You’re entitled to receive benefits through Ohio’s workers’ compensation system if you were hurt or got sick because of your job. If the state denies your workers’ comp claim, you can challenge that decision. But first, you may want to know what kinds of claims commonly get turned down, as well as the steps you should take to appeal a denial., This article explains what might derail your claim and the process for appealing decisions by the Ohio Bureau of Workers’ Compensation (BWC), which reviews claims and pays benefits.
Common Reasons for Claim Denials
Ohio compensates employees for most work-related injuries and illnesses, no matter who was to blame. However, the BWC might deny a particular workers’ comp claim for various reasons. For example, your claim could be rejected if:
- You missed the filing deadline. Your workers’ comp claim must be filed within one year of the injury. When you get medical treatment for your injury, tell the doctor that it’s work-related, and the doctor should file the claim with the BWC on your behalf. Your employer can also do this. But it’s up to you to make sure the claim has been filed and, if it hasn’t, to do it yourself. For more details on the deadlines and procedures, see How to File a Workers’ Comp Claim in Ohio.
- It’s unclear whether your injury is work related. Workers’ compensation covers only accidental injuries that happen on the job and are caused by work activities or conditions. Disagreements over coverage often hinge on this two-part requirement. For instance, your claim may be rejected if your injury happened during your normal commute, but it may be covered if you were hurt during a business trip or running a work errand. Medical evidence is usually critical to answer the question of whether your work duties or conditions caused the injury, especially when it developed over time rather than as a result of a sudden accident.
- Something else contributed to the injury. Even if your injury happened at work, it might not be covered under workers’ comp. For example, the BWC might deny your claim if you didn’t tell your employer about a preexisting heart condition, and you then suffered a heart attack while performing heavy labor at work. Your claim might also be rejected if you were hurt during a fight that you started.
Within 28 days after your claim is filed, the BWC will send you its written decision, along withan explanation for its reasons and any conditions (such as whether you’re entitled to benefits).
Appealing a Claim Denial
You have the right to appeal if your claim is denied. The BWC will tell you the deadline for filing the appeal (usually 14 days after your receive its decision). You can file a Notice of Appeal (IC-12) form or submit a written request by mail or in person at the local BWC office. Your signed request should include:
- your name
- the name of your employer
- the claim number
- the decision date, and
- your reason for appealing.
You may also file your appeal online at the website for Ohio’s Industrial Commission (IC).
The IC is responsible for hearing appeals and resolving workers’ comp claim disputes. Appeals may go through three different levels:
- An IC district hearing officer will hold a hearing. You’ll be able to present evidence at the hearing, including testimony from witnesses. The hearing officer will review the evidence and make a decision. (Learn more about what to expect at your workers' comp hearing.)
- If you disagree with the district hearing officer’s decision, you can appeal again. At that point, an IC staff hearing officer will hold another hearing.
- If the staff officer also denies your claim, you have one final chance to make your case before the IC. The IC’s three commissioners will consider your appeal and decide wwhether to hear it. If the commissioners grant the appeal, you will again have the opportunity to present evidence about your claim.
Appealing to the Courts
Once you’ve gone through all these steps, you may appeal the IC’s decision in the Court of Common Pleas in the county where you were injured. You must file this appeal within 60 days after you receive the IC’s final order.
How a Lawyer Can Help
Ohio’s workers’ comp appeals process can be complex, especially with the various levels and administrative and judicial procedures. An experienced workers’ comp attorney can help you navigate this daunting process, meet all the deadlines, gather the kind of evidence you need to bolster your case, and represent you at the hearings. Learn more about What a Good Workers’ Comp Lawyer Should Do for You. Also, most lawyers working in this field will give you a free consultation and charge only a percentage of the benefits they win for clients. (Learn more about How Much Workers’ Comp Lawyers Cost in Ohio.)