Just because you received a denial for your workers’ compensation claim, doesn’t mean you’re out of options. You may still be able to file an appeal.
A workers’ compensation denial letter can be a disheartening experience. You were injured on the job and you struggled while waiting for your benefits to come through, and then…nothing. No benefits, and no explanation as to why your claim was denied.
If this sounds familiar, you are not alone. Employers and the BWC routinely deny injured workers’ claims for benefits. Sometimes these denials are legitimate and other times they aren’t, but injured workers who have been denied compensation should promptly evaluate their options for filing an appeal.
Let’s start with the basics.
Why Was I Denied Workers Compensation Benefits?
For now, let’s assume that you’re entitled to workers’ compensation, meaning you’re an employee who was injured on the job.
There are several reasons why your claim may be denied or reduced. Below are some common reasons that can potentially be overcome by filing an appeal:
Your Injury or Illness was (Supposedly) Not Job-Related
Employers and the BWC will often deny workers compensation claims, many times in error, on the basis that the employee’s injury or illness was not job-related. You may have simply failed to present evidence that was available to prove your benefits.
You Missed the Deadline to Report Your Injury or File for Benefits
The deadline for reporting your injury and filing for workers’ compensation is based on the date that your illness or injury occurred. However, this isn’t always as straightforward as it might seem. You should report your injury immediately to your supervisor and the statute of limitations for filing a worker’s compensation claim in Ohio is one year. If you missed a deadline, you should speak with a workers’ compensation attorney to find out if you’re still eligible for benefits.
You Submitted an Inaccurate or Incomplete Claim Form
If you submit a claim form with incomplete, inaccurate, or inconsistent information, you may be denied benefits. These deficiencies can be overcome, but you cannot expect your employer the BWC to deal with them for you. Speak directly to a workers’ compensation attorney to discuss your options.
You Had Drugs in Your System at the Time of Your Injury
If you had alcohol, prescription medications, or illegal drugs in your system during your medical examination, there is a chance that the employer or BWC will try to use this against you. However, there are points to be argued. Were you under the influence when you were injured, and if so, was this a factor in the injury?
How Can I Appeal My Workers Compensation Denial?
If you’ve been denied workers’ compensation benefits, you have options. To determine the best steps to take, you need to understand why your workers’ compensation claim was denied. Whether due to a simple mistake on your part or the part of your employer or the BWC, appealing your denial may be as simple as straightening things out through a phone call.
However, in many cases, appealing a workers compensation denial means filing a formal appeal. This process usually begins with submitting an appeal to the Industrial Commission. While this is something you can do on your own, it’s a task best handled by an experienced work injury attorney. You may need to present your case to a hearing officer, and if they agree that you are not entitled to benefits, you may need to take your case to court.
Speak with an Attorney about Your Denial
If you need help understanding your rights after a workers compensation denial, call Tom Marchese. We’ll walk you through all of your options and begin appeal proceedings.
Related Workers Comp Articles
Cases involving workers' compensation can occasionally be resolved quickly (within a few weeks or months), but most can take years to settle. On average, a workers' compensation case will be settled within 16 months. A resolution could lead to a court hearing or a...
In this article, we’ll answer some of the questions that we hear most often. 1. What is a workers’ comp injury? “An injury whether caused by external or accidental means or accidental in character and result received in the course of and arising out of the employee's...
Remote work was already on the rise in Ohio before the pandemic. Now, many are working partially or fully from home, and while this is a win for flexibility, it also raises questions about the workers' compensation system, especially if you’re injured during work...