How long does it take to settle a Workers’ Comp claim?

How long does it take to settle a Workers’ Comp claim?

Cases involving workers’ compensation can occasionally be resolved quickly (within a few weeks or months), but most can take years to settle.

On average, a workers’ compensation case will be settled within 16 months. A resolution could lead to a court hearing or a settlement agreement. Under 20% of cases are resolved in the first 6 months. Most workers—roughly half—complete their claims within 13 to 24 months.

Each case is unique and will have a different time frame for settlement.

%

Cases resolved within 6 months

%

Cases resolved within 13-24 months

Can my Workers’ Comp case settle without a lawsuit?

In short, yes, but you may be losing some of your potential benefits from the case. If you can resolve the dispute without resorting to litigation, it will often greatly speed up the entire process. Without going to court, agreements can be reached in months.

Keep in mind that requests for workers’ compensation payments are considered claims for workers’ compensation. If you haven’t yet filed a lawsuit, you may still be able to make a claim for benefits.

Before filing a lawsuit, workers (and their attorneys) will frequently attempt to reach an agreement with the workers’ compensation insurance provider. This strategy is often successful, but if it fails, it may take more time because it delays the filing of your workers’ compensation complaint.

But just because an out-of-court settlement is quicker does not imply that it is always the right line of action. In many cases, you will need to file a lawsuit in order to receive the compensation you deserve to compensate you for your work injury.

Things that affect the average time to settle a Workers’ Comp case:

  • Type of injury
  • Recovery time from the injury
  • Whether you have a complete, partial, or full recovery from the injury
  • Involvement of a lawyer (or not)
  • Negotiation or acceptance of the funds offered to you
  • If the case goes to hearing
  • Whether you need to file an appeal

Longer Workers’ Comp cases often lead to higher settlements or awards. This is not always the case, but it’s important to remember that in the long run, it’s not a bad thing to have a case that takes a while to settle.

Do insurance companies prolong a Workers’ Comp settlement?

Since the insurance company typically covers the cost of workers’ compensation benefits, their actions have a significant influence on how the case progresses.

The case’s timing may be greatly impacted if an insurance company (or its lawyer, or the employer) is slow to assess the case, follow up, or set deadlines.

If an insurance company challenges the rate of permanent impairment that has been awarded to you, for instance, cases will typically take longer. The length of the case can alter significantly if your doctor determines that your disability is 30% while the doctor for the insurance company determines that it is 10%.

The impairment rating is the key area of focus for insurance companies since it significantly affects how much you are entitled to in workers’ compensation claims. If the permanent disability rating is contested, the case will frequently take close to an additional 5 months.

Insurance firms analyze claims and often handle numerous claims at once. Processing all of that data requires time and might result in severe process delays.

Here are some common delays for Workers Comp cases:
  • Slow response times
  • Lack of response from an attorney
  • Slow responses from hospitals and clinics to send medical records
  • Ignoring requests for medical treatment
  • Difficulty getting in to see a particular doctor or specialist
  • Delays in scheduling important events (i.e. independent medical examinations(IME) or depositions)

There are instances where an insurance company will purposefully hold up your claim, even though many of these delays are just a normal part of a workers’ compensation case. They might do this to irritate the employee in an effort to get them to drop their claim or settle for less money. Always consult a lawyer before accepting a lump sum settlement.

Should I accept a lump sum settlement for my Workers’ Comp claim?

It’s crucial to keep in mind that if you are awarded a lump-sum settlement, you’ll no longer receive weekly checks to replace your lost wages, medical expenses, or both.

Settlements can occasionally be helpful in shortening the payment timetable, notwithstanding their downsides. For years, you won’t have to be concerned about the employer’s insurer carefully examining your condition. If you recuperate and do not have a permanent handicap, you may also go back to work and keep the settlement.

When it comes to work-related injuries, every situation is unique. To determine whether a lump sum payment makes sense for your settlement offer, it is actually best to speak with your lawyer about your disability benefits, medical expenses, and long-term outlook.

