Disclaimer: This article is for informational purposes only and does not constitute legal advice. Consult an Ohio attorney for guidance specific to your situation.
Understanding Coordination of Workers’ Compensation and Personal Injury Benefits in Ohio
When a worker in Ohio is injured on the job and also files a third-party personal injury claim, the Ohio Bureau of Workers’ Compensation (BWC) or a self-insured employer may seek reimbursement for benefits paid. Proper coordination helps protect your right to compensation while satisfying statutory reimbursement requirements.
Ohio Statutes Governing Reimbursement and Setoff
Under Ohio Revised Code §4123.93, the BWC has a right to reimbursement from any third-party recovery for benefits it paid. Review the statute at O.R.C. 4123.93. Self-insured employers follow a similar process under O.R.C. §4123.931 (link).
Key points from these statutes:
- The employer or BWC must provide notice of its lien within 60 days after a third-party lawsuit is filed or settled.
- Reimbursement is limited to benefits actually paid, including medical and wage-loss benefits.
- Court approval may be required if you are a minor or under a protected class.
Step-by-Step Coordination Process
- Notify the BWC or Employer: As soon as you file a third-party lawsuit, send formal notice to the BWC’s Third Party Administrator or your self-insured employer. Include your claim number and attorney contact information.
- Include the Lien Holder in Settlement Papers: When negotiating a settlement with the third party, list the BWC or employer as a claimant to ensure any lien is addressed.
- Allocate Settlement Proceeds: Work with your attorney to allocate a portion of the settlement to cover past and future workers’ compensation benefits.
- Establish an Escrow Account: Place disputed or lienable amounts in escrow until the BWC or employer issues a final reimbursement demand.
- Calculate the Reimbursement Amount: Request a detailed ledger of benefits paid from the BWC (often called a “TOB letter”). This document lists all medical and indemnity benefits for which you owe reimbursement.
- Resolve the Lien: Pay the reimbursement directly to the BWC or employer. If you dispute the amount, you can petition the Industrial Commission of Ohio for a hearing under O.R.C. §4123.93.
- Distribute Remaining Funds: After satisfying the lien, your attorney can release the remaining settlement funds to you.
Helpful Hints
- Keep detailed records of all workers’ compensation benefits and settlement negotiations.
- Communicate early and in writing with the BWC or self-insured employer to avoid missed deadlines.
- Consult an attorney experienced in Ohio workers’ compensation and personal injury coordination.
- Check whether your policy or lien requires additional interest on reimbursement.
- Confirm that any court-approved settlement accurately reflects the lienholder’s interest.