Recently, we encountered a health provider that, as a policy, is not filing Workers’ Compensation claims with the Bureau of Workers’ Compensation (BWC) when the Employer is self-insured. Although lawful, this can cause problems for the Injured Workers’ claim.
For background, we should examine the difference between a self-insured and state-fund employer. The state-fund employer pays what is essentially an insurance premium to the BWC, who covers medical expenses and disability payments in the event one of their employees suffers a workplace injury. The self-insured employer chooses not to cover Workers’ Compensation claims through the BWC and cover them on their own. Benefits must be equal to or greater than those provided by the BWC. Many larger corporations choose to go this route.
The employer pays Workers’ Compensation medical payments through its representative called a Third-Party Administrator (TPA). To receive payment for medical bills, providers only need to file the necessary paperwork with the TPA, and may not file the claim with BWC. The TPA is only required to file with the BWC if there is at least seven days of missed time, if there is a death claim, or it contests the claim.
The two biggest concerns with this are the statute of limitations and the ability to access documents. The statue of limitations to file a Workers’ Compensation claim in Ohio is two years for injuries occurring prior to September 29, 2017, and one year for injuries occurring on or after September 29, 2017. The statute of limitations is not fulfilled if only filed with the employer, and the claim is allowed only if it begins to make payments for the injury. However, filing with the Bureau of Workers’ Compensation will satisfy the Statute of Limitations. Also important is the ability to obtain documents related to the claim. The BWC has a database called Dolphin which stores all documents related to a Workers’ Compensation claim. The Injured Worker and their attorney are each allowed access to these documents. However, a self-insured employer is under no obligation to file most documents to this database. As such, the proper filing of a Workers’ Compensation claim can ensure that all documents received by an employer are filed to the database for later use.
If your Workers’ Compensation claim is not filed with the BWC, it can cause issues that may affect your ability to secure benefits. If you need assistance filing your claim, call the attorneys of Allotta | Farley for a free consultation.