• Injuries on the way to or from your job: Workers’ compensation is designed to compensate for on-the-job injuries—that is, injuries when you’re on the clock. Driving to and from work typically does not qualify. However, injuries while driving for work-related tasks will likely be covered.
• Injuries involving alcohol or drugs: If you were under the influence of alcohol or drugs at the time of the injury, your benefits may be denied. Your employer must prove you were under the influence of drugs or alcohol when your injury occurred and that the intoxication is the proximate cause of the injury.
• Injuries during optional recreational activities: If you’re injured during an optional work-sponsored recreational activity, such as a work picnic or sports league, workers’ compensation is typically not granted. If the activity was not optional, however, speaking to an attorney will help you understand whether you may be able to receive workers’ compensation benefits.
• Injuries resulting from a violation of company policy: If your injury was caused by failing to follow company rules and safety standards, your workers’ compensation claim may be denied.
• Injuries from horseplay or fighting: When employees fight on the job or goof off, leading to an injury, the injuries are typically not covered by workers’ compensation. However, if your employer allows this behavior to take place, you may be able to recover benefits.
• Pre-existing conditions not aggravated by your job: Pre-existing conditions or injuries are generally not compensable under workers’ compensation, except when your job substantially aggravates those injuries. For example, if you had a pre-existing wrist injury which worsened after performing repetitive motions on a production line, you may be eligible for benefits for the aggravated condition.
• Injuries resulting from self-harm: If you purposely inflict injury on yourself, you likely will not be able to recover workers’ compensation benefits. There are very rare exceptions, so be sure to talk to one of the workers’ compensation attorneys at Dworken & Bernstein for more information.

We can review your claim and determine whether you may be eligible for workers’ compensation benefits. Call today to schedule your consultation.

Fault and workers’ compensation claims

Workers’ compensation is a no-fault system. That means that even if you’re to blame for your own injury, such as lifting something that is too heavy, you can still receive approved benefits after an injury.

This system is designed to keep employers and employees out of court. Instead of putting the burden on injured workers to prove they’re not at fault, and forcing employers to defend themselves, claimants simply need to show they were injured or sickened as a result of their employment. This saves everyone time and money, and helps keep more people in the workforce.

Exceptions to the no-fault workers’ compensation system

There are some exceptions to the no-fault system. First, if you were under the influence of alcohol or drugs and that directly led to your injury, your claim may not be approved. However, your employer must prove that being under the influence caused your injury.

Second, if you purposely inflict harm upon yourself for a workers’ compensation payout, your claim may be denied. Similarly, if you ignore company policy (such as safety standards) and get injured anyway, your claim could be denied.

Finally, injuries sustained during fighting or horseplay may not be covered—but this can depend on the company culture and whether employers allow the behavior.

If your claim is affected by any of these exceptions, a Dworken & Bernstein attorney can help. Even though you’re not required to show fault for a workers’ compensation claim, it may be denied for these reasons. A skilled workers’ compensation attorney can help you present your claim in the best light possible and defend you against accusations of being under the influence, purposeful harm, violating company policy or fighting and horseplay. They can also assist in appeals if your claim is denied, so you can pursue every possible avenue to a successful claim.

For more information about workers’ compensation claims, fault and benefits you may be able to recover, call Dworken & Bernstein today.

Here’s what you need to know about workers’ compensation and taxation.

Are all workers’ compensation benefits tax-free?

No matter what kind of workers’ compensation benefits you receive, they will not be taxed by the state of Ohio or the federal government. This includes wage loss benefits, death benefits for surviving family members, temporary total compensation, lump sum and structured settlements.

If you have received workers’ compensation benefits, you will not receive tax documents and will not be required to pay taxes on the wage or death benefits. The money is yours, to make up for what you lost due to your on-the-job injury or illness.

Keep in mind, however, that if you receive a lump sum payment, it’s a one-time payout. It’s your responsibility to budget that money to support yourself and your loved ones over the coming years or decades.

Other disability payments

Keep in mind that other disability payments, such as Social Security Disability Insurance, are taxable once they or your total income exceed the minimum threshold. Similarly, pensions, unemployment benefits and other wages are likely taxable on the state and federal level. For example, VA disability benefits are not taxable, but private or union pensions collected after becoming disabled can be, should they exceed the IRS’s minimum income filing requirements.

If you are cleared for restricted types of work while receiving workers’ compensation wage loss benefits, the wages you earn are taxed as income—even though the workers’ compensation benefits themselves are not taxed.

How do I know which benefits are taxable?

