Deteriorating Denied SignWhen someone contacts my office because their workers' comp claim was denied, the first thing they want to know is why it happened. I have been a workers' comp attorney in Ohio for over 30 years, so I should be able to give them an answer, but sometimes the only explanation seems to be that the hearing officer ate something wrong for breakfast that morning. There is just no rhyme or reason for some denials. Other denials are so nit-picky, they're hard to believe. Here are some of the more common denials I see.

Surprising Reasons for Workers' Comp Denials

It might come as a shock to you if you are given one of these reasons when your comp claim is denied:

  • You are an independent contractor. If your employer or the BWC decides that you are not an insured employee but, rather, you are a contractor who didn't have your own coverage, your claim will be denied. This might come as a shock to you if you believed you were an employee.
  • You waited too long to get medical treatment. You might have gone to the doctor when you realized you were hurt. Maybe it took a few days to get an appointment. Or maybe your supervisor told you to wait to see if your pain went away. Whatever the case was, you felt like you got there as soon as you could. Now you are being told that your claim is denied because you didn't see a doctor right away.
  • You were not actually at work. For an injury to be covered by workers' comp,  generally you have to have been on the clock. In your mind, when you slipped and fell on your way back from the break room, you were at work. But the BWC may say it was not in the scope of employment if you were still off the clock.
  • You're filing for a pre-existing condition. If your medical history shows you were treated for a similar injury in the past, you could be denied based on a pre-existing condition. If you have a history of certain medical tests, such as EMGs and MRIs, that could also lead your claims processor to conclude that you have a pre-existing condition that's the real reason for your current problems.

Sometimes when you are denied for one of these reasons, it is simply a mistake that can be easily cleared up. Other times, an appeal will be more difficult.

If I Think We Can Win, I Will Tell You How

Just because you are surprised by the reason for your denial, that doesn't mean it's not a fair denial. For example, if you thought you were an employee, but you were wrong, you will not win an appeal. However, if there is no good reason for your denial, I will help file an appeal that clears things up. To learn more about workers' comp claims in Ohio, request a free download of my book The Worker's Guide to Injury Compensation in Ohio, and then call us!

James Monast
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Board-Certified Workers’ Compensation Attorney in Columbus, Ohio
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Renee Latessa 01/29/2024 10:45 AM
My mom fell at work but she was just standing there, her leg gave out,Didn’t trip. Is this a workers comp claim?
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Monast Law Office 01/29/2024 2:49 PM
If that's literally all, then it'll be tough. But it may make a difference what she'd been doing beforehand. For example, if she had just finished activities that involved her legs and exhausted them, she may have a compensable claim. Typically, with these sorts of injuries, we try to determine what else was going on, floor conditions, any prior problems with knee giving way, etc. So, the answer at this point is "could be!" but we'd want some more information.
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