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17.10 Workers' Compensation Insurance

Types of Laws​

Compulsory vs. Elective​

Ohio’s Workers’ Compensation (WC) law is compulsory and monopolistic:

  • Compulsory — Employers are required to provide Workers’ Compensation benefits to their employees.
  • Monopolistic — Employers generally obtain coverage by paying premiums into the state Workers’ Compensation fund, rather than purchasing WC insurance from private insurers.

Qualified employers may also meet the requirement through self-insurance.

To qualify as a self-insured employer for Workers’ Compensation in Ohio, an employer must:

  • Have operated in Ohio for at least 2 years and paid into the state insurance fund during that period
  • Demonstrate strong financial stability
  • Establish an organizational plan for administering Workers’ Compensation requirements
  • Develop a plan to inform employees of the transition to self-insurance, including the procedures that will be followed and employees’ rights to compensation and benefits
  • Maintain an account with an Ohio financial institution, or confirm that Workers’ Compensation payments will be issued from the same account used for payroll

An employer that purchases or acquires an existing self-insured business that has operated in Ohio for at least 2 years may qualify for self-insured status.

An Ohio business owner who refuses to permit an inspection by the Ohio Bureau of Workers’ Compensation (BWC) may be held in contempt by the probate judge of the county in which the owner resides.

Ohio Workers' Compensation Laws​

Statute of Limitations for Filing Claims​

A Workers’ Compensation claim for an injury or resulting death must be filed within 1 year of the date of the injury or death.

A Workers’ Compensation claim for an occupational disease or resulting death must be filed within:

  • 2 years after disability from the occupational disease begins; OR
  • 6 months after the disease is diagnosed by a physician; OR
  • 2 years after death resulting from the occupational disease.

Exclusive Remedy​

If an employee is a resident of another state and is covered by that state’s Workers’ Compensation or similar laws, the employee and their dependents cannot receive Ohio Workers’ Compensation benefits. In these cases, the Workers’ Compensation laws of the employee’s state of residence provide the exclusive remedy against the employer.

An employee or dependent who chooses to receive Ohio Workers’ Compensation benefits cannot also receive benefits from another state for the same claim. The employee or dependent must sign a waiver of benefits from other states within 28 days after submitting the claim.

If an employee or dependent receives Ohio Workers’ Compensation benefits and later accepts benefits from another state for the same claim, the Ohio employer may seek repayment of the amounts paid, including interest, costs, and legal fees.

When an employee will perform work outside of Ohio, the employer and employee may enter into a written agreement choosing to be governed by either:

  • Ohio Workers’ Compensation law; OR
  • The Workers’ Compensation law of another state where some or all of the work will be performed.

The agreement must be filed with the BWC within 10 days after it is created.

Ohio Workers’ Compensation does not provide benefits to employees who are covered under the federal Longshore and Harbor Workers’ Compensation Act. For these employees and their dependents, benefits available under the federal Act are the exclusive remedy against the employer.

Employment Covered (Required, Voluntary)​

The following individuals must be considered employees for purposes of Ohio Workers’ Compensation:

  • Minors, aliens, part-time and seasonal workers, and employees related to the employer
  • Elected officials at all levels of government
  • Off-duty individuals who respond to an inherently dangerous situation as though they were on duty, including:
    • Off-duty peace officers
    • Off-duty firefighters of a legally established fire department, whether paid or volunteer
    • Off-duty first responders, EMTs, and paramedics, whether paid or volunteer

Workers’ Compensation coverage is not required for the following individuals, although an employer may choose to provide coverage:

  • Domestic and casual workers who earn less than $160 from one employer during any 3-month period
  • Ordained ministers
  • Officers of a family farm corporation
  • Incorporated individuals

Covered Injuries​

Under Ohio Workers’ Compensation law, injury does not include:

  • Psychiatric conditions, unless they result from an on-the-job injury, occupational disease, or forced sexual contact
  • Injury or disability caused primarily by the natural deterioration of a tissue, organ, or body part
  • Injury or disability occurring during voluntary employer-sponsored recreation or fitness activities when the employee signed a waiver before participating
  • A preexisting condition, unless a workplace injury substantially aggravates that condition and the aggravation is supported by objective medical findings

An employee who refuses to submit to required substance testing may be denied Workers’ Compensation benefits or compensation.

Occupational Disease​

An occupational disease is a disease contracted in the course of employment when:

  • The disease results from conditions or characteristics specific to the work; OR
  • The employment creates a hazard that is different from or greater than hazards found in employment generally.

Additionally, the employee’s work must create a greater and different risk of contracting the disease than the risk faced by the general public.

