Ohio Workers’ Comp Settlement Chart and PPD Awards

Workers sometimes call any lump-sum payment a “settlement.” That can create confusion when comparing an offer with a benefit award.

Ohio law permits settlements covering one or more claims or parts of a claim. That is why the question is not simply “How much?” It is also “What am I agreeing to close?” See Ohio’s settlement statute, ORC 4123.65.

A useful review starts with the claim file rather than an online average. Two people with the same diagnosis can have different allowed conditions, earnings, treatment plans and ability to work.

• Allowed conditions: compare the BWC orders with the diagnoses your physicians are treating. A disputed or missing condition can affect the benefits available.
• Future care: ask the treating physician about recommended procedures, medications, therapy and follow-up visits. Identify who would pay if medical benefits are settled.
• Work capacity: compare written restrictions with the physical demands of the job and realistic return-to-work options.
• Remaining benefits: review unpaid compensation and potential temporary total disability, PPD or other benefit applications before resolving them.
• Evidence and disputes: identify which parts of the claim are well supported, contested or still missing a medical opinion.
• Net proceeds: ask for an explanation of fees, expenses and any required allocations, so you understand the amount available to you.

For example, an offer can look attractive until a recommended operation is compared with the medical benefits being closed. The same dollar amount may have a different practical effect if medical coverage remains open. Those are terms to resolve before signing.

Settlement may be discussed when an offer arrives, treatment needs change or a return-to-work plan becomes clearer. Bring information about ongoing payments and immediate financial obligations as well as the offer. Compare those needs with future care and the benefits being resolved; a lump sum is not automatically a better choice than continuing eligible payments.

For a state-fund settlement under ORC 4123.65, the 30-day period runs after the BWC administrator approves the settlement. For a self-insured settlement, it runs after the employer and employee sign the final agreement. Consent can be withdrawn during that period subject to the statute’s rules and exceptions.

The Industrial Commission also reviews whether the agreement is clearly unfair. The 30-day period is not a promise that a check will arrive exactly 30 days after you accept an offer. Gathering signatures, approval and payment processing can add time.

Keep a copy of the complete agreement. Confirm the covered claim numbers, which medical and compensation benefits are being resolved, and any obligations that continue after payment.

A workers’ compensation lump sum can affect Social Security Disability Insurance payments. The Social Security Administration’s workers’ compensation offset guide (PDF) explains why a lump sum may be treated differently from ordinary savings.

Medicare is a separate issue. If the agreement resolves future medical expenses, Medicare’s interests must be considered. A Medicare set-aside may be part of that analysis, but not every settlement requires submission to CMS for review. See the CMS guidance on workers’ compensation Medicare set-asides.

Bring information about your benefits and Medicare status to the settlement review. The gross offer should not be evaluated without considering these interactions.