Why Is My Workers’ Comp Claim Taking This Long?

A serious incident at work where you’re injured could put you out of your job for a significant period.

The Ohio workers’ compensation system is designed to help ease the economic burden on employees when they suffer work-related injuries or illnesses. However, dealing with this system can be a frustrating experience.

What Happens After the Claim Is Filed?

You must report your injury to your employer as soon as possible. Leaving more time between your injuries and making your report makes it harder to prove you suffered a work-related injury. You or your employer can then report the injury to your employer’s insurance provider.

Once this is submitted, the insurance company investigates. They may require additional information for this.

How Long Does a Workers’ Comp Claim Take?

There is no exact period when workers’ compensation claims should be settled. Some claims take a few weeks, while others take a few years.

According to the Ohio Bureau of Workers’ Compensation, the BWC begins to investigate the claim immediately after receiving the First Report of Injury. A decision to deny or allow the claim should be made within 28 days.

What Makes the Process Take Longer?

If you feel your workers’ compensation claim is being delayed, it may be due to several reasons. Below are some of the most common reasons for workers’ compensation claim delays.

Fraud Prevention

The size of worker’s comp fraud is about one billion dollars a year. While this accounts for up to 2% of the workers’ comp payments, insurers are cautious because of the large amount lost to fraud.

They are suspicious of all claims that go through their systems and often apply stringent screening. It may therefore take some time to process your claim.

Employer Delays in Filing Your Claim

Several parties in the chain make up the workers’ compensation process, and every player has a role. Your employer is required to notify their insurance provider of the claim. They are required to complete the W1-C form and file it.

If your injury resulted in more than seven days away from work, it should be reported to the State Board of Workers’ Compensation. Late filing or a failure to file by our employer can result in delays in the hearing and settlement.

Claim Filing Errors

Specific procedures must be followed in making a workers’ comp claim. If you made an error, your claim might not go forward. For example, if you fail to notify your employer of your injury on time, you may not be able to prove your case.

If you fail to provide accurate information on the claim forms, the insurer may require you to refile them. This will cost you precious time.

Delays in Medical Reporting

Medical reports are required to prove your injuries and determine their extent. The insurer cannot process your claim without the medical report. If the physician fails to or delays in sending their report, it will cause a delay in settlement.

Sometimes, the medical report may be delayed as the physician waits for your condition to reach maximum medical improvement. This is often the case when severe injuries are involved.

Understaffing

Understaffing is a problem most insurance companies face. A single team may be required to review several cases, which strains their capacity.

If your claim goes to a busy team, it may take a while to get any attention. When the staff finally gets to it, they may make costly mistakes.

What If the Insurance Company Denies Your Claim?

If your claim is denied, you can file an appeal. You will have 14 days from the date of the denial to file your appeal in writing. Your case will then be referred to the Ohio Industrial Commission for review.

Injured at Work? Call Us Today

There are several reasons why your workers’ comp benefits could take longer than they should. Our work injury lawyers have handled numerous cases and know how the system works. Attorneys Adrienne Hines and Victor Kademenos are certified workers’ compensation specialists in Ohio who can offer an objective and knowledgeable assessment of your situation. We’ll file your claim the right way to avoid hiccups down the road and explain why the process might have stalled.

Contact Kademenos, Wisehart, Hines, Dolyk & Wright Co. LPA at 419-625-7770 to consult with an experienced workers’ comp attorney from our law firm and get your claim back on track.