Benefits Provided​

Workers’ Compensation benefits are generally not payable for the first 7 days of disability. However, if the employee is disabled for 14 consecutive days, benefits for the first 7 days become payable and must be paid immediately along with any other benefits due.

Workers’ Compensation benefits for work-related injuries and occupational diseases may include:

  • Medical, nursing, and hospital services, including examinations, diagnoses, and treatment recommendations
  • Medication, rehabilitation services, death benefits, and funeral expenses
  • The provision, repair, and replacement of artificial limbs
  • The repair or replacement of eyeglasses, dentures, or hearing aids when they are damaged in the same accident that caused the employee’s covered injury

If a worker dies as a result of a work-related injury or occupational disease, the BWC will pay up to $7,500 for funeral expenses.

Temporary Partial Disability​

Under Ohio law, temporary partial disability is addressed through wage loss benefits when an injured employee returns to work but cannot perform the same duties or work the same number of hours as before the injury.

Wage Loss Benefits​

An employee who experiences a wage loss because a work-related injury or occupational disease requires them to take a different position will receive:

  • 66⅔% of the difference between their previous and current average weekly wage
  • Benefits limited to no more than the state average weekly wage
  • Wage loss benefits for a maximum of 200 weeks

An employee who experiences wage loss because they cannot find employment consistent with limitations caused by a work-related injury or occupational disease may receive:

  • 66⅔% of the difference between the employee’s former average weekly wage and current earnings
  • Benefits limited to no more than the state average weekly wage
  • Benefits for up to 52 weeks
  • The first 26 weeks are in addition to the separate 200-week wage loss maximum
  • Any benefits received after the first 26 weeks are deducted from the 200-week maximum
  • Total wage loss benefits from both categories may not exceed 226 weeks

Temporary Total Disability​

For the first 12 weeks of temporary total disability, benefits are paid at 72% of the employee’s average weekly wage, but cannot exceed the lesser of:

  • The state average weekly wage
  • 100% of the employee’s net take-home weekly wage

After the first 12 weeks of temporary total disability, benefits are paid at 66⅔% of the employee’s average weekly wage, subject to the following limits:

  • Maximum: The state average weekly wage
  • Minimum: 33⅓% of the state average weekly wage

If the claimant is also receiving Social Security retirement benefits, the maximum temporary total disability benefit is reduced to 66⅔% of the state average weekly wage.

If the claimant’s full average weekly wage is less than the minimum benefit amount of 33⅓% of the state average weekly wage, the employee will receive compensation equal to 100% of their actual weekly wages.

Temporary total disability benefits end when the employee returns to work or when any of the following occurs:

  • The employee’s physician provides written confirmation that the employee can return to their usual duties
  • The employer makes suitable work available within the employee’s physical capabilities
  • The employee reaches maximum medical improvement (MMI)
  • The employee voluntarily abandons employment or becomes incarcerated
  • The employee works for any employer during the disability period

Ending one period of temporary total disability benefits does not prevent an employee from qualifying for another period of temporary total disability benefits at a later time.

An injured worker must undergo a medical examination after receiving temporary total disability benefits for 90 consecutive days. After receiving 200 weeks of temporary total disability benefits, the worker must be evaluated again to determine whether the disability has become permanent.

Permanent Partial Disability​

After receiving Workers’ Compensation benefits for at least 26 weeks, an employee may apply to the BWC for permanent partial disability (PPD). A district hearing officer determines the employee’s percentage of permanent disability.

For permanent partial disability, injuries and occupational diseases are compensated according to scheduled losses. Weekly compensation is based on the state average weekly wage and is paid for a specified period of time.

  • If the permanent disability is 90% or greater, the employee receives 200 weeks of compensation
  • A disability award may not exceed 100%, regardless of the extent of the impairment

Permanent disability compensation begins:

  • From the date of the last compensation payment, if the employee previously received benefits; OR
  • From the date of the injury or occupational disease diagnosis, if no previous compensation was paid.

If a permanent disability award is made before the employee dies, any unpaid installments, whether already accrued or due in the future, are payable to the employee’s surviving spouse, children, or other dependents.

Permanent Total Disability​

Permanent total disability (PTD) compensation is paid in addition to any benefits received for permanent partial disability (PPD).

Permanent Total Disability (PTD) may be established when a worker:

  • Has lost, or permanently lost the use of:
    • Both hands
    • Both arms
    • Both feet
    • Both legs
    • Both eyes
    • Any combination of two of these body parts, such as one arm and one leg or one hand and one eye
    • The loss or loss of use of one entire limb counts as one body part
  • Is unable to engage in long-term gainful employment using skills the worker already possesses or could reasonably acquire.