Workers’ compensation benefits can be confusing, especially if you’re receiving multiple types of disability or wage loss benefits. The best way to determine what’s taxable and what isn’t is to talk to your Dworken & Bernstein workers’ compensation attorney, along with your regular tax professional.

When you collect wage loss, unemployment, disability and other benefits, you’re likely on a limited or fixed income. It’s important to ensure that you’re not paying unnecessary taxes. Your workers’ compensation attorney can ensure that you’re receiving the appropriate benefits according to your settlement, and refer you to a tax professional or tax attorney if there are related issues to resolve.

For more information about workers’ compensation benefits, contact Dworken & Bernstein today.

Social Security benefits

You may still collect Social Security Disability Insurance (SSDI) benefits while you’re collecting workers’ compensation disability benefits, but there are certain caveats.

First, you must have a disability which prevents you from working any job. Workers’ compensation, however, will cover partial disability. Furthermore, your combined workers’ compensation and Social Security Disability benefits may not exceed 80 percent of your average monthly income. Finally, it is important to remember that workers’ compensation benefits are available when your disability prevents you from working for seven days, whereas SSDI benefits are not available to you, even if you qualify, for five months after the onset of your disability.

There are also Social Security retirement benefits available to workers over a certain age. Generally, you may still collect retirement benefits while you receive workers’ compensation benefits, but it may impact the amount of your award. Be sure to talk to your workers’ compensation attorney at Dworken & Bernstein to find out how your benefits may be impacted.

Unemployment benefits

Generally, you may not collect unemployment benefits while you are receiving workers’ compensation benefits. This is because, if you collect workers’ compensation, you are presumed to still have a job. Unemployment benefits are for people who do not have a job, but are ready, willing and physically able to work. Unfortunately, workers’ compensation claims can take a while to resolve, which means employees may struggle to make ends meet until their benefits begin. Talk to our attorneys to find out what your options may be.

If your employer fires, demotes or reassigns you for filing a workers’ compensation claim, be sure to talk to us right away. It is illegal for employers to retaliate against employees for filing for workers’ compensation benefits.

The attorneys at Dworken & Bernstein can help you navigate workers’ compensation, Social Security and unemployment claims. Call today for a consultation.

Provided below, is an overview of VSSR awards and when you may be eligible to collect them.

What is a VSSR award?

Employers have a responsibility to provide and maintain a safe workplace. Some workplaces, however, are more dangerous than others, such as in manufacturing or construction. Certain industries are regulated under the Ohio Administrative Code’s safety codes, or other statutory or regulatory guidance. If an employer violates a statute or regulation, and a worker is harmed as a result, VSSR awards act as a penalty against the employer.

VSSR awards are additional compensation above and beyond medical expenses and wage benefits. However, the burden of proof is on the worker.  The worker must show that the employer violated a statute. Injured workers have one year to file a claim from the date of the injury. After a claim has been filed, the BWC’s safety violations investigation unit will investigate the matter, and hold a hearing to determine whether the employee is eligible for a VSSR award.

If the award is granted, the worker may receive an additional percentage—between 15 and 50 percent—of their maximum weekly compensation for their injuries. For example, if you receive a 25 percent VSSR award and your maximum weekly compensation is $800, you would receive an additional $200 each week.

When are employees eligible for a VSSR award?

To collect a VSSR award, employees must show three things: the safety requirement was specific and applicable to the workplace (often defined under the Administrative Code), the employer did not meet that safety requirement when the accident occurred, and the failure to comply was the proximate cause of the on-the-job injury.

This can be proved through documentation, witness testimony and other evidence. Because the process can be complex, it’s important to work with an experienced workers’ compensation attorney long before the one-year time limit is up.

If you’ve been injured on the job and believe your employer violated VSSRs, call Dworken & Bernstein today. We can help you navigate the workers’ compensation process and collect the benefits to which you are entitled.

What is an occupational disease?

According to the BWC, an occupational disease claim “generally results from repeated work-related exposure…[which] has a harmful effect on the employee.” There must be a “causal relationship between the exposure and the harmful effect,” which is confirmed by a medical diagnosis, and the conditions of the worker’s employment must “cause a greater hazard to the worker than to the general public.”

