When Can Your Employer Deny Workers’ Compensation in Ohio?
For many Ohio employees, filing a workers’ compensation claim for a job-related injury involves dealing with the Ohio Bureau of Workers’ Compensation (BWC). This is because most employers participate in Ohio’s state-run workers’ compensation insurance system. But some employers self-insure, and if your employer is self-insured, then you will need to hire a Columbus workers’ compensation lawyer to help you deal with your employer directly.
Why is it important to hire a Columbus workers’ compensation lawyer to help you in this scenario? Simply put, filing for workers’ compensation is not an easy process. Not only are there several steps involved, but your employer may try to deny your claim for benefits.
5 Grounds for Denial of a Workers’ Compensation Claim in Ohio
Even though workers’ compensation is a no-fault system in Ohio, employers can still deny their employees’ workers’ compensation claims on various grounds. Here are five examples of grounds for employers to deny their employees’ claims for benefits:
1. You Are Not an Eligible Employee
Your employer is not required to cover your workers’ compensation claim if you are not an eligible employee. In most cases involving self-insured employers, this would mean that you are properly classified as an independent contractor.
Under Ohio law, employees are generally eligible for workers’ compensation benefits, while independent contractors generally are not. As a result, if you are properly classified as an independent contractor, then the company you work for (which is not technically your “employer”) may not be required to cover your work-related injury or illness.
Before you give up on your workers’ compensation claim, however, you should make sure that you have been properly classified. Sometimes, companies improperly classify employees as independent contractors in an effort to avoid liability for workers’ compensation (among other benefits).
Additionally, if you are properly classified as an independent contractor, then you may have grounds to file a personal injury claim instead of a workers’ compensation claim. While companies are generally immune from personal injury lawsuits for work-related injuries when they provide workers’ compensation coverage, they aren’t immune when they don’t provide coverage.
2. You Didn’t File Your Workers’ Compensation Claim on Time
Even if you are an eligible employee, your employer can deny your workers’ compensation claim if you don’t file your claim on time. Typically, this means that you must file your claim within one year of the date of your job-related injury or illness.
In some cases, determining how long you have to file a workers’ compensation claim will be fairly straightforward. For example, if you were injured in an accident at work, you will most likely have one year from the date of the accident before the statute of limitations for your workers’ compensation claim expires.
However, in other cases, determining how long you have to file can be more challenging—and employers will often try to use this to their advantage.
For example, let’s say you are dealing with a repetitive stress injury. If your injury developed over time, it may not be clear when the one-year statute of limitations for your workers’ compensation claim starts to run.
Given the potential challenges involved in filing a workers’ compensation claim with your employer, it is best to speak with a Columbus workers’ compensation lawyer about your legal rights as soon as possible. This will help ensure that you file your claim on time, and it will help ensure that you have the best chance to seek the benefits you deserve.
3. Your Injury or Illness Isn’t Work-Related
In Ohio, workers’ compensation only covers work-related injuries and illnesses. If you got hurt outside of work, you aren’t eligible to file a claim—even if your injury prevents you from working.
Employers will often rely on the “work-related” injury requirement to deny employees’ benefit claims as well. This is particularly common in cases involving:
- Repetitive stress injuries
- Exacerbation of pre-existing conditions
- Vehicle collisions during work hours
- Cancers and other serious illnesses
- Injuries and illnesses that workers don’t report right away
However, these are all conditions that employers will still be required to cover in many cases. This makes it important to document both the timing and the cause of your condition. To do this, you can take photos or videos with your phone, report your injury or illness to your employer promptly, and seek medical attention as soon as possible. If you take these steps, this will significantly improve your chances of filing a successful workers’ compensation claim (though success still is not guaranteed).
4. Your Workers’ Compensation Claim is Inaccurate or Incomplete
Your employer can also deny your workers’ compensation claim if it is inaccurate or incomplete. With this in mind, when filing a workers’ compensation claim, it is important to be as accurate and thorough as possible. While your Columbus workers’ compensation lawyer may be able to supplement your claim if necessary, it is best to avoid unnecessary complications if you can.
Once you hire a Columbus workers’ compensation lawyer to represent you, your lawyer will review your claim to determine if any additional information or clarifications are needed. If so, your lawyer will then begin the process of communicating with your lawyer on your behalf. If your claim contains all necessary information (and does not contain any inaccurate information), then your lawyer will begin the process by determining how much you are entitled to recover.
5. Insufficient Medical Treatment or Documentation
To successfully file for workers’ compensation benefits with your self-insured employer, you must have proof of your medical condition and its impact on your ability to work. This means that you need a medical diagnosis, you must obtain all necessary medical treatment, and you must have adequate medical documentation.
If you wait to seek a diagnosis, if you ignore your doctor’s treatment recommendations, or if you don’t submit the necessary medical documentation to your employer, all of these are issues that could lead to a denial of benefits. Even if you are clearly dealing with a work-related injury or illness, if you don’t take the steps necessary to establish your right to benefits, your employer doesn’t have to pay.
5 Improper Reasons to Deny an Employee’s Claim for Benefits
While the issues discussed above can provide employers with grounds to deny their employees’ workers’ compensation claims in appropriate cases, there are several invalid reasons for denials as well. Some examples of improper reasons to deny an employee’s claim for workers’ compensation benefits include:
1. Your Employer Doesn’t Have Workers’ Compensation Coverage
Employers that choose to self-insure cannot deny injured workers’ claims because they don’t have insurance coverage. If an employer chooses to self-insure, it must pay benefits to injured and sick workers just as the Ohio BWC would pay benefits had the employer chosen to participate in Ohio’s state-run workers’ compensation insurance program.
2. Your Employer Doesn’t Want a Claim on Its Record
Sometimes employers try to deny workers’ compensation claims because they don’t want the claims on their record. This is not a valid reason to deny a workers’ compensation claim. If you are an eligible employee, you got injured or sick at work, and you properly filed your workers’ compensation claim on time, then you are entitled to benefits regardless of what your employer would prefer.
3. Your Employer Doesn’t Understand the Law
Eligible employees can also face improper claim denials when their employers don’t understand the law. This is yet another important reason to have an experienced Columbus workers’ compensation lawyer on your side. If your employer improperly denies your claim but doesn’t realize that its denial is improper, you will need an experienced lawyer who can step in and ensure that your claim is handled appropriately.
4. Covering Your Workers’ Compensation Claim Will Be Expensive
If you are entitled to workers’ compensation coverage, your self-insured employer must fully cover your claim regardless of how much it costs. Wanting to save money is not an excuse for violating the rights of injured and sick employees. Here, too, your Columbus workers’ compensation lawyer will be able to assist with holding your employer accountable and ensuring that you receive the full benefits to which you are legally entitled.
5. Covering Your Workers’ Compensation Claim Will Lead to Additional Claims
Likewise, your employer cannot deny your workers’ compensation claim because it wants to avoid setting a precedent. If your employer is worried that covering your claim will lead to additional claims, this is your employer’s problem, not yours. You are entitled to medical and disability benefits in accordance with Ohio law, and if your employer wrongfully refuses to pay, you are entitled to take the necessary steps to hold your employer fully accountable.
Request a Free Consultation with a Columbus Workers’ Compensation Lawyer Today
Do you need to know more about filing a workers’ compensation claim with your self-insured employer? If so, we invite you to get in touch. To request a free consultation with a Columbus workers’ compensation lawyer at Malek & Malek Law Firm, please call 888-444-7440 or tell us how we can help online today.