Permanent Total Disability (PTD) will not be compensated when:

  • The impairment did not result from a qualifying work-related injury or occupational disease
  • The impairment is caused solely by the employee’s age or normal aging
  • The employee retired or voluntarily left the workforce for reasons unrelated to the qualifying injury or disease
  • The employee failed to participate in education or rehabilitation efforts to improve employability, unless those efforts were determined to be futile

Permanent Total Disability (PTD) benefits are paid for the remainder of the employee’s life and are calculated at 66⅔% of the employee’s average weekly wage, subject to:

  • Maximum: 66⅔% of the state average weekly wage on the date the injury or occupational disease began
  • Minimum: 50% of the state average weekly wage on the date the injury or occupational disease began

If the employee’s average weekly wage is less than the minimum PTD benefit, compensation will equal 100% of the employee’s actual average weekly wage.

If the employee also receives Social Security disability benefits, and the combined amount of those benefits plus weekly Workers’ Compensation benefits is less than the state average weekly wage, the maximum weekly Workers’ Compensation benefit may be increased up to the state average weekly wage.

If the employee’s Social Security disability benefits are reduced or terminated, the Workers’ Compensation award will be recalculated so the employee receives the maximum amount permitted under Ohio law.

A person receiving Permanent Total Disability (PTD) benefits due to traumatic brain injury may return to work without losing PTD benefits if:

  • The employment is with a sheltered workshop — a state agency or nonprofit organization that provides occupational activities for persons with disabilities
  • The employee earns no more than $2,000 in any calendar quarter from that work

Death Benefits​

If a deceased worker has no dependents, Workers’ Compensation death benefits are limited to a maximum of $7,500 for funeral expenses.

If the deceased worker has dependents, total weekly death benefits are 66⅔% of the worker’s average weekly wage, subject to:

  • Maximum: 66⅔% of the state average weekly wage
  • Minimum: 50% of the state average weekly wage

If there is one dependent, that person receives the entire weekly death benefit. If there are multiple dependents, the BWC Administrator divides (apportions) the weekly benefit among them.

Death benefits paid to a dependent surviving spouse continue from the worker’s date of death until:

  • The spouse dies; OR
  • The spouse remarries — at that point, the spouse receives a lump-sum payment equal to 2 years of benefits, and ongoing compensation ends.

For dependents other than a surviving spouse, death benefits continue:

  • Until age 18, or until age 25 if the dependent is enrolled full-time in an educational institution
  • For a dependent who is physically or mentally unable to earn, until the incapacity ends
    • Benefits cannot be denied or terminated solely because the incapacitated dependent works in a sheltered workshop, as long as earnings are less than $2,000 per calendar quarter.

For Ohio Workers’ Compensation death benefits:

  • Spouses and children are considered wholly (fully) dependent on the deceased worker.
  • Other relatives may qualify as partial or prospective dependents if they are a:
    • Descendant
    • Ancestor
    • Sibling
  • The BWC Administrator determines:
    • Who qualifies as a partial or prospective dependent
    • The amount/apportionment of benefits
    • The duration of benefit payments

Payments to prospective dependents, other than the deceased worker’s parents, are limited to a maximum total of $3,000.

If the deceased worker was living with one or both parents at the time of death, the parent or parents receive a one-time benefit of at least $3,000.

Note

A full dependent also includes a surviving spouse who was separated from the employee at the time of death because of the employee’s aggression.

Employer Reimbursement​

An employer may request reimbursement from the BWC for benefits or compensation it paid to an employee for an injury or occupational disease when:

  • The employee was not receiving Workers’ Compensation benefits at the time; AND
  • The injury or occupational disease was later determined to be compensable under Workers’ Compensation.

Professional Sports Franchise Employees​

For an employee of a professional Ohio sports franchise who becomes disabled due to a work-related injury or occupational disease:

  • Payments made under a contract or collective bargaining agreement are treated as advance payments of Workers’ Compensation
  • If the employee later receives a Workers’ Compensation award, the employer is reimbursed from that award for the advance payments it made.

Endorsements​

Foreign Coverage​

A Foreign Voluntary Workers’ Compensation endorsement or policy generally covers U.S. employees temporarily working overseas. Benefits are typically based on the Workers’ Compensation laws of the state where the employee was hired.

Foreign Voluntary Workers’ Compensation coverage may also apply to:

  • Workers hired in one country to work in another country that is not their home country
  • Workers hired to work within their own country

Participating Plans​

A Workers’ Compensation participating plan, also called a dividend plan, provides the same coverage as a standard Workers’ Compensation plan.

  • The employer pays the required premiums throughout the policy term
  • After the policy expires, the insurer audits the policy and reviews the loss ratio
  • Loss ratio = total claims ÷ total premiums
  • If the employer has a favorable loss ratio, the employer may be eligible to receive a dividend.