February 9, 2024

Three Steps to Take if Your Ohio Workers’ Compensation Claim is Denied

Category: Uncategorized

Author: Matthew T. Hurm, Esq.

Valid workers’ compensation claims are important to the injured worker because they provide the lost wages, payment for medical bills, and the support the injured worker needs to overcome the bad luck they suffered at work with the injury. Unfortunately, the Ohio Workers’ Compensation system is immensely complicated, and valid claims are rejected frequently for reasons someone without an attorney wouldn’t have known to address. 

Once a claim is filed with the Ohio Bureau of Worker’s Compensation (“BWC”), the BWC has thirty days to decide whether to accept or deny your claim. To make their determination, the BWC will request documents from your doctors and/or the emergency room. It will ask for documents and information from the injured worker. It will seek medical reports in support of the alleged work injury from your current doctor. Should you, any of your doctors, or the emergency room fail to produce all the documents the BWC needs to make their decision, they can and frequently do deny your claim. There are many other reasons valid claims are denied, including prior existing conditions, questions about one’s employment status, and questions about whether the injury was suffered within the scope of employment. Each of these issues is complicated and requires experienced legal counsel to navigate. That is why the first thing you should do when the Bureau of Workers’ Compensation denies your claim is…

#1 Hire Experienced Legal Counsel

You have nothing to lose by hiring legal counsel. Attorneys in workers’ compensation claims are paid on a contingency fee, meaning if you do not recover anything, you do not have to pay anything. And if your claim is denied, you are not going to receive any benefits, so there is nothing but upside in hiring an attorney.

An experienced attorney will also be able to help you overcome the frequently complicated legal analysis you need to prove your case. Issues such as independent contractor status, employment status, scope of employment, and evidence sufficiency can all be handled by an experienced attorney without you needing to get a legal degree of your own to protect your rights. Additionally, legal counsel will know the documents you need and the reports you need to request from your treating physician. There is no question that if you do nothing else once you learn of your valid workers’ compensation claim being denied, you must hire experienced legal counsel.

#2 Appeal Your Claim

When the BWC denies a claim, the injured worker has fourteen days to appeal that decision from when she or he receives a copy of the denial letter. The only way your denied claim can be overturned is if you timely appeal the denial. Without appealing the denial, your claim has failed and you are no longer eligible for lost wages, the payment of your medical expenses, or the lump sum payment nearly all workers’ compensation claims get upon their completion. When you hire an attorney, sometimes it takes a while for that attorney to fully take the reigns of your case, and it is your responsibility to make sure that your attorney knows of your appeal deadline and timely files the appeal on your behalf (or for you to file the appeal yourself, if necessary).

#3 Identify the Reasons for the Denial of Your Claim and Overcome Them

When the Ohio BWC issues a denial of a claim, sometimes it will share the reason for its denial. Sometimes it will not. You must determine the reason for the denial of your claim so that when you appeal the denial and a hearing is scheduled with the Ohio Industrial Commission, you are prepared to overcome your burden to prove that you have a valid claim. 

The injured worker has the burden of proof. The injured worker is required to overcome that burden of proof through objective evidence to prove that the claim was valid and should have been allowed. The injured worker must be able to prove that they were an employee (not an independent contractor) working in Ohio who suffered a work injury within the scope of their employment (not in transit to or from your employment). And that the work injury you suffered caused the condition your treating physicians have diagnosed you with.

At the end of the day, the most important step in protecting your valid workers’ compensation claim is hiring an experienced attorney. You need to hire an attorney you can trust who can handle all the documentation and evidentiary issues you face with your denied claim. The Hurm Law Firm is an experienced firm that handles workers’ compensation claims like yours every day. You can call the Hurm Law Firm for a free consultation at (216) 860-1922.

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