If your workers comp claim was denied, you should know you don’t have to take no for an answer.

The Workers’ Compensation system is complex, and your claim could be turned down for any number of reasons, but what you may not know is that if your claim is denied, you have the right to appeal this decision.

1. Your injury didn’t happen at work

To be eligible for workers’ comp benefits, your injury must have happened while you were performing your job duties.

For example, if you work in a restaurant and twist your knee while taking dishes to the kitchen, it’s likely you’re owed benefits. On the other hand, if you were injured while you were on your lunch break or on your commute to work, then you’re most likely not eligible to make a claim.

However, there is a grey area around this rule. If you were not at your jobsite but you were at a work assignment or event, such as a company retreat, you might have a claim.

You should keep in mind that insurance companies, and even your employer, might work very hard to try to prove that you were not at work when your injury happened, even if you know you were.

In a case where there are no witnesses or security camera footage, it can be difficult to challenge this decision. However, an experienced workers’ compensation attorney can be a powerful force in having this decision reversed.

2. You didn’t notify your employer of your injury within the required time

There are certain time limits in the workers’ compensation claim process. After you’re injured, it’s extremely important that you inform your employer about the injury as soon as you are able to. If you don’t report your injury as soon as possible, a number of things can happen.

Firstly, your employer will not be able to carry out an accident investigation, which is vital for the success of your claim.

Secondly, your employer, and the insurance company, can try to claim you were not really hurt at work, arguing that if you were hurt at work you would have reported the issue sooner.

Finally, the insurance company can try to claim your injury didn’t happen due to your job duties and argue that they were the result of a pre-existing condition or something that happened while you were off the clock.

3. You were intoxicated or under the influence of alcohol or drugs

Workers’ compensation is not about finding someone to blame. However, if alcohol or drugs were involved in your accident, you are not entitled to make a claim.

When you go to the doctor for a work injury, your boss has the right to require that you are tested for alcohol and/or drugs. If tests show that you were under the influence when the injury happened, then your claim will typically be denied.

4. You were not treated by an approved medical provider

Under the workers’ comp system, your boss and the insurance company have the right to provide you with an approved list of doctors you can visit to receive treatment.

In some instances, this may be a negative thing because these doctors can try to downplay your injuries, which means you could receive lower benefits.

Although you have to see an approved medical provider to be entitled to compensation, having the help of a workers’ comp lawyer will guarantee you the best chance of getting the treatment you require and the benefits you are entitled to.

5. You never received medical treatment

While you don’t have to see a doctor for every small scrape or bruise you get at work, if you think your injury is entitled to a claim, you will need the medical records to prove it. Without the supporting medical records, the insurance company can say you faked your injury to claim benefits, resulting in a denied claim.

Make sure you give your claim the best shot of being successful and visit a doctor.

6. You never filed your paperwork or failed to do so on time

There are specific time limits and deadlines for when you have to file your Workers’ Compensation claim. Even for injuries that develop slowly over time, like carpal tunnel syndrome, time limits apply.

If you do not file your papers on time, you are giving your employer and the insurance company another reason to deny your claim.

If you work with a Workers’ Compensation attorney they will be able to make sure you have all of your papers in order and that they are filed on time.

7. Your injury was the result of horseplay, roughhousing or practical jokes

If you’re goofing around at work and ended up getting hurt, it is unlikely that your injuries will be covered. In the eyes of the law, you are not considered working while you are roughhousing. So what can seem like fun and games can end up causing major stress later.

Similarly, if you start a fight at work and you get hurt, you generally will not be eligible for benefits.

8. Your injury is from a pre-existing condition

If you had an injury or illness before starting your job and your job did not make it worse, you are typically not eligible for workers’ compensation. The insurance company can and will fight very hard to get your claim rejected using this argument.

However, workers’ comp claims are complex and there is a lot of gray area. Some employees who are entitled to benefits see their claims rejected and do not fight back. Do not make this mistake.

9. Your employer disputes your claim

Your employer can, and most likely will, dispute your claim. They may be afraid that the cost of their workers’ comp coverage will increase if there is a claim on their policy. To combat this they could argue that the details of the case are incorrect or that you were not at work when you got injured.

This point can be especially true if there are no witnesses or surveillance footage to support your claim. If you were hurt and no one saw it, make sure you tell your employer and co-workers what happened as soon as possible.

10. You did not have a workers comp attorney

You do not have to have a workers’ compensation attorney to file a claim, but having one will definitely increase the chances of your claim being successful.

An attorney will be able to guide you through the process and advise you on the different steps and documents you need to give your claim the best chance of being successful.

If your claim has been denied, call Thomas Marchese. We can give you advice and we will improve the likelihood of your appeal being successful.

Let’s take a look at a hypothetical situation. Let’s say you’re having a bad week. You’re carrying your piping hot coffee through the warehouse when you trip over some cables that were being improperly stored.

