Facing a denied workers’ compensation claim can feel like a crushing blow if you’re already dealing with missed time at work and serious injuries. However, a denial is rarely the final word on your claim. There are important steps you can take, and this guide explores how to appeal a denied workers’ compensation claim in Ohio. An experienced lawyer can pursue the medical care and financial support you deserve after a work-related injury.
Ohio’s Workers’ Compensation
Employees are hurt in Ohio each day and across every industry, from quiet offices in Cleveland to busy construction sites along I-80. Most Ohio employers are required to maintain workers’ compensation insurance for their employees. So long as your accident happened as part of your work-related duties, you can typically file a claim for benefits.
However, your benefits do not automatically start. To begin a claim, you must report what happened to your supervisor or manager. Then, your company provides you with all of the paperwork you’ll need to file an Ohio workers’ compensation claim. You’ll usually have to visit an employer-approved doctor, and your insurance carrier will review your submitted paperwork to decide if you’re eligible for benefits. If approved, you’ll be advised of your available benefits.
However, if you’re denied, understanding how to appeal your denial is critical because:
- Ohio has strict deadlines. You only have 14 days from the date of the decision to file an appeal. If you miss this deadline, you permanently forfeit your ability to challenge the denial.
- It impacts your financial stability. A denial ultimately stops your wage replacement benefits, putting your household income and financial survival at immediate risk while you’re unable to work.
- It affects your medical continuity. Approved claims cover your medical treatments. A denial usually means you must find alternative ways to pay for care, which often delays your physical recovery.
- A denial does give you a second chance at benefits. An appeal allows you to present medical testimony and argue your case in front of a live hearing officer. Also, if you were working alone before, filing an appeal gives you a chance to work with an experienced workers’ compensation lawyer who can build a compelling appeal on your behalf.
If you were injured at work, file a workers’ compensation claim. You may feel like the process is overwhelming, but you are not alone in your recovery journey. During 2023, the Ohio Bureau of Workers’ Compensation (BWC) confirmed 171,857 open claims for lost time and 358,069 for medical issues, with paid medical benefits totaling $379,481,783 that year. Total compensation during 2023 was reported at $896,346,895.
Appeal a Denied Workers’ Compensation Claim
To appeal a denied claim, you must act quickly to navigate the appeals process. To avoid losing your right to appeal, you must file an initial appeal within 14 days from the exact date you receive the official denial order from the Ohio Bureau of Workers’ Compensation (BWC).
Then, a hearing is scheduled within forty-five days at a local Industrial Commission office. A Hearing Officer reviews your wage information, medical records, and statements. They’ll issue a written decision within seven days of the hearing.
If the Hearing Officer denies your claim, you then have another 14 days from receiving the order to file a second appeal. A Staff Hearing Officer (SHO) holds a new hearing to review the evidence and any additional medical documentation. They issue a decision, which represents the final mandatory administrative level of appeal.
If the SHO denies your claim, you may file a final appeal to the Commission within 14 days. The Commission is not required to hear this appeal and only accepts it if there is a significant legal issue or supplemental, critical evidence. If the Commission refuses to hear your case or denies the appeal, you may file a civil case in the Ohio Court of Common Pleas in the county where your injury occurred within 60 days of the final Commission decision.
FAQs
What Kinds of Benefits Are Available With a Workers’ Compensation Claim?
Workers’ compensation claims usually provide two different kinds of benefits, including:
- Compensation for your medical expenses incurred due to a workplace injury, including your emergency medical bills and all expenses required to manage your symptoms until you’ve reached maximum medical recovery.
- Ongoing temporary or permanent disability benefits if it’s been decided that you’re unable to work.
Should I Work With a Lawyer If My Workers’ Compensation Claim Is Denied?
You should consider working with a lawyer if your workers’ compensation claim is denied. Ohio’s workers’ compensation system offers a structured, multi-level appeals process that is designed to allow injured workers to present new evidence and to pursue their rightful benefits.
Yet, the process is complicated and can be overwhelming without help from a knowledgeable lawyer. Navigating the legal complexities and strict deadlines of the Industrial Commission of Ohio requires swift, strategic action.
Do Insurance Companies Pay What’s Fair Through Workers’ Compensation?
While insurance companies should pay what’s fair to injured workers through workers’ compensation, that’s unfortunately not always the case. Insurance companies often try to minimize your workers’ compensation payout by:
- Prematurely trying to have employees return to work.
- Outright denying legitimate injury claims without valid reasons.
- Delaying payments.
- Performing inadequate investigations.
- Pressuring you into recorded interviews designed to damage your case.
Do I Have to Hire a Workers’ Compensation Lawyer to Prepare My Claim Paperwork?
While you do not have to hire a workers’ compensation lawyer to prepare your claim paperwork or to assist with your appeal, having a lawyer on your side is often the most effective way to pursue the benefits you deserve through the workers’ compensation system in Ohio.
Many workers become frustrated and overwhelmed once they start digging into the claims process, and having a lawyer prepare their paperwork can make all the difference with their claim.
Hire a Workers’ Compensation Lawyer in Ohio: Choose Lallo & Feldman Co.
To hire a workers’ compensation lawyer, connect with Lallo & Feldman Co. Our Ohio workers’ compensation attorneys have a well-developed understanding of state workers’ compensation laws. From Willoughby to Cleveland and the surrounding areas, Ohioans count on us for their recovery.
Contact us for your initial consultation with an experienced attorney at Lallo & Feldman Co., L.P.A.
