Stock legal injury health xray

Getting injured and requiring medical care can be a scary thing. It can be even scarier if it happens at your place of work. While this is not a relatively common occurrence, when it does happen, it can lead to much uncertainty about what happens next.

Joe Hahn, independent contract worker and workers’ compensation attorney at Elk & Elk; David Steiger owner and managing partner of Karp Steiger in Woodmere; and Ben Wiborg, partner at Nurenberg, Paris, Heller & McCarthy in Cleveland, said there are a few vital steps an employee should take after an on-the-job injury.

Often, employers will require that an injured worker complete an incident report, Wiborg said.

But if that’s not an option, communicate that an injury happened or that an incident happened in writing as soon as possible, he said.

“There’s no Ohio law requiring that, but many employers require that per their handbook,” he said. “And a good way to get out of favor with the employer is by failing to comply with the recommendations contained in the employee-employer handbook.”

Hahn said one pitfall at the outset of work-related injuries is not reporting it at all. This might be because most people brush themselves off and assume they’re going to be OK. But oftentimes, there won’t be any witness to what happened, he added, and if something becomes much worse than it was on day one of the injury, it becomes extremely difficult to then get the claim allowed at a later date.

Another mistake Hahn cited is when injured workers will think they’re doing the right thing by not giving an accurate description of what happened in order to protect their employer.

“Those claims are extremely difficult to prevail on because an injured worker at the outset is nervous and thinks their employer will be mad at them,” Hahn said. “And then we have to go to a hearing later on and get the actual story. And employers, more often than not, will deny that claim.”

Including, but not limited to, these reasons are why Steiger said claims are often denied by either the self-insured employer or by the Ohio Bureau of Workers’ Compensation. This is where an attorney would come in and help the injured workers through the appeal process, he said.

“Sometimes, claims are denied because the description of what the employer believes happened is different from what’s in the medical records,” Steiger said. “Sometimes, claims are denied because the incident may not be an incident that occurred in the course and scope of the injured worker’s employment.”

The entity known as the Ohio Industrial Commission is the adjudicative branch for workers’ compensation decisions. So when a party disagrees with a decision from the Ohio Bureau of Workers’ Compensation and they file an appeal, that appeal is heard by the Ohio Industrial Commission which is essentially the judges of workers’ compensation disputes.

“So, my job is to assist the injured worker in getting a successful outcome at these industrial commission hearings,” Steiger said. “The way we do that is to make sure that we have sufficient medical evidence and we are aware of any legal issues that could come up regarding the dispute that’s being heard by the industrial commission. And we need to be prepared to argue both the medical and legal aspects of our client’s case before the industrial commission.”

So what happens when an employee wins a claim? Wiborg said the workers’ compensation system covers two major components, the first of which is medical expenses. Any treatment for an injury that happened on the job should be covered through the workers’ compensation system and not through health insurance, he said. Additionally, he said, the treatment is good indefinitely, so long as it’s considered to be reasonable and necessary. These treatments can include the initial emergency room visit, subsequent consultation, diagnostic tests such as X-rays, MRIs and CT scans, physical therapy, injections and surgery. One thing to take note of, Wiborg said, would be that it has to be done with prior authorization, unless it’s an emergency.

The other component to a claim is the financial compensation component. If somebody cannot work because of an on-the-job injury, that person is eligible to receive temporary total disability benefits, or “work comp benefits.” And those benefits are meant to replace income loss as a result of being unable to work due to an injury. These benefits would continue until the injured worker can return to work or their condition plateaued. After that, the checks would stop, but that’s not the end of the inquiry, Wiborg said.

Injured workers who are able to go back to work would later be eligible for a permanent partial disability award. That’s a one-time award meant to compensate an injured worker for the limitations he or she has as a result of an allowed condition.

“For example, if somebody tears an ACL and that gets surgically repaired, that person may go back to work, but the knee may never be the same,” Wiborg said.

The system has created a permanent partial disability award to provide some type of compensation for having that injury, and it’s as close as the system gets to pain and suffering, but it’s not technically that, he added.

Wiborg said if somebody gets hurt and cannot go back to work in any capacity, an attorney could pursue permanent total disability benefits, which is a check for the remainder of the injured worker’s life if they can show that the injury renders the injured worker incapable of any sustained employment.

Hahn said employees should always give accurate and detailed medical history to a treating provider. Sometimes, people will not give pre-existing problems and they won’t indicate that they’ve already had some sort of injury.

“You can get a claim allowed for substantial aggravation of a pre-existing injury,” Hahn said. “For example, a back problem or a torn meniscus. Something that has not bothered you in some time, and then is injured. And your employer will often go back and look to try and find something in the past that would preclude a new claim.”

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