1. How long does an injured employee have to file a claim? An employee can file a claim for up to two years following the date of injury. However, in the case of an occupational disease, such as hearing loss or asbestosis, a disabled employee or the dependant of an employee whose death is caused by an occupational disease must file a claim: 1) within two years after the disability due to the disease began, 2) within six months after the diagnosis of an occupational disease, or 3) within two years after the employee's death; whichever comes later.
2. What kinds of injuries qualify for workers' compensation benefits? In order to be compensable, an injury must be received in the course of and arising out of the employee's employment. Generally, this does not include injuries sustained going to and coming from work, injuries or disabilities incurred in voluntary participation in an employer-sponsored recreation activity after the employee has signed a waiver, injuries or disabilities caused primarily by the natural deterioration of some part of the body, injuries that are entirely psychological in nature without some physical component, pre-existing conditions not substantially aggravated by the injury, or injuries caused by the employee being under the influence of drugs or alcohol. However, there will be situations where exceptions do apply.
3. What types of benefits are available to an employee who files a worker's compensation claim? An employee is eligible to receive temporary total disability (TTD) benefits if the injury or disability prevents the employee from returning to his or her pre-injury position of employment. The amount of the TTD benefits is calculated as a percentage of the employee's wages, with a maximum and a minimum amount. The Bureau of Workers' Compensation will schedule the claimant for an evaluation after 90 days of disability. TTD benefits will cease once a claimant has returned to work, the claimant's treating physician provides a written statement that the claimant is able to return to his or her former position of employment, or the claimant has reached maximum medical improvement.
If a claimant returns to the workforce but is unable to return to his or her former position of employment, that employee may be eligible to receive wage loss compensation for the difference between what he or she was making prior to the injury, and what he or she is currently making. This is known as working wage loss compensation. Payments for working wage loss may continue for up to a maximum of two hundred weeks. In some situations, an employee may also be eligible for wage loss compensation if he or she is unable to find employment consistent with his or her disability as a result of the injury or occupational disease. This is known as non-working wage loss compensation. Payments for non-working wage loss may continue for up to a maximum of 52 weeks, 26 of which will be offset by working wage loss. Both types of wage loss compensation are paid at two-thirds of the lost wages, up to the statewide maximum.
If the employee's injury or disability results in some type of permanent disability, that employee may be eligible for permanent partial disability (PPD) benefits. PPD benefits are also calculated as a percentage of the employee's wages, with a maximum and a minimum amount, and are awarded based on the percentage of residual whole person impairment recommended by a physician. The claimant must wait twenty-six weeks after the date of termination of the latest period of TTD payments to file an application for PPD benefits. In the absence of TTD payments, the claimant must wait twenty-six weeks after the date of the injury or the contraction of the occupational disease to file for PPD benefits.
If the injury or disability renders the employee unable to engage in sustained remunerative employment utilizing the employment skills that he or she has or may reasonably be expected to develop, that employee may be eligible for permanent total disability benefits. These benefits, which are calculated in a manner similar to the TTD and PPD benefits, continue for the remainder of the claimant's lifetime. (workersxzcompxzkit)
If an employee's death is caused by his or her workplace injury or occupational disease, the spouse and/or dependants of that employee may also be entitled to death benefits. In the case of a dependant spouse, such death benefits are payable for life with a two-year dowry benefit upon remarriage.
Author George B. Wilkinson, Partner. Attorney Wilkinson is Workers Compensation Group Practice Leader at Dinsmore & Shohl in Cincinnati, OH. He can be reached at George.wilkinson@dinslaw.com or 513-977-8316. Many thanks to Attorney Wilkinson who has helped my clients and employers reduce workers' comp costs over the last 20 years.
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