Get an experienced Ohio Workers’ Comp Attorney on your side

As one of the first attorneys in the State of Ohio to be board certified as a specialist in Worker’s Compensation Law, Tom Marchese has the knowledge and experience to greatly benefit your case. He will personally handle every aspect of your case. It won’t be passed off to a junior associate, and it won’t be treated like any other file in a stack. He will support you throughout the process, from consultation to resolution.

Whether you need to file a new claim, your claim was denied, or you need to appeal a denied claim, contact Thomas Marchese. To discuss a potential settlement amount or the time frame for your settlement, call today.

Additionally, here are steps to take after a workplace injury.

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Workers’ Compensation Frequently Asked Questions

Workers’ Compensation Frequently Asked Questions

In this article, we’ll answer some of the questions that we hear most often.

1. What is a workers’ comp injury?

“An injury whether caused by external or accidental means or accidental in character and result received in the course of and arising out of the employee’s employment.” More simply; an injury that occurred either at your place of employment (on-site or off-site) during your working hours while on a job-related task.

2. How do I file a workers’ compensation claim?

The injured worker or their workers’ comp attorney, as well as employers and medical providers, can all file a claim online at the BWC Website or by manually completing the First Report of Injury (FROI) form and filing it with any BWC office.

3. How long do I have to file a workers’ comp claim?

In Ohio, you have one year from the date of injury or death to file your workers’ compensation claim. However, we recommend you file as soon as possible following the incident.

4. Does every workers’ comp claim require a hearing?

No. Hearings are held only when there is a dispute between the injured worker and the employer.

5. How will I be notified of a hearing?

A notice will be sent to you at least 14 days prior to the scheduled hearing date.

6. How is my weekly rate of pay determined?

The first 12 weeks of disability (if needed for the long) are based upon your full weekly wage. This is determined by taking an average of your earnings for the six weeks prior to your injury or the earnings for the week prior to your injury, minus any overtime. The higher of these two figures is considered your full weekly wage. Your weekly rate of pay is determined by taking 72% of that number.

After the first 12 weeks of disability, the weekly rate of pay is based on your average weekly wage. This is determined by the average of the earnings for the entire year prior to your injury. The rate of pay is determined by taking 66.66% of that number.

It is important to note that there are minimum and maximum rates applicable to the year you were injured.

7. What is the difference between an MCO and the BWC?

The BWC is the Ohio agency that is responsible for Ohio’s workers’ compensation system. They make decisions regarding claim allowances and handle any issues with the payment of benefits.

The MCOs are private companies either selected by or assigned to each state-funded employer to medically manage an employer’s workers’ compensation claims and make treatment decisions and coordinate medical care.

8. How do my medical bills get paid if I’m collecting workers’ compensation?

Once your claim is approved, the medical providers who have treated your injury should submit their bills for payment to your MCO, who reviews the bills and then sends them electronically to the BWC, who then disburses payment to the medical providers. If you receive a bill, contact the medical provider and advise them the treatment was for a work-related injury. Give them the name and address of your MCO and ask that they forward the bills there.

9. How do I get reimbursed for medications I’ve paid for?

If the pharmacist sent the bill information to RxNet then you do not need to do anything. You will be reimbursed once your claim is approved. If you paid cash for your prescription and the bill information was not sent to RxNet, you will need to have your pharmacist complete and submit a C-17 form.

10. What happens to my workers’ comp claim if I move out of state?

Although hearings on your claim are only held in Ohio, medical and compensation benefits are paid regardless of where you live.

Have more questions? Contact us. Getting workers’ comp for injuries sustained while working can be a complex process. An experienced workers’ compensation attorney can advise you of your options and protect your legal rights at every stage in the process.

Schedule your free consultation with attorney Thomas Marchese today. Workers’ compensation is all we do.

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What to do when your workers’ compensation claim is denied.

