Understanding Workers’ Compensation Settlements in Ohio

Workers’ compensation cases are supposed to be simple, right? But what happens when you or your employee don’t agree with the decision passed down by the Industrial Commission?

Believe it or not, a small portion of workers’ compensation claims will go to trial. Any employer or employee can appeal an industrial commission’s decision by taking their case to the court of common pleas. If you do, there’s a good chance that your case will get settled at the Attorney General level before it ever sees a judge or jury.

How can you prepare for this process? What does a workers’ compensation appeal look like? What steps do you need to take to get the best possible settlement?

Understanding the Appeal Process of Workers’ Compensation in Ohio

Sometimes a workers’ compensation decision can be detrimental for your premiums, employees, or business. When this happens, you have the right to appeal the case.

In Ohio, workers’ compensation appeals can be initiated by an authorized representative of an employee, an employer, or the BWC itself. If the determination on a claim was unfavorable to either an employer or employee, you or your employee can submit an appeal within 14 days after the date of the order.

All appeals must be filed in writing. If you send the appeal via regular mail, the BWC will attach four extra days to the due date — making it 18 days after the receipt of the order.

Almost all claims are filed using the IC-12 Notice of Appeal form, but, technically, the BWC will accept an appeal if it contains all of the following pertinent pieces of information.

The claim number
The date of the order that’s being appealed
The name of both the injured worker and the employer
A reason for the appeal

You can also file the appeal directly with the Industrial Commission online.

Once an appeal is accepted, you will go through three layers of Industrial Commission appeals prior to taking your case to the court of common pleas.

Once the first appeal is accepted, the Industrial Commission will assign a district hearing office to handle your case. The district hearing officer will hear your case, examine the evidence, and listen to testimony from witnesses.
If you wish to appeal the district hearing officer’s order, you can appeal again. This time, an Industrial Commission staff hearing officer will hear your case. The process is similar to the process before; the difference is the hearing officer.
If you wish to appeal the IC staff officer’s order, you can appeal a final time to have your case examined by three IC commissioners. This will be your final IC appeal.
After you receive the decision for your final appeal with the IC, you can choose to take the case to the court of common pleas within 60 days of receiving the final order.

Appealing to the Court of Common Pleas

The court of common pleas is the second-to-last option you have for resolving your workers’ comp case. Typically, cases that have dragged through the IC are resolved in the courts. In rare cases, it may go to the Ohio Supreme Court.

If you’re self-insured, you will be required to retain your own attorney and file an R1 for them. They will act as your legal counsel and representation during trial. However, when you’re state-funded, the Ohio Attorney General will typically step in and attempt to settle the case before it goes to court.

Almost all cases that go to the court of common pleas are settled before they go to trial.

The Settlement Process at the Attorney General Level

Before the appeal makes its way into court, the Attorney General will likely attempt to settle the case to save both parties time and money. During this process, it’s critical that you communicate with your TPA. They can assist you in cost-analysis and give you insights into how the case could potentially impact your premiums.

Typically, the Attorney General will agree with the employer regarding settlement solutions. In extremely rare situations where this doesn’t happen, the AG can pass defense to the employer — and refuse to actively defend the case.

How a TPA Can Help

TPA’s will act as your primary financial guidance during the appeals process. Remember, TPA’s are not legal representation, and they won’t have an active role during the trial.

They will assist you in evidence gathering, information processing, and creating the necessary workflows and processes to facilitate your entire workers’ compensation strategy. You should also communicate all settlement agreements with your TPA. They can help you do a cost analysis and determine what kind of impact the settlement will have on your premiums.

An effective strategy is to align your attorney with your TPA, so that, when your attorney receives a settlement offer, they can communicate the offer to the TPA who can run the numbers. This will give the attorney an idea of how fair the settlement is and how much of an impact it will have on you.

Workers’ Compensation Settlement FAQs

Do I have to have an attorney to handle my workers’ compensation claim in Ohio?
- It’s always a good idea to have an attorney. As PEOs and TPAs, we won’t get involved in the legal proceedings and we urge you to make a smart decision regarding your legal representation.
How much will a workers’ compensation appeal cost me?
- That depends. Your TPA should be able to assist you in determining how much of an impact your settlement will have on your premiums. They’ll help you calculate costs associated with the entire workers’ compensation process outside of legal fees.

Need Help With Workers’ Compensation?

Whether you’re dealing with workers’ comp claims, appeals, or cost reductions, Sheakley is here for you. By partnering with Sheakley’s TPA or PEO services, you can maximize your benefits, reduce costs, and minimize premium impacts resulting from workers’ comp cases.

Are you ready to transform your business? Do you want to gain a competitive edge with full-spectrum HR assistance? Contact us! We’ll handle your business’s HR needs so you can focus on what really matters — growing your business.