An Overview of Workers' Compensation
While most employers take numerous steps to keep the workplace safe and healthy, injuries and accidents happen occasionally. Workers' compensation provides pay and benefits for workers injured while working, and also saves employers' liability and medical expenses.
Workers' Compensation Defined
Workers' compensation is insurance that replaces an employees' compensation and medical benefits when they become injured on the job.
Employers contribute to a common state insurance fund which compensates workers on the job. In turn, they are relinquished of the right to sue their employer for negligence, and are immune from full liability if an employee is injured while employed. Employers who do not obtain coverage may be disqualified from lawsuit protections afforded by the workers' compensation system, and may be subject to statutory penalties and personal liability.
In Ohio, all private and public employers with at least one employee are covered under the law, and nearly all Ohio employees must be covered by workers' compensation insurance. Ohio employers can obtain insurance coverage through Ohio's state fund or through self-insurance programs. The Ohio Bureau of Workers' Compensation (BWC), specifically, provides workers' compensation insurance coverage for work-related injuries, diseases, and deaths to employees in the State of Ohio.
Workers' Compensation Claims Process
The workers' compensation claims process can be time-consuming and requires accuracy and timely reporting. Below are the five (5) steps employees must take in a workers' compensation claims process in Ohio.
- The employee must tell their employer that they have been injured and would like workers’ compensation benefits.
- After seeing a healthcare professional, a formal claim will be filed on behalf of the employee by the health care provider online or with the managed care organization (MCO).
- Upon receipt of the claim, the BWC issues a claim number (immediately if filed online) and the investigation begins.
- The BWC allows or denies the claim after its investigation.
- If the employee believes the employer declines the reasonable claim, they can appeal to the Bureau and request a hearing.
Intersection with Other Employment Laws
Employers need to be aware that a single work-related injury can intersect with other employment laws, and afford an employee other rights, for example, under the Family and Medical Leave Act (FMLA), Americans with Disabilities Act (ADA), or other federal or state law. If more than one statute applies to the situation, then the injured worker must be afforded all the rights under each applicable statute.
Employers should first determine the employee’s workers' compensation rights, then separately determine the employee’s FMLA and ADA rights.
HR's Role in Workers' Compensation
HR's primary role in workers' compensation is to develop and implement workers' compensation policies and procedures; keep updated with important workers' compensation-related dates and deadlines; ensure that workers' compensation is administered lawfully in connection with FMLA and ADA policies and procedures; communicate with employees that have workers' compensation claims; communicate with legal counsel; and supply information to upper management in order to resolve workers' compensation litigation or address systemic issues.
In addition, HR generally needs to:
- Inform their workers' compensation insurance carrier about the injury as soon as possible.
- Thoroughly investigate all accidents and injuries immediately following to make sure they are work-related. Identify witnesses.
- Write up an incident report and make sure the employee signs it.
- Evaluate whether other laws apply to the situation, such as FMLA and ADA.
- Treat employees on workers' compensation fairly and equally to avoid issues of discrimination or retaliation.
- Stay updated with the employee's progress during their medical treatment.
HR is also typically responsible for making sure that any discipline, termination, or other adverse action taken against an employee on workers' compensation is lawful. Because these actions can create legal issues and complications, it is strongly recommended that HR seek legal advice prior.
In larger organizations or in cases where the incidence of workers' compensation claims is high, employers generally find it useful to employ an HR professional with specialized knowledge of workers' compensation.
These are just the basics of workers' compensation, and specifically, Ohio's system. It is critical for the employers to be familiar with local and federal regulations regarding workers' compensation and comply with them to avoid unnecessary lawsuits and provide appropriate insurance to the employees.
References: SHRM (2013). Managing Workers' Compensation Costs and Caseload; Ohio Bureau of Workers' Compensation; Lexis Nexis (2013). The Basics of Ohio Workers' Compensation; BNA (2011). Ohio Workers' Compensation Overview
Please note that by providing you with research information that may be contained in this article, ERC is not providing a qualified legal opinion. As such, research information that ERC provides to its members should not be relied upon or considered a substitute for legal advice. The information that we provide is for general employer use and not necessarily for individual application.
Workers' Compensation Managed Care Organization
ERC endorses CareWorks as the preferred workers’ compensation Managed Care Organization (MCO) for members. CareWorks can deliver substantial medical savings through provider network discounts. These discounts can help employers reduce claim costs and help control future premiums,”
Workers' Compensation Cost Management
ERC's Preferred Partner, ERSco, works with employers to identify workers’ compensation claims that have the potential to generate the greatest losses and focuses on controlling all associated costs. ERSco is able to do this by providing legal expertise as well as financial/risk expertise in a coordinated effort with an MCO to truly control the total cost of risk.