8 Legal Terms to Know When Filing a Workers’ Comp Claim

8 Legal Terms to Know When Filing a Workers’ Comp Claim

Understanding Workers' Compensation

The Workers’ Compensation system has its own unique version of ‘legalease.’  The last thing you want to do when you’re hurt is figure out what the state and the workers’ comp carrier are talking about.  Especially when getting it wrong means not getting the money you deserve.

Here on the Knisley Law blog, we’ve written about how to successfully file a claim for workers’ compensation and social security disability.  We want to make sure you know some of the key steps to take.  But the forms and steps we tell you about are full of words people will never see outside courts and state bureaucracy.

We want you to know these eight workers’ comp claim terms to help you understand the process better:

  • Workers’ Compensation

Workers’ Compensation is insurance that gives you wage replacement and medical care, if you were injured in the course of employment.  The Ohio Bureau of Workers’ Compensation was established in 1912.  It covers about two-thirds of the state’s workforce. It’s the second-largest provider of workers’ compensation in the country.

  • Employee / Employer

According to Ohio workers’ compensation law, an “employee” is anyone who works for someone else.  They’re expected to make more than $160 per quarter.  The law has a long list of ways a person could be an employee.  If someone meets 10 of those criteria, they’re considered an employee.

“Employers” include the state, counties, cities and any person, firm or organization that has one or more qualified employees.

  • Course of Employment

“Course of Employment” means it happened at a time or place related to your job.  It can also mean other places related to your employment, like training or off-site activities.  It does not mean you had to be “on the clock” at the time, or performing a job task.  But if you were doing something for personal business without your employer’s knowledge or permission, it may not be “course of employment.”

  • Injury

An “injury” in workers’ comp is any physical injury or illness caused by things or events in your job.  Workers’ compensation law in Ohio does not count some things as injuries.  Most psychiatric conditions, natural aging and some pre-existing conditions are not legally work injuries.

  • Claim Pending

If the Ohio BWC says your workers’ compensation claim is “pending,” that means your claim is still being investigated.  It’s a step past “new claim” because it has been coded with the right medical codes for your injuries.

  • Disallowed vs. Allowed

A workers’ comp claim is “disallowed” when the investigation is done and they’ve decided your injury does not meet their requirements to be paid.  The claim is “allowed” when they’ve decided the opposite – that your injury and how it happened meets the legal requirements.  In Ohio’s system, both statuses can be appealed within a certain amount of time.

  • Dismissed

A workers’ compensation claim is called “dismissed” when you withdraw a claim before the BWC has a chance to rule on it one way or another.  It’s neither allowed nor disallowed, and you can apply again later if you choose to.

  • Settled

Your claim is “settled” when it has been closed out in exchange for a lump sum payment from insurance or your employer.  A settlement agreement may happen if you and your employer agree that a lump sum is better for your situation than a series of payments.  If the employer no longer does business in Ohio or you were no longer employed with them by the time the claim was made, this may be the outcome.

  • Bonus term:   Authorized Representative

“Authorized Representative” is someone that you can select or hire to help and represent you with your workers’ compensation claim.  The experts at Knisley Law can help you by being your authorized representative.  Make sure you receive the compensation for your injuries that you deserve.  Contact us today to discuss your case!