Your Options If Your Ohio Workers’ Compensation Claim Is Denied

Work Injury Claim With a Red Denied StampThe state of Ohio runs one of the largest workers’ compensation systems in the country. Last year, the state’s bureau of workers’ compensation (BWC) addressed over 99,000 claims for a variety of workplace illnesses and injuries. While billions of dollars were paid out to help injured workers and their families, not every workers’ compensation claim was approved. In 2016, about 11 percent of claims were denied or dismissed, equal to nearly 11,000 claims. While it can feel frustrating and overwhelming, injured workers may still have options, even after a claim is denied. It can still be possible to obtain benefits to provide important medical care and wage replacement.

Ohio’s Large and Comprehensive Workers’ Compensation System

Every Ohio business with one or more employee is required to carry workers’ compensation insurance to protect employees after workplace injuries and illnesses. There are few exceptions to this rule, including sole proprietors, family farm corporate officers, partners, and limited liability companies acting as a partnership or sole proprietor.

Ohio is one a few states that use monopolistic workers’ compensation system. This means that employers must purchase workers’ compensation insurance from the state or self-insure. There are no private insurance options. Either employers pay into the state fund and the state pays the benefits to the injured worker, or employees pay the injured workers directly. Additionally, the state uses managed care organizations (MCOs) to administer the care.

What to Expect After Your Columbus Workplace Injury

When an Ohio employee is injured, there are certain expectations and rules that must be followed. The first steps are to seek medical care and notify the employer of the injury. Depending on the circumstances, the employee may need to seek immediate care, or there may be time to notify the employer first. In Ohio, injured workers are permitted to see any provider for the initial treatment. In those cases, injured workers should let their doctor know that the injury is work-related so the provider can properly document the visit. After that, the employer will provide the employee a list of certified providers. Then, the workers’ compensation claim will be filed. The employee, employer, medical provider, or other authorized representatives can file the claim online. The state will make a decision to approve or deny a claim within 28 days.

When Your Workers’ Compensation Claim is Denied

In some cases, a claim is denied. Claims are denied for a variety of reasons. According to the BWC, many claims are rejected simply because there is not enough information provided by the injured worker. Other common reasons for a denial include:

  • Missed filing deadlines
  • Discrepancy between the accident report and documented injuries
  • The injury did not happen at work
  • The injury is not severe enough to warrant benefits
  • The employer is disputing the claim
  • Medical treatment was not sought
  • Medical providers were outside the certified list

In every case, the injured worker will receive a letter that states the exact reason for the denial and information regarding a possible appeal, including the timeframe for filing.

An Ohio Workers’ Compensation Denial Can Be Appealed

It can be possible to appeal the initial decision and still obtain workers’ compensation benefits. In Ohio, there are three levels of appeals:

  • District
  • Staff
  • Commission

Appeals start at the district level and can proceed further if necessary. At all levels, a hearing will take place within 45 days of filing the appeal. An officer will hear the appeal and make a decision within seven days. If denied again, the injured worker then has 14 days to file an appeal to the next level. The commission may refuse to hear the appeal, and the employee may decide to pursue the matter in the court system. In those cases, employees have 60 days to file a claim.

How Our Experienced Ohio Workers’ Compensation Attorneys Can Help

Obtaining workers’ compensation benefits can provide vital medical care and wages for an injured worker and his family during a very difficult and stressful time. When those benefits are denied, the health and security of your family can be at risk. At the Monast Law Office, we understand just what is at stake, and we can help ensure that injured workers obtain the compensation they need and deserve. Our experienced legal team has helped others navigate the often confusing and frustrating system. When your claim is denied, it can feel especially hopeless. However, we can help you and your family:

  • Fill out paperwork
  • Meet filing deadlines
  • Obtain medical information
  • Find and interview witnesses
  • Prepare and present your case at a hearing
  • Negotiate with insurance companies

The decisions of the BWC are binding, and those decisions directly affect your well-being. The process can be adversarial, and Ohio’s injured workers deserve to have their voices heard. Even if your initial claim was denied, it can be possible to obtain the benefits you deserve.

If you or someone you love has suffered a work-related illness or injury, the lawyers at the Monast Law Office may be able to help. Call our Upper Arlington workers' compensation law office today at (614) 334-4649​ to learn more about your rights and possible options.