Question

What happens if my Ohio workers’ compensation claim is challenged?

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David E. Nager - Workers' Compensation - Super Lawyers

Answered by: David E. Nager

Nager, Romaine & Schneiberg Co., L.P.A.
Euclid, OH
Phone: 216-289-4740
Fax: 216-289-4743

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Answer

Although all employers in the state with one or more employees must provide some form of workers’ compensation coverage, few are overjoyed at the prospect of having to deal with employees who aren’t able to work. Workers’ compensation insurance premiums can rise when an employer faces multiple claims, so money can play a key role in why they might challenge your claim. If your employer challenges your claim, they may assert that:

  • You were an independent contractor and not covered by workers’ compensation insurance
  • The injury wasn’t work-related or serious enough to warrant medical treatment
  • You were engaging in inappropriate horseplay on the job when the injury occurred

If the Ohio Bureau of Workers’ Compensation is challenging your claim, it may be because you were unable to follow the complex set of claim application guidelines. Common reasons for BWC claim rejections include:

  • Lack of supporting medical or work-related documentation to support your claim
  • Inadequate evidence that the injury was work-related
  • Injury not considered compensable – no medical treatment was needed and/or no time was lost from work
  • Employer challenges the validity of the claim

As you can see, there is overlap between the types of challenges that can block your claim. The BWC has 28 days to consider your claim, but you only have 14 days to appeal their decision if they deny your claim. It is important to hire a skilled lawyer well-versed in workers’ compensation law at the beginning of the claims process, so they can help you prepare a compelling appeal if your initial claim is denied.

How The Workers’ Comp Appeals Process Works

The BWC administrative appeals process for rejected workers’ compensation claims follows this structure:

  1. Your first appeal will be presented in front of a district hearing officer.
  2. The next step for an appeal that is denied at the district level is a hearing in front of a staff hearing officer.
  3. If the result at the staff level is inadequate, the appeal can move to the commission level, where three commissioners review the case and can decide either to conduct a hearing or deny the appeal.
  4. Beyond the commission level, if you have not succeeded in your appeal, you may submit a claim in the court of common pleas in the county where you were injured. If your claim is rejected there, you may ask to have the matter settled by a jury trial.

At each step in the BWC appeals process, you have only 14 days to appeal an unsatisfactory decision and have it moved to the next level. Additionally, during the BWC’s administrative appeal process, you may be asked to undergo a new medical examination, which can be used as evidence in the new hearing.

A qualified workers’ compensation attorney will understand which medical records will prove most useful in your claim and subsequent appeals, and will fight for the compensation to which you are entitled.

Disclaimer: The answer is intended to be for informational purposes only. It should not be relied on as legal advice, nor construed as a form of attorney-client relationship.

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