What to do when your workers’ compensation claim is denied.

Just because you received a denial for your workers’ compensation claim, doesn’t mean you’re out of options. You may still be able to file an appeal.

A workers’ compensation denial letter can be a disheartening experience. You were injured on the job and you struggled while waiting for your benefits to come through, and then…nothing. No benefits, and no explanation as to why your claim was denied.

If this sounds familiar, you are not alone. Employers and the BWC routinely deny injured workers’ claims for benefits. Sometimes these denials are legitimate and other times they aren’t, but injured workers who have been denied compensation should promptly evaluate their options for filing an appeal.

Let’s start with the basics.

Why Was I Denied Workers Compensation Benefits?

For now, let’s assume that you’re entitled to workers’ compensation, meaning you’re an employee who was injured on the job.
There are several reasons why your claim may be denied or reduced. Below are some common reasons that can potentially be overcome by filing an appeal:

Your Injury or Illness was (Supposedly) Not Job-Related

Employers and the BWC will often deny workers compensation claims, many times in error, on the basis that the employee’s injury or illness was not job-related. You may have simply failed to present evidence that was available to prove your benefits.

You Missed the Deadline to Report Your Injury or File for Benefits

The deadline for reporting your injury and filing for workers’ compensation is based on the date that your illness or injury occurred. However, this isn’t always as straightforward as it might seem. You should report your injury immediately to your supervisor and the statute of limitations for filing a worker’s compensation claim in Ohio is one year. If you missed a deadline, you should speak with a workers’ compensation attorney to find out if you’re still eligible for benefits.

You Submitted an Inaccurate or Incomplete Claim Form

If you submit a claim form with incomplete, inaccurate, or inconsistent information, you may be denied benefits. These deficiencies can be overcome, but you cannot expect your employer the BWC to deal with them for you. Speak directly to a workers’ compensation attorney to discuss your options.

You Had Drugs in Your System at the Time of Your Injury

If you had alcohol, prescription medications, or illegal drugs in your system during your medical examination, there is a chance that the employer or BWC will try to use this against you. However, there are points to be argued. Were you under the influence when you were injured, and if so, was this a factor in the injury?

How Can I Appeal My Workers Compensation Denial?

If you’ve been denied workers’ compensation benefits, you have options. To determine the best steps to take, you need to understand why your workers’ compensation claim was denied. Whether due to a simple mistake on your part or the part of your employer or the BWC, appealing your denial may be as simple as straightening things out through a phone call.

However, in many cases, appealing a workers compensation denial means filing a formal appeal. This process usually begins with submitting an appeal to the Industrial Commission. While this is something you can do on your own, it’s a task best handled by an experienced work injury attorney. You may need to present your case to a hearing officer, and if they agree that you are not entitled to benefits, you may need to take your case to court.

Speak with an Attorney about Your Denial
If you need help understanding your rights after a workers compensation denial, call Tom Marchese. We’ll walk you through all of your options and begin appeal proceedings.

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Remote work was already on the rise in Ohio before the pandemic. Now, many are working partially or fully from home, and while this is a win for flexibility, it also raises questions about the workers’ compensation system, especially if you’re injured during work hours. You could be left wondering, can I get workers comp if I’m a remote worker?

The short answer is yes, however, proving that you were on the job when the injury occurred can be difficult, to say the least.

Workers’ comp protects the worker, not the workplace

To simplify this, you are protected by workers’ comp whenever you’re on the job, meaning that you’re working on the clock doing job-related activities, regardless of where the location may be. This is how workers’ compensation protects traveling employees like delivery drivers.

For remote workers, your home is no different from any other location where you perform work activities. You’re still on the job, therefore any injuries sustained while on duty are still covered by workers’ comp. The problem is that the line between “on duty” and “off duty” can become blurred, so your employer, as well as the Bureau of Workers’ Compensation, may have grounds to dispute whether you were “on the job” at the time the injury occurred.