You fall, hot coffee burns your hands, ruins your shirt, and your morning, and you land pretty hard. In a huff, you pick yourself up off the ground, you mutter a few choice words, and decide this is the last straw.

You quit.

A few days later, you’re still hurting. You go to the doctor, who says you’ve got a herniated disc and second-degree burns. You’re going to need physical therapy and pain management, which means you’ll be out of work for a while.

You might be wondering, “Can I still get workers’ compensation if I quit my job?”.

The short answer is yes, you can still qualify… but if you haven’t quit, don’t.

_______________

When you’re injured on the job and have a worker’s compensation claim, your claim really has two aspects, the medical portion, and the indemnity portion.

• The medical portion: This part covers your doctor visits, treatment, and anything you need to help you heal or feel better. The goal is to help you recover so you can go back to work.
• Wage Replacement (also called indemnity): This part pays you money if you can’t work while you’re recovering.

These two parts are connected, but they’re also handled a bit differently.

So, you can quit your job and still get workers’ comp, but leaving your job could affect the amount or type of benefits you get.

Let’s revisit the example above:

Say your job injury is approved for workers’ comp. That means:

• They’ll cover your medical treatment, like therapy.

• They’ll also pay you about two-thirds of your regular paycheck while you’re off work.

But then your employer says, “If you want to keep your health insurance, you’ll have to pay the full COBRA price”—and that can be really expensive.

So, you think: I’m not totally unable to work. I can still do some lighter tasks.
You end up taking a part-time job with a friend. It doesn’t pay as much, but it’s easier on your body and comes with health insurance.

This brings us to our next question.

What happens to my open worker’s work comp claim if I get a new job?

Well, the fact that you left your job and took a new one should have no effect on your entitlement to medical care. Your new job isn’t aggravating your back, and it’s not preventing you from attending your physical therapy sessions.

So, the worker’s comp adjuster should have no problem continuing to pay for medical care.

The other aspect of the claim, however, will be impacted.

Now that you’re receiving wages, you certainly will see a reduction in the indemnity benefits you’re receiving.

Those weekly checks that were $400 a week might drop to $150 a week now since you’re receiving wages from a new job. You may even see the checks stop completely if, for example, your old employer claims that they would have offered you a temporary, light-duty job at your pre-accident wage rate if you hadn’t quit.

Other things to consider.

Quitting your job could also hurt you when it comes time to settle your claim. The BWC prefers that a settlement agreement includes having the injured employee resign from their job. We take a strong stand for our clients in this regard and when clients don’t want to resign from their jobs, we try extremely hard to take that option off the table.

Another thing to consider is that the BWC or your employer tends to drag their feet on approving medical care, especially when they’re not paying someone weekly checks. When they know they are going to be paying a claimant until they recover, they have more motivation to give the medical care that will get you back to work.

Given all the factors that go into a worker’s compensation claim, it’s wise to consult with a worker’s comp attorney before taking steps that might impact your claim. Workers comp is all we do; give us a call.

When it comes to falls, the Bureau of Workers Compensation (BWC) has requirements that have to be met in order for the accident to qualify for coverage. Just being on the clock or at your employer’s location is not enough.

Trip and Fall Injury

Trip and fall injuries can happen no matter what type of occupation you have and are especially common. When you trip, the body typically falls forward. You tend to use your hands and knees to brace your fall. Therefore, a trip and fall tends to cause injuries in the hands, knees, face, or wrists. This is different from a slip and fall. (Read more about the differences here.)

Even if your accident and the resulting injury doesn’t seem serious, it’s still a good idea to get it examined by a doctor and to report the incident to your supervisor. Failure to do so may jeopardize ability to get Workers’ Compensation benefits for this injury in the future.

Trip and fall accidents may require medical attention and time away from work. If this has happened to you, consider filing for Workers’ Compensation to help pay for your medical treatment and related expenses.

Common Causes of Trip and Fall Injuries

Many types of soft tissue, bone, and nerve damage from trip and fall injuries can take weeks or even years to present themselves and you’ll need to have the medical evidence and paperwork to back you up in a Workers’ Compensation claim.

The most common causes include:

• Tripping on wires or debris
• Tripping on uneven concrete or pavement
• Falling or tripping due to damaged work equipment or unkempt property
• Falling from height (fall from scaffolding or other work equipment)

Trip and fall injuries in the workplace can have serious consequences. If you’ve experienced a trip and fall injury on the job and are having trouble paying for medical bills or making up for last wages, pursuing a Workers’ Compensation claim may help you stay financially afloat.

In a time that’s probably already confusing and stressful, it’s important that you follow these steps:

• report the incident to your supervisor
• see a doctor as soon as possible for treatment of injuries
• write down your account of the event that led up to the accident and what occurred afterward
• make a list of possible witnesses

Getting Your Workers Comp Claim Approved

You have to know the reason you fell. Simply reporting that you fell at work won’t be enough to get you workers’ compensation benefits. You also have to have suffered a fall that was somehow related to your job. If you fell because you were texting and walked off a curb…chances are that’s not going to be covered. If you fell because there was equipment being improperly stored and lose cables caused you to trip and fall, well, that’s a valid case.

