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Northwest OH Legal Blog

Thursday, October 20, 2016

Workers' Compensation Claims Against Self-Insured Employers

In every Workers’ Compensation claim, it is important for the injured worker to know the difference between the two types of employers in the Ohio Workers’ Compensation system: State-Fund Employers and Self-Insured Employers. In particular, the injured workers should be aware of the differences if the employer is self-insured.

Remember, the Workers’ Compensation system is an insurance by which employees are compensated for medical benefits and lost time due to a workplace injury. State fund employers pay premiums to the Ohio Bureau of Workers’ Compensation (BWC), which in turn pays benefits and handles the initial processing of the employer’s Workers’ Compensation claims. In contrast, the self-insured employer itself is responsible for paying Workers’ Compensation benefits, and it handles the initial processing of the claim.

It is important for the injured worker who works for a self-insured employer to realize that the employer itself is responsible for the administration of the claim, not the state. Claims against a self-insured employer are usually handled by an entity known as a Third-Party Administrator (TPA). The employer hires the TPA to allow or disallow medical treatments, determine whether lost time benefits are necessary, and make the initial determination as to what conditions should be allowed to the claim.

However, the self-insured employer and its TPA do not make the final determination on Workers’ Compensation benefits. The decisions of the self-insured employer are appealable to the Industrial Commission, which is tasked with resolving disputes between injured workers and their employers. If an employer refuses to allow a claim, denies treatment, or refuses to allow a medical condition from the workplace injury, the injured worker has the right to have the Industrial Commission hear and decide his or her issue. Having legal representation is important for appeals to the Industrial Commission because the process can be onerous for an injured worker to handle on their own.

Another important aspect of the self-insured employer is access to claim documents. The self-insured employer is responsible for uploading claim documents, such as medical records and other paperwork, to the BWC website. There are requirements as to what needs to be filed but in practice many self-insured employers will only file a few basic documents for the injured worker to view online. In these cases, it is necessary for the injured worker to submit a request to the TPA for all documents associated with the claim. It also may be necessary to get records from the injured worker’s doctor. It is again important to have an attorney represent the injured worker to ask for and review claim documents to make sure the correct benefits are being received.

As a final note, Workers’ Compensation payments of an employer are not dischargeable in bankruptcy. This means that the injured worker is entitled to payments even if the self-insured employer is forced to file for bankruptcy. The BWC will cover the benefits for any employer who is insolvent.

Should you have questions regarding your Workers’ Compensation claim or you believe your self-insured employer is improperly denying you benefits, you should contact Allotta | Farley Co., L.P.A. at (419) 535-0075 for a free consultation. 


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With offices in Toledo and Lima, OH Allotta Farley Co., L.P.A. serves clients throughout northwest OH with various legal matters. Areas of service include Allen County, Ashland County, Auglaize County, Crawford County, Defiance County, Erie County, Fulton County, Hancock County, Hardin County, Henry County, Huron County, Lucas County, Marion County, Mercer County, Morrow County, Ottawa County, Paulding County, Putnam County, Richland County, Sandusky County, Seneca County, Van Wert County, Williams County, Wood County, Wyandot County.

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2222 Centennial Road, Toledo, OH 43617
| Phone: 419.535.0075
121 West High Street, 10th Floor, Lima, OH 45801
| Phone: 419.224.0075

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