Understanding how Ohio workers’ compensation insurance protects employees and employers

Why is workers’ compensation important?

In Ohio, workers’ compensation insurance is equally as important to your employees as it is to your business. For employees, it provides a level of reassurance that they will be provided with medical care and other benefits should they be injured or contract an occupational illness while on the job. For employers, workers’ compensation insurance protects them from costly litigation and other expenses that may occur if an employee is injured or experiences a work-related illness.

Now that we know how workers’ comp benefits employers and employees, let’s find out which companies must carry it.

What are Ohio’s workers’ compensation requirements?

In a nutshell, any employer with more than one (1) employee, whether full time or part time, is required to have workers’ compensation coverage. This requirement includes any person in the service of another person, firm, or corporation and includes aliens and minors, household workers and casual workers who earn at least $160 per quarter. In addition, corporate officers are regarded as an employee under Ohio law.

Ohio law states that employers must have workers’ compensation insurance coverage for their employee from the first date that an employee is hired, so new business owners must apply for workers’ compensation insurance prior to hiring employees.

Are there any exemptions to the workers’ compensation requirement?

Ohio does provide some exemptions to its workers’ compensation requirements, with coverage optional for the following types of employers.

• Sole proprietors without employees
• Partnerships
• Limited liability companies (LLCs) that act as sole proprietors
• LLCs acting as a partnership
• Family farm corporate offices
• Incorporated individuals
• Ministers of a religious organization
• Domestic workers that earn less than $160 quarterly
• Casual employees that earn less than $160 quarterly

Moving on, workers’ compensation insurance has a lot of benefits that employers and employees should know about in the event of an injury or illness on the job.

What does workers’ compensation cover?

The state of Ohio has numerous benefits available to injured workers.

Medical care

Complete medical care is available for all employees injured on the job. Medical benefits inlcude payment for all medical treatment, approved surgery, rehabilitation services, and any return to work services. In addition, any necessary prescriptions and necessary travel expenses are also covered. All medical services are managed by the employer’s selected managed care organization or MCO.

Temporary total (TT) compensation

Any worker who becomes disabled is entitled to TT compensation if the injury lasts more than seven (7) days, with the worker compensated at full wage for the first 12 weeks after the injury. If the injury lasts beyond 12 weeks, they are compensated using an average weekly wage rate.

Permanent partial disability

If a worker is suffers a permanent partial loss such as loss of vision, hearing, or loss of a limb, they will receive a payout based on the nature of the injury.

Permanent total disability

If a worker is determined to be permanently disabled, theare are eligible for both a one-time award as well as a supplement fund.

Change of occupation

Change of occupation benefits are payable for a certain class or workers such as coal miners, police officers and fire fighters who have been advised by a physician to change their occupation.

Death benefits

Death benefits including funeral expenses and compensation are paid to the survivor(s) of the deceased worker.

Ohio also offers other benefits, depending on the injury suffered.

How is workers’ compensation insurance purchased in Ohio?

Ohio uses a monopolistic state fund for employers to obtain insurance, regardless of the industry or risk level of the business. There is not an option to purchase workers’ compensation insurance from private insurance brokers, but employers do have the option to apply for self-insurance. Employers interested in applying for self-insurance must have two years of claims experience with the Ohio State Insurance Fund, must demonstrate financial stability, and must provide a financial guaranty.

Employers without current Ohio workers’ compensation insurance will have to complete an Application for Ohio Workers’ Compensation Coverage or U-3, along with a non-refundable application fee. The fee varies but is set at a minimum of $120, and depends on the number of employees you have, the type of work they do, and the location of your business. Once the application is processed, the employer’s workers’ compensation coverage begins.

Are there any penalties for not having workers’ compensation coverage?

Workers’ compensation premiums in Ohio are set by the state, with employers required to pay their premium by a specific due date. If payment is not received by the due date, workers’ comp coverage will lapse, leaving employers responsible for paying the claims for any employee while coverage is lapsed. Employers may also be assessed a penalty from Bureau of Workers’ Compensation (BWC) of 1% of the premium due. In addition, employers paying premiums late will be fined $30 fee along with an additional charge of up to 15% of the premium due, depending on how late the payment is received.

Any employer that fails to pay its premium or fails to apply for workers’ compensation coverage is considered a non-complying employer. Non-complying employers may have a lien placed on both business property and tangible personal property until all monies due have been paid.

What happens after an employee is injured?

Employees are required to report a workplace injury to their employer as soon as it’s feasible. In addition, they need to inform their employer when a claim for medical care or other workers’ compensation benefits has been filed. In turn, once notified, it’s the employer’s responsibility to ensure that their employee receives adequate medical care. Employers are also required to inform their MCO about any workplace related injuries.

Any employee that is injured on the job can directly request medical benefits and wage compensation, though the two are requested separately. Medical claims can be filed by the injured employee or by a medical provider. Any claims filed by a medical provider must be filed within 24 hours of the employee’s visit. If filed by the worker or the worker’s representative, or the employer, they must first complete the First Report of Injury, Occupational Disease, or Death (FROI). There is no 24 hour time limit for an employee filing a claim.

Can an injured employee use their own physician?

After an injury, an employee can see any doctor they choose for their first visit. However, after the first visit, if ongoing care is required, employees must select a BWC-certified physician as their Physician of Record (POR) to manage treatment for their injury. With the exception of an initial visit or an emergency room visit, an employee will be responsible for their own medical bills if they are treated by a non-certified medical provider.

Additional resources for Ohio employers

For more information, you can contact the Ohio Bureau of Workers’ Compensation at 1-800-644-6292, with both live support and chat options available. You can also contact them using the contact us form on the BWC website.  Additional resources are listed below.

• Workers’ Compensation Rules and Laws for Employers 
• Ohio Laws and Administrative Rules 
• BWC resources for workers 
• BWC resources for employers 
• Forms for employees 
• Ohio Attorney General