Who Pays for Prosthetic Limbs After an Accident in Ohio?

If the amputation happened at work, the Ohio Bureau of Workers’ Compensation must pay to buy, repair, and replace the device. If someone else caused the accident, their liability insurance pays as part of your injury claim, and that covers future replacements too. If you are relying on health insurance or Medicare, expect to pay a share yourself.

Why Does the Payer Question Matter So Much?

A prosthesis is a lifetime expense, not a one-time purchase. Devices wear out, sockets stop fitting as the residual limb changes shape, and components break with daily use. Most users replace a device every few years and need refittings and repairs in between.

Costs climb with the level of amputation. Below-knee devices generally start in the low thousands and can reach around $20,000. Above-knee devices cost more because they replace the knee joint, and a microprocessor-controlled knee alone can add tens of thousands. Across decades, the total often reaches six figures.

That is why identifying who pays, and for how long, matters as much as the first invoice.

Does Ohio Workers’ Compensation Pay for Prosthetics?

Yes, and Ohio’s rule here is stronger than most people expect.

Under Ohio Revised Code 4123.57, when a worker suffers an amputation or a listed loss from an allowed claim, the BWC administrator is required to pay the cost to purchase, repair, or replace a prosthetic device. The money comes from a state surplus fund, and the statute says this applies even if no scheduled loss award was made.

There is a second protection worth knowing. Under Ohio Revised Code 4123.52, the commission or administrator may order payment for a prosthetic device regardless of the date of injury or the date of the last payment of compensation. In practical terms, an old claim does not automatically shut the door on getting a replacement limb paid for years later.

Ohio workers’ compensation also pays a scheduled loss award for the amputation itself, separate from medical care. ORC 4123.57(B) sets a fixed number of weeks for each body part, including:

• Loss of an arm: 225 weeks
• Loss of a leg: 200 weeks
• Loss of a hand: 175 weeks
• Loss of a foot: 150 weeks
• Loss of a thumb: 60 weeks
• Loss of a great toe: 30 weeks

Those weeks are paid at the statewide average weekly wage, a rate the BWC adjusts annually.

Who Pays if Another Driver or Business Caused the Injury?

When someone else’s negligence caused the amputation, their liability insurance is the primary source. In that claim, prosthetic costs are economic damages, and Ohio does not cap economic damages.

A settlement should account for every replacement device, socket, and repair you will need for the rest of your life, not just the prosthesis you have now. Once you settle, you cannot go back for more. A claim that only covers the first device leaves decades of expense uncovered.

If the at-fault driver was uninsured or fled, your own uninsured or underinsured motorist coverage may apply.

How Much Does Health Insurance Actually Cover?

Less than most people assume.

Medicare Part B covers 80% of the approved amount for a prosthetic device after you meet the annual Part B deductible. You are responsible for the remaining 20% coinsurance, and that share is not capped. On an expensive device, 20% is a large number.

Private health insurance varies widely. Some plans cap prosthetic benefits, limit replacements to a set number of years, or deny advanced components as not medically necessary. About half of states have passed prosthetic parity laws requiring coverage on par with other medical benefits, but those laws reach only state-regulated plans. Many people are covered by self-funded employer plans that state insurance law does not govern.

Common coverage obstacles include:

• Denial of microprocessor components as more than medically necessary
• Replacement limits that do not match how fast devices actually wear out
• Annual or lifetime dollar caps on prosthetic benefits
• Exclusion of activity-specific or waterproof devices as convenience items

What Happens When Sources Overlap?

Often several payers are involved at once, and one may seek reimbursement from another. A health insurer or Medicare that paid for early treatment may assert a lien against your injury settlement. Workers’ compensation may have a subrogation interest if you also recover from a third party.

Sorting these out before you settle protects how much of the recovery you actually keep.

FAQ

Does Ohio BWC have to replace a prosthetic limb, not just buy the first one?

Yes. The statute requires payment to purchase, repair, or replace a prosthetic device for an allowed amputation claim.

Can I get a prosthetic paid for on an old workers’ comp claim?

Possibly. Ohio law allows payment for a prosthetic device regardless of the date of injury or last payment of compensation.

How much does Medicare pay?

Part B pays 80% of the approved amount after the deductible. You owe the remaining 20%, with no cap on that share.

Will a settlement cover prosthetics I need in 20 years?

Only if the claim was valued to include them. Future replacement costs must be projected and included before you settle.

Does health insurance cover advanced prosthetic knees?

Not always. Insurers frequently deny microprocessor components as beyond medical necessity, and appeals with physician documentation are often required.

Paying for a Prosthesis Long Term

The first prosthetic device is rarely the expensive part. The cost that matters is the one that repeats every few years for the rest of your life, and it is the part injury settlements most often leave short.

The Jones Firm helps injured people in Columbus and throughout Ohio account for lifetime prosthetic costs when valuing a claim. To talk through who should be paying in your situation, contact The Jones Firm for a free consultation.