If your fall at work was because an altercation with a co-worker turned physical, you likely will not be covered because workers compensation does not cover injuries stemming from personal disagreements. If you fell because you were drunk or high at work, you will not be eligible to receive workers’ compensation benefits because you were doing something that was not within the scope of your job. (Read more about drug use and workers comp claims here.)

If I was traveling for work and fell, can I get workers comp?

Let’s say you’re on your way back to the office after a business meeting but then make a small detour to stop by the grocery store and get injured in the process, you’re not eligible for workers’ compensation benefits. Once you veer off the path and embark on an errand that is not related to your job, workers’ compensation will not cover your injuries because this was no longer related to your job duties.

The difference between your claim being approved or denied often lies in the details. If you are still unsure if your injuries will be covered, call attorney Thomas Marchese. Workers Comp is all we do. The discussion is confidential and without obligation. Let’s get started.

When someone is injured on the job, all too often, the focus is on the most severe parts of the body hurt, while the minor aches and pains from other parts of the body are ignored. However, in a workers’ comp claim, it’s extremely important to report every ache, bruise, or swollen body part no matter how minor it may seem. Here’s why…

The human body is interconnected. When you fall, you might land on your knee, but your hands could have eased the impact, which can cause shoulder and arm pain down the line.

Or, if you injure your back, the nerve pain and/ or damage can cause problems in your legs. It might be a day or two before you feel any symptoms in those other areas, but these areas can get worse over time and require additional medical treatment.

It’s important in a workers’ compensation claim to document every part of the body that was affected by the accident no matter how small it might seem. It’s more difficult to try and convince an insurance company that another body part was also injured in the same accident if it wasn’t documented within a few days of the accident.

What’s In The Injury Report Matters

This rule is important to remember when filling out your workers’ compensation claim form, accident report at work, and any forms you’re given at the medical office you visit after the accident. All too often, I read emergency room reports where an injured body part is left out.

Hospitals are busy places and not everything is documented with 100% accuracy, but employers may use this to discredit your injuries. So, make sure to tell the medical professional you are dealing with every ache and pain you’re feeling.

Contact Us With Questions

If you have any questions about a new pain or problem that developed after your injury it’s always best to contact an attorney. We have years of experience and know the right questions to ask to ensure that you receive the full coverage, you are entitled to for your injuries. Call Tom Marchese today.

Medical marijuana is a hot topic throughout the nation right now. While there has been great strides in the legalization of marijuana for the treatment of medical diagnosis, there has also been much debate about its use during activities such as driving, working and testing in professional sports. Naturally one of the debates involves workers compensation. 

Is testing positive for pot enough to disqualify an injured employee from receiving workers’ comp benefits?

James Hahn, 32, worked at the County Juvenile Detention Center when he suffered an injury to his right shoulder and neck while subduing an unruly, combative teen. After realizing the injury was worse than he initially thought, he reported it to his employer in a timely manner, four days later to be exact.

He was then given a post-accident drug screen on the same day he reported the injury. He also had a second screening the following day. Both drug tests were positive for marijuana. Hahn never disputed the test results. He had a prescription given to him by his doctor to treat his anxiety and insomnia. He assumed this wouldn’t be an issue when it came time to collect benefits.

The BWC found there was no evidence presented to show Hahn was high on the day he was injured, nor was there any evidence to show the marijuana in his system was the “major cause” of his injury. But the BWC denied his workers’ comp benefits anyway.

Medical Marijuana Law and Workers Compensation.

In 2016, the Ohio General Assembly set up the framework to legalize medical marijuana in Ohio, effective Sept. 8, 2018. It was approved for certain medical conditions, including chronic pain, PTSD, and traumatic brain injuries. At this time, the only legal forms of medical marijuana will be edibles, oils, patches, plant material and tinctures and vaporization. 

The impact of the new law on the Bureau of Workers’ Compensation (BWC) and its programs is limited although it expressly states that an employee whose injury was the result of being intoxicated or under the influence of marijuana is not eligible for workers’ compensation.

Specifically:

• An employer is not required to accommodate an employee’s use of medical marijuana;
• The law does NOT prohibit an employer from refusing to hire, fire, or taking an adverse employment action because of a person’s use of medical marijuana;
• The law specifies that marijuana is covered under “rebuttable presumption.” This means that an employee whose injury was the result of being intoxicated or under the influence of marijuana is not eligible for workers’ compensation regardless of whether the marijuana use is recommended by a physician;

While the law does not specifically address reimbursement for medical marijuana recommended for injured workers, Ohio law already has rules and statutes in place that limit what medications are reimbursable by BWC to those that are approved by the United States Food and Drug Administration. Marijuana has not been approved by the FDA and remains a Schedule I illegal drug under federal law, therefore does not qualify for a reimbursement.