“acting in furtherance” vs. “personal comfort”

Essentially, if you’re actively doing your job or job-related tasks at the time of the injury, you’re entitled to workers’ comp. For example, let’s say you received a work-related phone call and tripped while walking to the phone, that should be a compensable injury. Or, if you received a delivery of work materials and were injured while carrying them into your home, that too should be a compensable injury. However, there are always gray areas.

“Acting in furtherance” basically refers to any work duties intended to administer to an employee’s “personal comfort”. For example, if you were injured while going to the bathroom or getting a drink during your workday, that injury should still be compensable. The law recognizes that workers are human beings with basic needs which are required for the employee to do their job effectively, thus satisfying the basic “acting in furtherance” principle.

However, the “personal comfort” doctrine only goes so far. Let’s say you were injured while performing a task that was well outside your work duties and was not considered a job-related task, your injuries may not be compensable. For example, if you were hurt while throwing in a load of laundry or getting your personal mail during your workday, that is probably not covered by workers’ comp.

What to do if you’re injured while working from home

As with any work injury, there are steps that need to be taken to ensure that you have the greatest chance of getting a workers comp claim approved. First, you need to report the injury to your supervisor as soon as possible. In a remote work situation, you will probably need to call your manager on the phone to make that initial notification, however, you should also send an email or other written communication as well, to make sure you have it in writing.

Next, seek prompt medical attention. Tell the doctor who sees you that you were hurt while working, and describe your symptoms in detail. This not only protects your health but also creates a record of your injuries which supports your claim.

Then, contact us. Getting workers’ comp for injuries sustained while working from home is an often complex process. An experienced workers’ compensation attorney can advise you of your options and protect your legal rights at every stage in the process. Schedule your free consultation with Thomas Marchese today.

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For anyone injured on the job, workers’ compensation can serve as a lifeline.  If you find yourself in this situation, you probably feel stressed about the uncertainty of the future, wondering how you will pay medical bills along with other daily expenses.

Filing a workers’ comp claim can help you and your family with these expenses so that you can focus on your recovery. However, workers’ comp claims are often complex and those who are unexpectedly hurt and unable to work often don’t know how to properly file a claim. That is what we’ll discuss in this article, so you can ease some of the uncertainty that comes along with a work injury.

Is my injury eligible for workers comp?

You are eligible to receive workers’ compensation if you are injured while acting within the normal scope of your job.

Exceptions:

  • You may not be able to receive workers’ compensation if your injury can be remedied by basic first aid, such as small cuts or scrapes, and does not require treatment by a medical professional.
  • If you are doing something illegal while at work and you’re injured as a result, you will not be eligible to receive worker’s compensation payments.
    If you are an independently contracted worker, you may not qualify.

Do I have to be at work when I’m injured to receive workers comp?

No. As long as you were performing a work-related duty when you were injured, you are eligible for workers comp regardless of your physical location at the time the injury took place.

Exceptions: 

  • Commuting to work is generally considered outside of the scope of your employment, and an injury that happens during your commute will not qualify for workers’ comp.

How do I report a workplace injury?

Before filing a worker’s compensation claim, you should first report your injury to your employer. It’s important to do this as soon as possible. If you wait too long, it could negatively impact your claim. 

It’s a sad fact that there are those who are looking to defraud the system and file a workers’ comp simply for financial gain. The longer you wait to file a claim, the less likely that you’ll maximize your benefits. Waiting to file allows too many opportunities and questions as to the true extent and severity of your injury. 

For this same reason, it’s important to also seek medical treatment as soon as possible. This allows your recovery to begin while also adding to the legitimacy of your claim. 

What happens after I report my injury to my employer?  

A first report of injury filed (FROI) with the BWC will begin your formal claim. This can be done by either your employer or your doctor, however, if neither party reports your injury to the BWC, then you will have to report it yourself. 

