When an employee gets injured on the job, there can be plenty of factors that contributed to the accident that caused their injury. Sometimes, it’s the fault of a 3rd party and you may qualify for rebuttable presumption. But, what happens when an employee gets injured due to something entirely different? What if a physical or mental impairment caused their accident?
Many employers don’t realize that events such as cardiac disease, muscular dystrophy, diabetes, and arthritis can significantly contribute to severity of workplace accidents. When they do, you can attempt to refund a percentage of the claim — reducing the case costs and lessening its impact on your premiums.
Here’s what you need to know about Handicap Reimbursements and its role in reducing your claims.
What is Handicap Reimbursement?
In Ohio, the BWC can refund (or charge) a percentage of the cost of a workers’ compensation claim to the Statutory Surplus Fund if there was an eligible handicap that contributed to the injury. The Ohio BWC defines a “handicapped employee” as, “one who is afflicted with or subject to a physical or mental impairment, whether congenital or due to an injury or disease, such that the impairment constitutes a handicap in obtaining employment or re-employment.”
The BWC will make refunds on the following claim awards:
- temporary disability total
- permanent total disability
- scheduled loss awards
- death benefits
- medical payments
- claims reserves
- and lump-sum settlements
Luckily, the time limits for a handicap reimbursement are long, and claims can be retroactively refunded. While the exact time limitations differ depending upon your employment type (see here for details), you have around six years to file the claim if you are a state-funded or public employer.
Note: Claim settlements DO NOT impact your ability to file for a handicap reimbursement. They are separate processes.
What Evidence Do You Need to File for a Handicap Reimbursement?
In order to request a handicap reimbursement, you must provide the following supporting evidence:
- Medical evidence showing the employee suffered from one or more of the qualifying conditions
- Evidence that the employee’s condition constitutes a handicap within the meaning of the law
The most significant piece of evidence that you need is medical evidence. The second requirement — proof that the issue constitutes a handicap — can usually be provided via the medical evidence. It’s important to note that there are only 25 conditions types which are considered for a handicap reimbursement in Ohio. There is a full list here.
How to Gather Evidence for a Handicap Reimbursement
The evidence-gathering stage is best left to your TPA. They will help you find the relevant information and they will send it to the BWC on your behalf.
Generally, there are two ways to gather evidence for handicap reimbursement claims.
- Access past medical records
- Get an Independent Medical Examination (IME)
At Sheakley, we always start by requesting past medical records from the employee. These past medical records are the primary source of information during this process. We are looking for any pre-existing conditions that are directly related to the claim that could be partially responsible for the injury.
Sometimes, we will also request an Independent Medical Examination (IME) — where we have an independent doctor evaluate the employee and give their recommendation on the root cause(s) of the injury. This recommendation can usually be leveraged to increase the handicap reimbursement percentage. Remember, this can also have the opposite effect (the doctor claims that only a small percentage of the accident was due to the handicap). It’s critical that your TPA understands the nuances of the case they are working and makes the right decision.
Handicap Reimbursement FAQs
Do handicap reimbursements impact my worker’s claim?
- No! The handicap reimbursement only impacts how much your business will end up paying via premiums. Your worker is not impacted by a handicap reimbursement, and it can’t be used against them.
How much will a handicap reimbursement help me?
- It will depend upon the nature of the claim. Some handicap reimbursements can help reduce costs significantly, while others will have a negligible impact.
What if the medical evidence is unclear?
- If you can’t get the evidence you need from past medical records, talk to your TPA. There are other ways to prove that the accident was uncontrolled.
Why do I need to pursue a handicap reimbursement?
- Handicap reimbursements can help significantly reduce claims costs and lower your premiums. For example, let’s say that you hired a worker with any of these pre-existing conditions for which they’ve undergone extensive rehabilitation. If that worker then suffers an injury on the job that is exacerbated by their qualifying pre-existing condition, you’re looking at a potentially significant workers’ compensation claim that will almost certainly raise your premiums. Handicap reimbursements provide you with a tool to recover a sizeable portion of that cost.
Do You Have a Worker Who Was Injured With a Pre-Existing Condition?
At Sheakley, our analysts review every claim in-depth to help you identify problem areas and reduce your overall claims costs. Workers’ compensation should help your employees — not sink your business. Let us help you minimize costs at every turn so you can get back to what you do best — growing your business.
Contact us to learn more!