Occupational diseases may be caused by:

• Chemicals and toxic substances
• Dust, gases and fumes
• Extreme changes in temperatures, noises or pressure
• Infections and organisms
• Physical vibrations, constant pressure or use, physical movement in constant repetition or radioactive rays
• Radiation

Most common occupational diseases

The National Institute for Occupational Safety and Health (NIOSH), has studied occupational diseases for decades. Here are a few of the most common conditions:

• Allergic and irritant dermatitis: Allergic and irritant dermatitis, also known as contact dermatitis, is the most common form of occupational skin diseases. Skin diseases account for 15 to 20 percent of all reported occupational diseases, across all industries. When the skin is exposed to chemicals and contaminants, it can trigger painful and unpleasant reactions.
• Asthma and COPD: Airway diseases, like asthma and chronic obstructive pulmonary disease (COPD) are the most commonly diagnosed respiratory diseases. Millions of workers are exposed to sensitizers and irritants, which can cause mild to severe respiratory illness. It’s estimated that as many as 30 percent of all adult asthma and COPD cases have roots in the patient’s occupational exposure.
• Fertility and pregnancy abnormalities: Millions of workplace chemicals may cause fertility problems and pregnancy abnormalities—but since they remain largely untested, their use continues. NIOSH reports these chemicals can cause “birth defects, developmental disorders, spontaneous abortion, low birth weight, preterm birth, and various other disorders affecting offspring; they also include reduced fertility, impotence, and menstrual disorders.”
• Infectious diseases: Workers may contract infectious diseases such as tuberculosis (TB), hepatitis B and C and HIV. Healthcare workers, social workers and corrections officers are particularly at risk for infectious disease exposure.

If you believe you have developed an occupational disease, help is available. Contact Dworken & Bernstein for assistance with your workers’ compensation occupational disease claim.

What happens if the BWC denies your claim? Here’s an overview of the workers’ compensation claims and appeals process.

Filing a workers’ compensation claim

Ohio has a “no fault” workers’ compensation claims system. With few exceptions, it doesn’t matter how the accident occurred or who was at fault. However, benefits are not automatically granted. You must visit a BWC-approved medical provider and file a claim before you can receive compensation.

Why workers’ claims are denied

Despite the no fault system, your claim may be denied. Here are some of the most common reasons your claim could be denied:

• Deadlines: Workers’ compensation claims are subject to strict deadlines. If you miss the deadline to report your injury or file a claim or an appeal, you may lose out on collecting benefits.
• Employer dispute: If your employer disputes the claim, the BWC may side with them. The workers’ compensation attorneys at Dworken & Bernstein can help you understand why your claim was denied, and your options for appeal.
• Failure to seek medical treatment: You must have medical records demonstrating the nature and severity of your injury or occupational illness. If you don’t seek medical treatment, the BWC will not approve your claim.
• Failure to visit an approved provider: Unless you’re seeking emergency medical treatment, you must visit a BWC-approved provider. Seeing unapproved providers is grounds for denial of benefits.
• Inaccuracies: If there are inaccuracies on your claim forms or discrepancies between what you, your medical provider and/or your employer provide, your claim may be denied.
• Injury or illness did not happen on the job: Finally, if the BWC finds that your injury or illness did not happen on the job, your claim may be denied.

The workers’ compensation appeals process

If your claim is denied, you have 14 days after the receipt of the order denying your claim to file an appeal.

You or an authorized representative, such as your Dworken & Bernstein attorney, must file an appeal in writing. The appeal must include the names of the injured worker and their employer, the claim number, the date of the order being appealed and the reason why the order was appealed.   If the appeal is not properly filed, you may be barred from pursuing your claim and receiving benefits.

All appeals and disputes will be referred to the Industrial Commission of Ohio (IC), and an administrative hearing will be scheduled. You may represent yourself or have your attorney handle the hearing. If your claim is approved, your benefits may be granted. If the denial is upheld, there is an appeals process through the IC.  If you exhaust all of your appeals and are denied, you may be able to file an appeal in state court.

Having a skilled workers’ compensation attorney on your side is key to winning workers’ compensation appeals. Call Dworken & Bernstein today to learn more about your legal options.

When you reach maximum medical improvement, the Bureau of Workers’ Compensation (BWC) terminates temporary total disability—however, if you need continued medical treatment to maintain your medical stability, that may still be covered.

How does the BWC determine maximum medical improvement?

Maximum medical improvement can be determined in three ways. First, your BWC-approved physician may declare that you’ve reached MMI, and submit that information to the BWC. The BWC will then terminate total temporary disability as of that date.

Next, an independent medical examination can determine that you’ve reached MMI. The BWC sends a copy to your physician, your representatives and your employer. If your doctor agrees with the determination, the BWC will terminate temporary total disability at that time.

Finally, the Industrial Commission (IC) can rule on maximum medical improvement. If your doctor doesn’t agree with the independent medical examiner’s report, the BWC may send your claim to the IC for a final decision. At that point, they will schedule a hearing and notify you, your representatives and your employer. There are hard deadlines for appeals, so be sure to stay in contact with your Dworken & Bernstein workers’ compensation attorney.