You can do that here: File a workers comp claim with BWC

Your next step is to hire a workers comp lawyer. Workers’ comp claims can be very complex. The best chance at getting the compensation you deserve is to have an experienced workers comp lawyer to ensure nothing is overlooked. Contact me for a free case evaluation.

 

Next, the BWC will review your claim by speaking with you, your doctor, and your employer. It’s important to be honest and thorough with officials. If you are approved, you will begin receiving benefits. However, if you are denied, your  workers comp lawyer can help you prepare an appeal, which must be filed within 14 days.

Even if you are approved for your claim, the BWC may pay you insufficient benefits. As a workers comp lawyer, I’ve helped over 3,400 people get the benefits they deserve. I understand every part of the workers’ compensation process in Ohio, and I can help you make sure that you get the help you and your family need during this difficult time.

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How To Win your Slip and Fall Workers Comp Claim

Let’s say you work in a factory or warehouse setting. You’re taking inventory when you slip, landing hard on your back. Turns out someone spilled a jug of liquid and you didn’t see it. You’re hurt but your pride is really what’s injured. So, you get up, have a laugh or two with your co-workers, go home, and a few days later, you wake up with horrible back pain.

After a visit to the doctor, you’re diagnosed with a sprained pelvis. The treatment? Bedrest for three weeks. Can you collect workers’ compensation for medical expenses and lost wages from a slip and fall? Absolutely. Under Ohio’s Workers Compensation laws, workers do not need to prove fault to bring a claim.

However, the best chance of having your claim approved depends on you following the workers’ compensation claim process.

Step 1: Report the injury to your employer

An injured employee is required to provide written notice in a timely manner. While some injuries may require immediate treatment at an emergency room, others may require a doctor’s visit for diagnosis. Regardless of how insignificant the injury may seem, report it to your employer right away.

Step 2: Contact a workers comp lawyer

Workers compensation laws are complex and updates are frequent, you are probably qualified for more benefits than you think. Filing incorrectly or incompletely can result in claim denial and/or abbreviated benefits. Benefits may include; injury compensation, medical benefit, death benefit, loss of use benefit, temporary disability, permanent partial disability, change of condition, vocational rehabilitation, and multiple injury compensation.

Step 3: Fill out the necessary paperwork

In Ohio, the majority of workers’ comp matters involve the BWC (Bureau of Workers Compensation), while some large employers are granted the privilege of administering and paying claims on their own (self-insured employers). Regardless, your claim is filed in the same way.

Your claim can be filed on your own, by your employer, by your treating physician, your managed care organization, or by your authorized representative (e.g., workers comp attorney or union representative).

The party who files the claim completes a First Report of Injury (FROI) on the BWC website or completes and mails a paper copy to any BWC service office.

Step 4: The insurer approves or denies the claim

If your claim is approved:

The insurer will inform your employer and you with payment details. You and your workers’ compensation lawyer may:

  • Accept the insurance company’s payment offer, which might cover the costs of medical bills, medicine, disability payments, and a portion of lost wages
  • Negotiate for a lump-sum settlement or larger structured settlement

If your claim is denied:

  • Request a reconsideration from the insurance carrier
  • You or your lawyer can file a formal appeal through the state workers’ comp board.
Step 5: Return to work

Once you can return to work, you must provide written notice to both your employer and the insurance company. Depending on the severity of your injury, the insurance company may have to pay permanent disability benefits.

Many employers choose to implement a formal return to work program, to help employees return to work as quickly as possible. These programs may offer modified duties or teaching alternate skills if they’re unable to resume their regular responsibilities.

Don’t Handle This Alone.

The simplest way to maximize your claim is to hire an experienced workers’ comp attorney. 

Although these tips are the best ways to maximize your workers’ compensation claim, with over 40 years of experience, workers’ comp lawyer Thomas Marchese has other skills and proven litigation tactics to further maximize what you may be entitled to.

If you’ve been injured on the job, call me today. We’ll get started on your case so you can focus on healing.

 

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