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Can my Employer stop self insured payments for not updating my restrictions?

Bowling Green, OH |

This question is related to Workers Compensation in Ohio. Plus my employer is self insured. My injury date is 8/25/2012. The date that I went off was 12/20/2012 So Thursday of last week I get a phone call from my employer stating that they didn't have my updated restrictions. (This is the first time that I have been aware of this). So today I get a call from my employer stating that they are stopping my payments until I give them an update on my restrictions.

First off it was their mistake by them not telling me that they hadn't received my updates. Secondly, they haven't even given me enough time to get them the updates. So can anyone help me understand how or why they can do this. This is very frustrating.

Attorney Answers 4

Posted

I'll pop in the Ohio Bureau of Workers Comp site, has some helpful answers... get familiar with this!

In California, if there is not current medical evidence proving you cannot work, you get your Temporary Disability payments cut off... you have the obligation of providing up-to-date information to the adjuster.

WHY they can do this? because they hold the purse strings.

STRATEGY: I GET THE Insurance Adjuster's fax number (and the HR Fax number) and have the DOCTOR'S OFFICE FAX the 'Work Status' one-page reports to both HR and the Adjuster... if they don't, YOU GET the one-page 'Work Status" report (or the form Ohio physicians are required to use to report current temporary work restrictions) and YOU FAX THIS and save each Fax Transmission report.

TRY THIS: SHOW UP FOR WORK and when they send you home, apply for ohio state temporary disability insurance. When that state application form comes across the adjustor's desk (pretty sure you put in the insurance adjuster details on that form), she will have to explain to them why you are not permitted to work light duty but are refused temporary disability payments.

Of course, you would be MOST wise to hire an attorney specializing in Ohio Workers Compensation laws and regulations.

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3 comments

Asker

Posted

I know my adjuster has my up to date information. But I didn't know that my HR dept. did not have my work restrictions. Its just funny because I tell them that my doctors state that they want me on very limited work restrictions, and my HR dept. tells me they have no work for me. Then about a month later they have work for me, and all of sudden they have work for me, not to mention that they are shorting me pay every time I go to work also by 6 hours. Plus they state that now they do have work for me that all of sudden appeared. So now they are trying to play hardball with me. Is it possible to just quit this job and do something that won't aggravate my injury? (My injury is an acl injury to my knee). Or should I go to my lawyers office and tell them what is going on. They way they are treating me, makes me not want to work for them at all anymore. If I can do something that won't aggravate my knee then I should do. But I am worried how this will look to worker's compensation or other parties and could they consider this fraud, even though I have more than enough medical evidence to prove my injury?

Asker

Posted

sorry for the repeats but this message window doesn't allow me to read the message completely.

Nancy J Wallace

Nancy J Wallace

Posted

MAKE A GAME PLAN with your lawyer ASAP.... DO NOT QUIT OR LEAVE. if anything gets worse, the old employer sues the new employer for making things worse...VERY BAD idea to leave before it's finished.

Posted

Short story is that you need a Board Certified Ohio workers' compensation specialist attorney.

It is your responsibility to make sure you have updated medical submitted to the employer. A self-insured claim is managed by the employer rather than the BWC. However, all complaints, motions, disputes are submitted to the Ohio Industrial Commission for resolution.

Download my Free Ohio Work Comp Guide for general information. But you will need a lawyer to protect your legal interests.

Mike Gruhin

www.gruhin.com

If you think this is a good answer, please complete the survey below. This response does not create an attorney-client relationship. Do not consider this response legal advice. Do not rely on this response or take action based on anything contained herein. Please note that this answer does not constitute legal advice, and should not be relied on, as each situation is fact specific, and it is not possible to evaluate a legal problem without a comprehensive consultation and review of all the facts and/or legal documents. This response does not create any attorney-client relationship

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Posted

Why don't you get a copy of your restrictions from the doctor's office and take them over to your employer and give it to the person who handles work comp there?

Then, on your way home, stop by and interview a couple of local workers' comp lawyers. I suspect your problems with the case are just beginning.

This answer is intended as general information and not as specific legal advice. If you want to have a free consultation with me, please contact me through AVVO.

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Posted

In order for a self- insured employer, or the Ohio Bureau of Workers' Compensation on state fund claims, to be required to pay you for your time off work, you must complete a C-84 and your doctor must complete a Medco-14. This must be done on a regular basis. How often depends on what period of time your doctor puts on the Medco-14, but even if he/she is keeping you off for a year, they have to do a new one every time they see you and must do an updated one every 90 days at the most. You are responsible for this, not them. They have not obligation to do anything for you. You must make them do so. Sorry, but an injured worker always has this responsibility.

If you do not have a qualified, Ohio Workers' Compensation attorney, preferably a board certified specialist in Toledo, you should get one. They are allowed to begin trying to cut you off of this benefit as soon as March and sooner if your doctor makes a mistake. There are things you can do to avoid this and also to obtain the other benefits, besides this that are available.

As former head of the Toledo Bar Association Workers' Compensation Committee I can tell you we have many such attorneys in Toledo, including myself and we would all meet with you on a no cost, no obligation basis and only charge you based upon obtaining new benefits for you. or a contingent fee basis.

This answer does not constitute legal advice for your situation and no attorney-client relationship has been formed. We can only assist you if you come into our office, meet with one of our attorneys, sign the necessary fee agreement and other necessary workers' compensation forms. Until then, we are not acting as your attorney and can take no actions to protect your interests. Further, we can not properly advise you as to the deadlines to act, also known as the statute of limitations. We can tell you missing such a deadline, even when you are unaware of, will result in you losing all rights under your claim.

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