Top 5 Reasons an Ohio Workers’ Comp is Denied

No one plans to be hurt at work, but accidents happen. The good news is that if injured in the course of your employment because of some risk or danger on the job, you are eligible for workers’ compensation. Unfortunately, an Ohio workers’ comp claim isn’t automatically approved.

Denials are common, and if that happens, you might wonder “Why was I denied workers’ compensation?”

At Kademenos, Wisehart, Hines, Dolyk & Wright Co. LPA, we are more that just experienced workers’ compensation attorneys. Attorneys Adrienne Hines & Victor Kademenos are certified workers’ compensation specialists, a rare qualification from the Ohio Bar Association.

With a considerable experience and success in worker’s comp cases, we can help you understand why you were denied and assist you in appealing the decision. A denial is not the end of your claim! Workers’ comp laws are complicated, but our attorneys will apply their specialized training to get your claim approved.

Call (419) 625-7770 to set up a free, initial consultation.

Top 5 Reasons for Workers’ Comp Denials

In 2019, 96,604 workers’ comp claims were filed with the Ohio Bureau of Workers’ Compensation (BWC) and 12,240 were ultimately disallowed or dismissed.

Here are the top reasons a workers’ comp claim is denied:

  1. Failed to file claim correctly and with proper documentation: The rules and law of workers’ comp are complicated. Even the forms can be confusing. If you fail to fill it out correctly or completely, your claim could be denied. For example, if your explanation of the accident doesn’t relate to your injuries, the claim likely will be denied.
  2. Missed the filing deadline: In Ohio, the statute of limitations for filing a workers’ comp claim is one year from date of injury, or if your injury or illness was hidden, the date you discovered it.
  3. Employer disputing: If hurt on the job you must timely notify your employer. Failure to do so could undermine your claim. In addition, if you didn’t inform your employer of a pre-existing condition that if it had been known the employer would not have had you doing certain activities, the employer may deny responsibility for your on-the-job injury or illness. An employer may also dispute your claim if it is unclear whether you were hurt on the job or the work presented the risk that led to your injury.
  4. Medical treatment insufficient: Under Ohio law the injury or illness had to cause you to miss more than seven working days and those days are not compensable until you have missed 14 consecutive working days. If your injury had you off the job less than that amount of time, the claim will be denied. Your claim could be denied as well if no medical treatment was sought or you used a provider outside the certified list.
  5. Exclusions: Injuries or illnesses that are intentionally inflicted by the employee upon himself, that occur because of impairment from intoxication or illegal drug use, or because of fights or assaults can result in a claim denial.

The Appeals Process

If your workers’ comp claim is denied, you need a lawyer immediately. Our Ohio workers’ comp claim attorneys will review your claim, determine why you were denied, and what can be done about it.

Filing errors or issues of evidence can often be overcome through the appeals process. Keep in mind too, that if you were hurt, but it is not the responsibility of your employer, you may have a personal injury claim against a third party. In other words, you may have a different legal claim to receive compensation for your injuries. Our firm can assist you with those legal claims as well.

Keep in mind that the clock starts ticking upon the denial of your claim and you have just 14 days to file an appeal to request a hearing with the Industrial Commission of Ohio. Wait too long and your claim may be lost for good.

We Can Help if You’ve Been Injured at Work

Getting hurt on the job is a major life disruption. Not only will you need to concentrate on recovery, but there are financial burdens to consider. That’s why it’s important to have a workers’ comp attorney from Kademenos, Wisehart, Hines, Dolyk & Wright Co. LPA on your side from the start. With our experienced lawyers, there’s less chance of a claim denial for failure to follow the law or process. And, if there is a denial, we can immediately appeal to protect your rights.

Call us today at (419) 625-7770 for a free consultation.