Skip to Content
Appealing Denied Workers Comp Claims

Our Colombus Workman Compensation Attorneys will Help You Fight a Denied Claim

The Ohio workers’ compensation process is often a frustrating one for unrepresented individuals, and a claim denial is just the cherry on top of an already stressful process. You have a right to appeal any denial of your workers’ compensation claim, but if you’ve gone through the process unrepresented by an attorney up to this point, now is the time to get legal assistance from a Columbus workman compensation attorney. An experienced attorney at Malek & Malek Law Firm can review the basis for your claim denial and help you build a strong appeal so that you can get the compensation and medical benefits you need. 

Why Workers’ Comp Claims Get Denied in Columbus

Workers’ compensation claims can be denied for a wide variety of reasons, including on technical grounds such as missing a deadline or submitting paperwork incorrectly. However, many claims get dismissed for similar reasons such as the following: 

  • Your injury is not work-related. Proving that your injury is work-related is fundamental to your claim as you are entitled to workers’ comp only if you were injured in the course of your employment. This can be challenging if you have a pre-existing injury that was aggravated or re-injured at work.
  • Inconsistencies. When submitting a claim, it’s important that your documentation is consistent with the initial accident report. Even minor inconsistencies can result in your workers’ compensation claim being denied. 
  • You did not seek medical treatment. Many people figure that they just need time off from work and rest. Whether or not this is the case, many workers’ comp claims are denied due to a lack of medical documentation. Your medical records are an important part of your claim because they document the cause of your injury and explain why you are unable to work.
  • Non-certified medical providers. If you need to pursue a workers’ compensation claim, you must be evaluated by a BWC-certified medical provider. Workers’ compensation will only cover medical expenses for treatment from a certified provider, with the exception of the initial emergency room visit.

Appealing Your Denied Claim to Court with a Columbus Workman Compensation Attorney

Under Ohio law, you have the right to appeal a denial of your claim. However, we recommend you consult with a Columbus workman compensation attorney as soon as possible as you must file your appeal within 14 days of receiving notice that your claim has been denied. If you don’t file your appeal within that time period, you may lose your rights and jeopardize your claim to compensation. 

The Industrial Commission (IC) hearing process offers the opportunity to appeal claims decisions at three levels 

  • The district level (first appeal)
  • The staff level (second appeal)
  • The commission level (third appeal)

The appeal process starts at the district level and each step must be taken in turn. For example, you can only appeal to the staff level after the district hearing officer has denied your claim. Again, you have 14 days to request an appeal at each level, and hearings will be held within 45 days of filing your appeal. 

If you are denied at the final level of appeal, you can then file a lawsuit within 60 days of the denial asking the court to order the BWC to pay your benefits. A Columbus workman compensation attorney can help you navigate the appeal process efficiently so that you can get your compensation and medical benefits as quickly as possible. 

Attending the Hearing

When you appeal a denial of your claim, it will be scheduled for a hearing before representatives of the Industrial Commission. Many people become immediately intimidated by the prospect of a hearing, but it is intended to be less formal than a court proceeding. You are not required to hire an attorney to represent you at the hearing. 

That said, you should not assume that the hearing will be easy or unimportant. On the contrary, it is your opportunity to present your case as to why you are entitled to workers’ compensation benefits. You will be expected to submit documentation regarding your claim and why it should be paid. Your employer and the BWC will also have an opportunity to make their own case, ask questions, and call witnesses. To be successful, it is critical to be well-prepared and able to prove your claim. For these reasons, your best chance at a successful hearing is to work with a Columbus workman compensation attorney. 

Your Appeal May Require Additional Medical Examinations

As part of the appeal process, you may be required to undergo additional medical examinations – sometimes for each level of your appeal. Your employer or the BWC may pay for the examination, and you may not be able to choose your own doctor. As you might imagine, this examination may be intended to bolster the denial of your claim. As a result, it’s important to know how to challenge the result of these examinations and what you can do to submit your own documentation. An experienced Columbus workman compensation appeals attorney, called an appellate attorney, will know how to meet these challenges and prevail. 

When Your Appeals Are Exhausted

If you have exhausted the appeal process and your claim is still not approved, you may then file a lawsuit in the Court of Common Pleas. However, you must file your claim within 60 days of your final appeal. If you do not file within that time frame, you could lose your right to receive workers compensation benefits. 

To be clear, filing a lawsuit is incredibly difficult for non-lawyers. You will be required to comply with all procedural and evidentiary requirements. Even a minor mistake can jeopardize your claim. In addition, it’s important to understand that it can be very difficult to succeed in these cases – the Court is often unwilling to overrule the findings of the IC after the appeal process has been exhausted. These cases also typically require expert testimony and often proceed to a jury trial. As a result, we strongly recommend that you contact a Columbus workman compensation attorney if you have lost your final appeal as soon as possible and before you take action. 

Should You Reopen Your Claim for Worker’s Comp Benefits?

Reopening a claim is a different process than appealing your claim, but isn’t always an option. In order to reopen your claim, you typically have to meet one of the following conditions:

  • There is new evidence proving that your injury was legitimate
  • There is new evidence demonstrating that the compensation you received was inadequate
  • Your injury has become worse or has recurred
  • Your claim was due to fraud or an administrative or legal error

If you believe that one of these conditions applies to your case, you should contact a Columbus workman compensation attorney as soon as possible.

Contact the Malek Law Firm Today

The appeal process can be time-consuming and frustrating. Let Malek Law Firm help you get the compensation you need to pay your medical bills and take care of your family. Contact a Columbus workman compensation attorney who can help by calling 888-444-7440 to schedule a free consultation today.