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How Do I File an Appeal for My Workers’ Comp Claim?

Injured patient consulting her lawyer about injury claim.

Ohio law provides workers’ compensation benefits to most workers who are injured while on the job. However, all too often, the Ohio Bureau of Workers’ Compensation denies legitimate claims. If this recently occurred to you, don’t let it be the end of your fight for the benefits you deserve.

Heller, Maas, Moro & Magill, Co., LPA, helps injured workers throughout northeastern Ohio to pursue the workers’ compensation benefits they are entitled to receive. We know how the Ohio workers’ compensation system works. We can guide you through the appeals process and ensure you get treated fairly.

Here, we briefly explain the workers’ compensation appeals process. To discuss the specific details of your own case, contact us today. We will provide a timely and free consultation.

Common Reasons Workers’ Compensation Claims Denied in Ohio

The Bureau of Workers’ Compensation (BWC) must decide whether to accept or reject your claim for workers’ compensation benefits within 28 days after you file your initial claim. If the BWC denies the claim, it must send you a letter which explains why. Some of the most common reasons are:

  • Incomplete or conflicting information. Filing for workers’ comp requires completing the First Report of Injury, Occupational Disease or Death (FROI) form. The BWC also needs your medical records to determine your eligibility for benefits. So, if you fail to provide complete and accurate information, you make it easy for the BWC to deny your claim and move on to the next file.
  • Lack of evidence that your injury is work-related. Workers’ compensation pays benefits if workers suffer a job-related injury or illness. So, your claim must show that you were hurt while on the job.
  • Not a compensable injury. Workers’ compensation pays medical bills and part of your lost wages. If an injury does not require medical care, then there is no reason to compensate you. A lost-time claim seeks compensation to replace wages if an injury or illness causes you to miss work for eight days or more. You need to document treatment for a medical-only claim and/or time missed at work for a lost-time claim.
  • Employer disputes claim. It is not unusual for an employer to say that a worker is an independent contractor and not eligible for benefits, or that the employee was not on the job when an accident happened, did not need medical care or was hurt during “horseplay.”

You will never be able to overcome these issues unless you appeal the decision to deny your benefits claim. However, you have only 14 days to file written notice of your appeal. The notice should contain new information if you want a different outcome. Our workers’ compensation attorneys can help you to file your appeal, and we can represent you if your employer challenges your claim.

Understanding the Ohio Workers’ Compensation Appeals Process

You have several opportunities under Ohio law to appeal the BWC’s decision to deny you workers’ compensation benefits. The process involves as many as three levels of appeal to the Ohio Industrial Commission (IC):

  • District. First, your appeal will go before a district hearing officer (DHO). All parties involved (which typically means you, your employer and/or the insurer) may present information. After the hearing, the DHO will issue an order detailing the DHO’s decision and mail a copy to each party.
  • Staff. After the DHO issues a decision, any party may appeal and get a second hearing before a staff hearing officer (SHO).
  • Commission. If the SHO’s decision is not satisfactory, parties may appeal to the Commission. Three commissioners will review all submitted material and may agree to a hearing or refuse to hear the appeal.

At each level of appeal, you will be notified by mail of a decision and have 14 days from receiving the decision to submit your written request for another hearing. Each request for a new hearing should include new, relevant information to support your claim. You will also need to submit the original and two date-stamped copies of your request and supporting documents.

Also, at any point during an appeal, the BWC may require you to undergo a new medical exam at the BWC’s expense. The results of the exam will likely serve as evidence in your next hearing.

What To Expect At Workers Comp Hearings in Ohio

The hearings are meant to be informal. Each party gets the chance to put on testimony and answer questions. Each party can also be represented by an attorney or another person authorized by the IC. If your employer or their representative fights your claim, you can expect them to send experienced lawyers who are well-versed in Ohio workers’ compensation law to present their side and challenge you. This is why you will fare much better if you have an experienced attorney of your own on your side.

If the result of your appeal at the Commission level is unsatisfactory, you can appeal to the Court of Common Pleas in the county where you suffered your workplace injury. This is a formal process that may lead to a jury trial.

What Our Workers’ Comp Attorneys Can Do for You In Ohio

Our goal at Heller, Maas, Moro & Magill Co., LPA, is to secure the allowance of your workers compensation claim as quickly as possible. This allowance will cover your medical bills and replace a portion of income you have lost while out of work. We know how important those funds are to you and your family.

We will review your benefits application and help you to resolve any problems that are keeping a legitimate claim from being approved. If technical issues are hindering your claim, we can clear them up quickly. If you need additional evidence to support your claim, we will help obtain records to document your accident, injury and treatment. If necessary, we can refer you to a doctor who understands what the Industrial Commission requires of a claim.

If your employer disputes your claim, we will fight back on your behalf. We know the system, and we will know how to stand up for you. For more than 30 years, we have helped injured workers in the Mahoning Valley and surrounding areas in northeastern Ohio to successfully pursue appeals. We are ready to go to work for you today. Contact us today and find out more in a free and confidential consultation.