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What Can I Do if the Ohio BWC Denies My Workers’ Compensation Claim?

Workers' Compensation

When you get injured on the job in Ohio, seeking benefits for your injury involves filing a claim with the Ohio Bureau of Workers’ Compensation (BWC). But, even though you file your claim with the government (instead of filing it with your employer’s insurance company, as in most other states), this does not necessarily mean that you will receive the benefits you deserve. In this article, our Columbus workers’ compensation lawyers explain what you need to know if the Ohio BWC has denied your claim for benefits.

Ohio’s “No-Fault” Workers’ Compensation System

In Ohio, workers’ compensation is a “no-fault” system. This means that eligible employees can file for benefits regardless of how they get injured or sick on the job (with a few exceptions). However, it does not mean that injured workers are able to collect benefits automatically.

There are several requirements for filing a successful workers’ compensation claim in Ohio, and there are several reasons why the Ohio BWC will deny injured workers’ claims. If the Ohio BWC has denied your claim, determining what you can do first requires an understanding of why your claim has been denied.

Why Workers’ Compensation Claims Get Denied

The Ohio BWC denies workers’ compensation claims for a variety of different reasons. Depending on the circumstances involved, your denial may be final, or you may have grounds to file an appeal. Some of the most common reasons for workers’ compensation denials in Ohio include:

  • Missed Deadlines – Workers’ compensation claims are subject to strict deadlines in Ohio. If you missed the deadline to report your injury or file your claim, you may have lost your right to benefits.
  • Discrepancies – When reporting your injury and filing your claim, you need to be as accurate as possible. If there are discrepancies between the information you provide and the information your employer or doctor provides, this could lead to a denial.
  • Non-Work-Related Injury or Illness – Workers’ compensation benefits are only available to eligible employees who suffer work-related injuries and illnesses. If your medical condition is not work-related (or if you haven’t proven that it is work-related), this may be the reason for your denial.
  • Failure to Seek Medical Treatment – In order to seek workers’ compensation benefits, you need medical records that show the nature and severity of your injury or illness. The Ohio BWC won’t pay benefits if you haven’t sought treatment for your medical condition.
  • Failure to See a Certified Provider – In order to remain eligible for workers’ compensation benefits after suffering a job-related injury or illness, you need to see a medical provider who has been certified by the Ohio BWC. Seeing a non-certified provider is grounds for denial (unless you need emergency treatment, in which case you can go to the emergency room for your first visit).
  • Employer Dispute – If your employer disputed your workers’ compensation claim, the Ohio BWC may have sided with your employer in the dispute. You will need to work with a Columbus workers’ compensation lawyer to determine why this happened and what options you have available.

The letter from the Ohio BWC denying your workers’ compensation claim should explain the basis for the denial. It should also state how long you have to file an appeal (14 days from the date of the denial)—and you will want to speak with a Columbus workers’ compensation lawyer as soon as possible to make sure your lawyer can file your appeal on time.  

Understanding the Appeals Process for Workers’ Compensation Claims in Ohio

The process of challenging a workers’ compensation denial in Ohio starts with filing an appeal with the Ohio Industrial Commission. There are actually three stages of appeal at the Ohio Industrial Commission; and, if you still aren’t satisfied with the outcome of your claim after all three stages, you then have the right to take your workers’ compensation claim to court.

For the first stage of appeal, you need to complete the IC-12 Notice of Appeal form and submit it to the Ohio Industrial Commission. Alternatively, you can submit a written notice to your Claims Service Specialist that contains all required information. As long as you do so within the 14-day deadline, the Industrial Commission will schedule a hearing before a District Hearing Officer, and you should receive notice of this hearing about 14 days in advance.

Similar to filing a workers’ compensation claim, while you have the option of trying to file an appeal on your own, it is in your best interests to hire an experienced Columbus workers’ compensation lawyer. Not only do you need to make sure you do everything that is required to file an appeal, but you also need to be able to convince the District Hearing Officer to reverse your denial of benefits. If the District Hearing Officer upholds your denial, you will need a lawyer to guide you through the remaining stages of the appeals process—and to take your workers’ compensation claim to court if necessary.  

Preparing to Appeal Your Ohio Workers’ Compensation Denial

When preparing to appeal a denial of workers’ compensation benefits, the first step is to confirm that you have grounds to file an appeal. If the denial is justified (i.e. if your injury or illness isn’t work-related), then there is no point in filing an appeal.

If you have grounds to file an appeal, then you will need to work quickly. You will need to collect evidence that proves your right to benefits, and you will need to get ready to present your evidence to the District Hearing Officer. An experienced Columbus workers’ compensation lawyer can take these steps for you and present a strong case for benefits on appeal.

Talk to a Columbus Workers’ Compensation Lawyer for Free

Has the Ohio BWC denied your claim for workers’ compensation benefits? If so, you should discuss your situation with a lawyer promptly. To schedule a free, no-obligation consultation with a Columbus workers’ compensation lawyer at Malek & Malek Law Firm, call 888-444-7440 or request an appointment online now.