Appealing A Denied Workers’ Compensation Claim

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After taking the time to submit a workers’ compensation claim for your injuries, it can be incredibly frustrating to receive a denial. Between medical bills and lost income from missed days at work, the financial consequences of your injury can quickly become overwhelming. Having your claim denied often means that you must split hairs attempting to navigate these turbulent times. Fortunately, there are options available to injured workers that need help appealing a denied workers’ compensation claim.

At Schaffer & Associates LPA, we work closely with our clients to ensure that they receive a full and fair compensation package for their work-related injuries.  Our years of experience representing injured workers allow us to guide you through the appeals process, explain your rights, and help build a strong case for your appeal.  We understand the stress of dealing with the Bureau of Workers’ Compensation and a self-insured employer to secure payment for your medical expenses and lost wages, and work diligently to make the process faster and easier for our clients. To learn more about how we can help with appealing a denied workers’ compensation claim, consider scheduling a consultation with our Toledo office today at (419) 350-8277.

Can I Appeal My Workers’ Compensation Claim Denial?

After you file a workers’ compensation claim, you will receive a written order detailing whether the claim is approved or denied based on the nature of the injury. Claims may be denied for a variety of reasons, such as:

  • Employer disputes 
  • Late reporting or missed deadlines
  • Intentional employee misconduct
  • Failure to seek medical attention from an approved medical provider
  • The injury is due to a pre-existing condition

Regardless of the reason, appealing a workers’ compensation claim is possible in Ohio. Through the appeals process, it is possible to dispute the decision and obtain benefits if you believe that your claim has been denied for unsubstantiated reasons. This is valuable protection for a  worker who has been unfairly denied much-needed compensation for their work-related injuries.

It is also important to include pertinent medical information and any other requested evidence within your written appeal. Once the appeal is received, an administrative hearing will be held before the Industrial Commission of Ohio.  While you can represent yourself at this hearing, representation from an experienced workers’ compensation attorney will help ensure that your appeal is handled with the utmost care and discretion.

Once an appeal to the Industrial Commission is filed, a hearing is scheduled before a hearing officer. There are three steps in an appeal process before the Industrial Commission:  

  • Level 1: District Hearing Officer (DHO);
  • Level 2: Staff Hearing Officer (SHO);
  • Level 3: Appeal to the Industrial Commission of Ohio (IC).

All appeals will begin at hearings before a DHO.  Either party may appeal the decision of the DHO that results in an appeal hearing as a matter of right before a SHO.  Either party may appeal the decision of the SHO.  This appeal, however, is discretionary and in most cases, results in a denial of the appeal without further hearing.  

Where the issue involves the allowance of the claim or an additional condition in an already allowed claim, either party may appeal to the court of common pleas where the injury occurred.  An appeal in the common pleas court results in the scheduling of a trial before a jury of your peers.  There are complicated rules of evidence, including discovery and depositions prior to the trial.  Thus, such appeals are very complicated and require an experienced attorney to guide you through the process.  An experienced attorney will ensure that all procedural requirements are met, help navigate you through the complicated legal complexities, and make strong arguments on your behalf

If your workers’ compensation claim has been denied, you will be required to follow a specific process to initiate an appeal. The workers’ compensation appeals process is complex, involving extensive paperwork and requiring a certain level of proof to fully evidence your claim. To initiate an appeal, you can either submit an (IC-12) Notice of Appeal form to the Industrial Commission of Ohio or submit a written document containing information regarding:

  • The name of the injured worker and the employer
  • Your claim number
  • Reason for the appeal
  • Date on which the decision was received
  • Signature and date

What Is the Timeframe to Appeal a Denied Workers’ Compensation Claim?

In the majority of cases, an appeal must be filed within fourteen calendar days of the denial. Once the Industrial Commission of Ohio receives your written appeal and holds an administrative hearing, they will issue a decision within seven days. If the appeal is denied, the injured worker has an additional fourteen calendar days to file a second appeal. 

The appeals process can become time-consuming, especially if multiple appeals are necessary. These issues can greatly delay the process of receiving workers’ compensation, making it essential to abide by the time limitations and regulations set forth by the relevant governing agencies.

How Can Hiring an Attorney Help With the Claims Process?

Many people turn to workers’ compensation attorneys to help with the claims process. This is largely due to the legal complexity of the process and the financial consequences of having a claim repeatedly denied. In some situations, the denied workers’ compensation claim can be easily remedied by a legal professional. In other cases, litigation is necessary, which necessitates the knowledge and experience of a workers’ comp attorney. At Schaffer & Associates LPA, we provide representation to injured workers and assist with the following issues:

  • Filing claims for workers’ compensation
  • Determining the type of benefits that you are eligible for
  • Obtaining, organizing, and compiling all relevant evidence related to the workers’ comp claim
  • Appealing a denied workers’ compensation claim
  • Negotiating with the BWC or self-insured employer for the fullest compensation package
  • Litigating a workers’ compensation claim in court.

Hiring an attorney to help with the claims process can be critical, particularly for injured workers who are experiencing a denial of their workers’ compensation claim. Securing benefits is necessary for the vast majority of injured employees and an experienced attorney can help ensure that compensation is awarded swiftly and efficiently while avoiding the common pitfalls that people experience while filing for workers’ comp and appealing denied claims. 

Contact Schaffer & Associates LPA Today

Appealing a denied workers’ compensation claim is a complicated and demanding process. Many injured workers and their families are busy handling other more important matters and may be unsure that help is available to secure workers’ compensation benefits. At Schaffer & Associates LPA, through our compassionate and strategic representation, we have been able to secure workers’ comp benefits for hundreds of Ohio workers. To begin the process today, consider contacting us at (419) 350-8277 or complete the intake form here.