Benefits after reaching maximum medical improvement

You may still be eligible for benefits, even after reaching MMI. For example, rehabilitative programs can help you return to work. If your medical restrictions from the accident cause you to lose hours or results in a reduced wage, you could be eligible for working wage loss—and if there are no jobs available with your new limitations, you could qualify for non-working wage loss.

The BWC also awards compensation for permanent partial or total disability. Finally, you may be able to receive a lump sum of money to settle your claim.

If you’ve been injured in an on-the-job accident, you don’t have to navigate the workers’ compensation claims process on your own. The attorneys at Dworken & Bernstein work hard to make sure their clients receive the compensation to which they are entitled. When you have issues with maximum medical improvement determinations, we can help! Call the workers’ compensation attorneys at Dworken & Bernstein today to discuss your work injury claims.

Here’s an overview of your rights and responsibilities when filing a workers’ compensation claim in Ohio.

Your rights as an injured Ohio worker

Ohio workers have specific rights. According to the BWC, injured workers are entitled to:

• Workers’ compensation benefits for work-related injuries and occupational diseases
• Fast access to quality healthcare from your BWC-certified provider of choice
• Quality independent medical examinations, when necessary
• All benefits, medical treatments and rehabilitation services for which you may be eligible
• Approved medical bills paid—you should not be billed any additional charges
• Timely payments for approved conditions and treatments
• Compensation after the first hearing, even if the claim is contested
• Access to your records both in person and online
• Represent yourself or hire a lawyer (at your own expense)
• Appeal a decision to the BWC, your managed care organization (MCO) or the Ohio Industrial Commission (IC)

While you may be able to handle simple claims on your own, working with Dworken & Bernstein is always a good idea, especially for complex claims and major injuries. The sooner you have quality legal representation, the faster you’ll receive benefits to which you are entitled.

Your responsibilities

As an Ohio worker, you also have certain responsibilities. For instance, you must use your claim number each time you’re dealing with your MCO, self-insuring employer or the BWC.

You’re also required to maintain contact with your BWC claims specialist or if your employer is self-insured, with the third-party administrator (or have your Dworken & Bernstein attorney do so.)

Finally, in most situations, you cannot work and collect workers’ compensation benefits at the same time. Be sure to talk to your Dworken & Bernstein attorney when you return to work, and/or notify the BWC yourself.

Having a trusted attorney on your side can make the claims process easier—especially if your claim is contested or dismissed. Call Dworken & Bernstein today for a consultation. Our experienced workers’ compensation lawyers can help you navigate your Ohio worker’s compensation claim, and ensure your rights are protected.

“Pre-existing conditions” are medical conditions that a worker already had before they were injured on the job. This includes illnesses, chronic conditions and old injuries. Generally, “they are not addressed as part of a workers’ compensation claim until relatedness and medical necessity considerations are addressed.”

Medical Necessity

The BWC requires that treatment be “medically necessary” to be covered under workers’ compensation. The 1994 case State ex. rel. Miller v. Indus. Comm. affirmed that the BWC must consider medical necessity, as well as relatedness and cost, before approving treatment. In other words, any treatment must be related to the on-the-job injury and medically necessary: if you sprain your ankle, the BWC only covers what’s necessary to heal that injury.

Co-morbidity

Pre-existing conditions can affect how well your injury heals and what kind of medical treatment is deemed medically necessary. These are called “co-morbidity conditions,” and their treatment may be covered “for as long as the allowed conditions or medical care are affected; however, the conditions are not included in the workers’ compensation claim.”

That is, treatment for the co-morbidity condition is covered as long as it’s impacting your healing and recovery. It is not part of the workers’ compensation claim itself, because the pre-existing condition was not an on-the-job injury or illness.

Substantial Aggravation

Treatment of pre-existing conditions may also be covered when a work injury substantially aggravates the old injury. It is possible for a pre-existing condition to become an allowed condition in the claim but a substantial aggravation must be documented by objective diagnostic findings, objective clinical findings, or objective test results. Subjective complaints without objective findings are insufficient to substantiate a substantial aggravation.

For example, if your old back injury is aggravated by lifting heavy objects at work, the BWC may cover your claim. Although lifting the heavy objects did not cause the original injury, it aggravated the injury.

Recurrence

Note that there’s a difference between a pre-existing condition and a recurring injury. Recurring injuries are on-the-job injuries which have already healed, but are re-injured due to the employee’s job. A pre-existing condition, on the other hand, already existed before the worker was injured on the job. Each recurring injury may be treated as a separate workers’ compensation claim.

The attorneys at Dworken & Bernstein can help you navigate pre-existing conditions and the workers’ compensation process. Call us today for assistance.