim. C-92/C-92A awards are based on medical information and the findings of the exam/review. The C-92/C-92A determination is supported by an independent exam and the examining physician will not contact the injured worker’s doctor/provider of record for medical information. It is important to note that the initial award for permanent partial can be challenged and increased. The BWC initially only awards the amount their doctor specifies. An attorney specialist can have you evaluated by Doctors wgo specialize in evaluations and can often have this award increased.
Scheduled Loss (SL)
A certain amount of permanent damage (called residual damage) may remain as a result of the injury. A scheduled loss (formerly known as a permanent partial) award encompasses amputations and loss of use, including vision and hearing. A scheduled loss award is based on the loss suffered by the injured worker prior to treatment, not on the injured worker’s condition after treatment.
A scheduled loss award does not have to be requested on a Motion (C-86). A SL award can be requested on the First Report of Injury or identified during the initial claim investigation. Compensation for this type of award is based upon the nature of the injury as well as the year that the injury occurred.
BWC or the self-insuring employer will pay all initial awards of Scheduled Loss (SL) compensation under ORC 4123.57(B) . This includes payment of all scheduled losses (amputations), loss of use, ankylosis, loss of vision and total loss of hearing. These awards are commonly referred to as "Paragraph B" awards.
Permanent Total Disability (PTD)
Permanent Total Disability (PTD) is the injured worker’s inability to perform sustained remunerative employment due to the allowed condition(s) in the claim. The purpose of PTD benefits is to compensate the injured worker for impairment of earning capacity. Compensation for PTD is payable for life. When an injured worker applies for permanent total disability, he/she must attend an Industrial Commission examination and hearing to determine if he/she meets the eligibility criteria for this type of compensation.
Disabled Workers’ Relief Benefits (DWRF)
Disabled Workers’ Relief Fund (DWRF) is a separate supplemental fund established to provide relief to an injured worker who is receiving permanent total disability (PTD) compensation benefits by raising the cost of living level.
Change of Occupation (COA)
Injured workers who have contracted silicosis, coal miners’ pneumoconiosis or asbestosis may be entitled to a change of occupation award according to ORC 4123.57(D). These injured workers have been medically advised that a change of occupation is recommended in order to substantially decrease further exposure to silica dust, asbestos or coal dust.
Firefighters and police officers who have contracted a cardiovascular and pulmonary disease as defined in ORC 4123.68 may be entitled to a change of occupation award according to ORC 4123.57(E). These injured workers have been medically advised to change their occupation in order to substantially decrease further exposure to smoke, toxic gases, chemical fumes and other toxic vapors.
Wage Loss (WL)
Wage Loss compensation may be paid to an injured worker (IW) that suffers a reduction in earnings as a direct result of restrictions from the allowed conditions in the claim. Wage loss is payable in claims with a date of injury or diagnosis on or after Aug. 22, 1986.
Two conditions must be met to be eligible for WL.
A loss or decrease in wages exists.
The wage loss is a direct result of the restrictions caused by the allowed conditions in the claim.
There are two types of wage loss benefits that may be considered in a claim.
Working Wage Loss (WWL)
This is payable when the IW returns to employment other than his or her former position of employment. This would include return to work with the employer of record or a new employer with different job duties, less hours and less pay resulting from the physical restrictions.
Non-Working Wage Loss (NWWL)
This is payable when the IW is unable to find suitable employment. In order to qualify for NWWL the injured worker must demonstrate that he/she is making a good faith effort to secure employment within his/her physical restrictions.
Living Maintenance Wage Loss (LMWL)
LMWL may be paid to an injured worker with a date of injury on or after Aug. 22, 1986. The injured worker must have completed a rehabilitation plan and continues to have physical restrictions and experiences a wage loss upon return to work.
Living Maintenance (LM)
A type of compensation paid to an injured worker while they are actively participating in an approved rehabilitation plan. This section in the MCO Policy Reference Guide information about living maintenance (LM) payments which are provided to the injured worker in place of temporary total compensation when participating in a vocational rehabilitation plan. This information also includes information about suspending and terminating LM. When an injured worker is actively participating in a vocational rehabilitation plan, he or she shall receive living maintenance payments in place of temporary total compensation (OAC 4123-18-04 ).
ORC 4121.63 states that BWC will issue this compensation for a period not to exceed six months in the aggregate, unless BWC’s review reveals the injured worker will benefit by an extension. The CST can issue living maintenance upon receipt of the vocational rehabilitation agreement and plan.
Death Claims
A dependent's right to death benefits does not begin until after the death of the worker. If the decedent settled a workers compensation claim prior to their death, this will not stop the dependent's right to file a claim for death benefits. A death claim is filed by the dependents of an injured worker (IW) who died as a result of an industrial injury or occupational disease. Dependent death benefits will be based on the level of dependency or support each dependent had while the worker was living.
Death benefits can be divided into two categories. The first is when death results instantaneously as a result of an injury. The second is when death is not an instantaneous but a proximate result of an injury or occupational disease.
A managed care organization (MCO) can also report the death due to injury or disease by filing the claim via External Data Interchange (EDI).
Claims alleging that death is the result of an injury or occupational disease must be filed within two years of the date of death according to OAC 4123-3-08(D)(6)and ORC 4123.85.
Violation of Specific Safety Requirement (VSSR)
No employer will violate a specific workplace safety requirement established by legislation or BWC. The injured worker (IW) or dependent, (when there has been a fatality) may file an application for a Violation of Specific Safety Requirements (VSSR) award if there is evidence that a violation has or may have occurred from the failure of the employer to comply with a specific safety requirement. Ohio Constitution Article II 35, ORC4121.47(A), OAC 4123-3-20.
Lump Sum Settlement (LSS)
Per Ohio Revised Code (ORC) 4123.65, a settlement can be initiated only by the injured worker/injured worker representative, employer/employer representative or BWC. The managed care organization (MCO) is not a party to the settlement; therefore, the MCO may not initiate nor advise the IW to settle their case. However, an MCO may identify potential candidates for pursuit of settlement based on treatment patterns/trends.
The Settlement Agreement and Application of Settlement Agreement (C-240) is to be used by the injured worker or employer for the settlement of state fund claims. The purpose of this application is to document the agreement to the terms and conditions of the settlement. If you employer is self-insured, the settlement application should be filed on a SI-42 and be submitted to the SI employer.
If you would like more information in regard to settlements, contact an attorney certified as a specialist in ohio workers Compensation law, so you don't settle cheap.
Lump Sum Advancement (LSA)
A Lump Sum Advancement (LSA) is the prepayment of future compensation. Advancement applications will be reviewed for meeting financial relief and rehabilitation purposes only. Advancements may be requested by injured workers or dependents (in case of death) who are currently receiving Permanent Total Disability, Scheduled Loss or Death Benefits. Lump Sum Advancements may be requested on the following applications: IC-32, IC-32A and OIC-3016.
Requests for financial relief, such as household bills, estimates of emergency repairs or purchases, school tuition, handicap lift installed in an existing or new van, etc. must have supporting documentation attached to the application. Determination of attorney fees remains with the Industrial Commission (IC). All requests for advancement of attorney fees should be forwarded to the IC. After determination, the IC returns the request to the assigned BWC claims service specialist for processing.
by Anthony Castelli Attorney a certified specialst in Ohio Workers Compensation law . For more information go to his web site www.castellilaw.com/Workers-Compensation.html
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