Workers’ Comp: Employee Eligibility

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This week we are partnering with the Ohio Bureau of Workers’ Compensation.  In addition to our free webinar we are also providing more information to you on our blog.

Workers’ compensation is a system of no-fault insurance that provides medical benefits and monetary compensation to employees or their survivors for work-related injuries, diseases and deaths. Workers’ compensation is governed by state law.

In Ohio, the workers’ compensation system is governed by the Ohio Workers’ Compensation Act (OWCA). The Ohio Bureau of Worker’s Compensation (OBWC) administers the state workers’ compensation system and resolves any coverage disputes in the state.

ELIGIBILITY IN GENERAL

To qualify for workers’ compensation benefits, an individual must:

  • Meet the OWCA’s definition of a covered employee; and
  • Sustain a compensable condition.Most workers are covered under the OWCA. The OWCA’s definition of a covered employee includes “every person in the service of any person, firm, or private corporation.” The OWCA specifically includes the following as covered employees:
  • COVERED EMPLOYEES
  • Minors;
  • Aliens;
  • Household workers who earn $160 or more in cash in any calendar quarter from a single household;
  • Casual workers who earn $160 or more in cash in any calendar quarter from a single employer;
  • Employees of the state or any Ohio county, municipal corporation, township or school district; and
  • Individuals who perform labor or services under certain construction contracts.

Exclusions

The OWCA also specifically excludes certain individuals from its definition of covered employees. Those who are not automatically covered under the OWCA include:

  • Duly ordained, commissioned or licensed ministers, assistants, and associate ministers in the exercise of ministry;
  • Officers of family farm corporations;
  • Individuals incorporated as a corporation; and
  • Officers of a nonprofit corporation who volunteer their officer services.

Elective Coverage

Other than officers of a nonprofit corporation who volunteer their officer services, most individuals who are not automatically covered under the OWCA may elect coverage for themselves or have the employer elect coverage. More information on elective coverage is available on the OBWC’s website.

In addition, covered employees may exclude themselves from coverage by submitting a signed waiver and affidavit to and obtaining approval for the waiver from the OBWC.

COMPENSABLE CONDITIONS

Compensable conditions include both work-related injuries and occupational diseases. All conditions must be supported by medical proof.

For an injury to be compensable, it must be the result of an accident arising out of and in the course of employment.

For an occupational disease to be compensable, it must be:

  • Contracted in the course of the employment in which the employee was engaged;
  • Caused by the nature of any of the specific processes described in the OWCA (these processes include the use of certain chemicals, materials and compounds); and
  • Caused by hazards of employment that are distinguishable from employment in general; and
  • Contracted in employment that creates a greater risk of contracting the disease than the public in general.

For more information on occupational diseases, the OBWC maintains a list of diseases it recognizes as compensable.

Exclusions

Under the OWCA, the following are not compensable:

  • Psychiatric conditions (except where the conditions arise from forced sexual conduct);
  • Injury or disability caused primarily by the natural deterioration of tissue, an organ, or part of the body;
  • Injury or disability incurred in voluntary participation in an employer-sponsored recreation or fitness activity if the employee signed an OWCA waiver prior to engaging in the activity;
  • Pre-existing conditions, except where they are substantially aggravated by an injury;
  • Conditions caused by the employee’s purposeful self-infliction; or
  • Conditions caused by the employee’s intoxication by alcohol or being under the influence of a controlled substance that was not prescribed by a physician.

EMPLOYEE RESPONSIBILITIES

In addition to the above eligibility requirements, the OWCA imposes affirmative responsibilities on individuals who claim workers’ compensation benefits. An employee’s failure to perform these duties may cause the employee to lose his or her rights to receive benefits, in whole or in part. Among the responsibilities, employees are expected to:

  • Promptly inform the employer of any work-related injury or disease;
  • Provide a signed release for medical information upon the employer’s request;
  • Submit to medical and vocational examinations upon the employer’s or the OBWC’s request;
  • File a claim with the OBWC within two years after an injury, after the first day of disability from an occupational disease or after the employer’s last payment of benefits or wages in lieu of workers’ compensation benefits.

MORE INFORMATION

For more information on workers’ compensation in Ohio, contact Associated Underwriters Insurance or visit the OBWC’s website.

2019-03-07T20:31:12-05:00