Claim Appeal Stops Clock on Oversight Limit

A five-year limit on the Ohio Industrial Commission’s oversight of a claim doesn’t impact a workers comp court case once an appeal has been filed, the Supreme Court of Ohio has ruled.
The decision allows Brian Caldwell to continue to pursue his appeal for a work-related injury he suffered in 2015.
He was injured while working at Whirlpool in 2015 and was awarded permanent-partial-disability compensation for a hernia.
Under Ohio’s workers’ compensation self-insurance option, Whirlpool made payments to Caldwell until January 2017.
In December 2019, Caldwell sought additional coverage for “disc protrusions or bulges” in his back, which he claimed were related to the original injury.
The Industrial Commission denied his right to additional coverage.
The Court reversed a Third District Court of Appeals decision that terminated a Whirlpool Corporation employee’s appeal in court because five years had elapsed since his last workers’ compensation payment.
The panel rejected the appliance maker’s argument that an appeal of an injury claim expired five years after the last payment, regardless of whether the appeal was pending.
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Optum has sold its workers’ compensation Settlement Solutions business to ExamWorks Compliance Solutions.
Financial details were not disclosed.
The Settlement Solutions unit was housed within Optum’s workers’ compensation and auto no-fault business segment, Becker’s reported on Monday, citing an Optum spokesperson.
The unit includes Medicare Secondary Payer compliance solutions.
Lawrenceville, Georgia-based ExamWorks specializes in Medicare compliance and mandatory insurer reporting for insurers, third-party administrators, self-funded employers and other entities.
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