After a workplace injury, you’re counting on your workers’ comp benefits to help pay your medical bills and help you get by financially until you’re able to return to work. Unfortunately, your employer (or the workers’ compensation insurance carrier) had different plans.

As with any insurance claim, there are important deadlines, rules, and exceptions that will ultimately determine if the claim is approved.

If your workers’ comp claim was denied, the first thing you need to do is determine the reason why. This should be in your denial letter as well.

Here are some common reasons for a denial of workers’ comp benefits: (This is not an exhaustive list and an experienced Ohio workers’ comp attorney will be able to assess your case in detail.)

• You didn’t report your injury within the deadlines given.  While you should notify your employer immediately following the injury, the Ohio statute of limitations for filing a workers’ compensation claim is one year.
• No one witnessed your accident. Whether your witness was a coworker or even a surveillance video, any proof that can verify how you became injured can drastically help your case. If you know that your accident had no witnesses, it should encourage you to report your injuries to your employer immediately and get prompt medical attention.
• Your accident report or medical records seem suspicious. Your employer’s workers’ compensation insurance carrier will be tediously going through your claim with a fine-toothed comb. If your report differs from those of your coworkers or your doctor, or if your medical records show that you had drugs or alcohol in your system at the time of the accident, it will be very difficult to get workers’ compensation benefits.
• You refused to cooperate during the claims process. Being cautious when dealing with insurance companies is always advisable, and it’s a good idea to consult with an attorney before signing or recording any statements or documents. Oftentimes, your signature or recorded statements aren’t required to obtain benefits, but many insurers will try to use this as an excuse to deny your claim. This is usually not a valid reason to deny a claim, and an attorney can help you sort this out in an appeal.
• Your employer or their workers’ comp insurer made a mistake or is being difficult. Often, employees can follow procedure by the book when it comes to reporting their injuries and filing claims, but they’re still denied benefits. Whether the employer or their carrier overlooked a key detail or simply made a mistake, a workers comp attorney can help you appeal your denial if your case is sound.

Now that you understand why your workers’ compensation claim has been denied, there are several steps you can take:

1. Review the denial letter: Carefully read the denial letter provided by your employer’s insurance company. Understand the specific reasons for the denial and any deadlines for appealing the decision.
2. Consult an attorney: Consider seeking legal advice from an attorney who specializes in workers’ compensation. They can assess your case, explain your rights, and guide you through the appeals process.
3. Gather supporting evidence: Collect any relevant documents, such as medical records, incident reports, witness statements, and other evidence that supports your claim. This evidence can be crucial when appealing the denial.
4. File an appeal: Follow the instructions provided in the denial letter to file an appeal within the specified timeframe. Be sure to include any additional evidence or documentation that supports your case. Depending on your jurisdiction, there may be multiple levels of appeals, so be prepared for the process to take time.
5. Attend hearings or mediation: In some cases, you may be required to attend hearings or mediation sessions as part of the appeals process. These proceedings allow you to present your case and provide further evidence supporting your claim.
6. Keep records: Maintain a detailed record of all communications, including dates, times, and the individuals you speak with regarding your claim. This documentation can be valuable if there are any disputes or misunderstandings during the appeals process.
7. Follow up: Stay in touch with your attorney and the relevant parties involved in your claim. Keep track of any updates or requests for information and respond promptly.

Remember, the workers’ compensation process can be complex, and outcomes vary depending on the circumstances. Seeking legal advice and assistance from an experienced workers’ comp attorney is often beneficial when navigating the appeals process.

One of your most important rights as an injured worker in Ohio is your right to appeal a workers’ compensation claim denial. If you have been denied benefits for any reason, workers’ compensation attorney Tom Marchese can help. Schedule your free consultation with us today to discuss your case.