It may seem natural to you that if you are injured at work you will automatically be entitled to workers’ comp. This is in theory usually the case but too often insurers are trying to pick holes in a workers’ comp. claim and devise any reason or reasons for either not paying the full amount requested or not paying anything at all. This isn’t fair to you especially if you know deep down you are entitled to workers’ comp. It could mean you suffer financial hardship if your claim is denied. Fortunately, Ohio like most states, allows you to appeal workers’ comp. denials giving you the chance to prove your request. However, it’s best to talk to an experienced workers’ comp. attorney and not take on this sometimes arduous battle on your own. Workers' Comp Law in Ohio Any illness or injury that happens while you are at work should be covered by workers' comp. It doesn’t matter who or what caused the accident as long as it wasn’t deliberately caused. For the 1st 12 weeks, benefits for total temporary disability are calculated at 72 percent of your total weekly wage. Once the 12 weeks are up, you will get 66.33 percent of average weekly earnings. There is a cap imposed on the maximum you may receive and that currently stands at $902 weekly. There are certain things that you need to do to claim workers’ comp. entitlements once you have reported your injury to your employer. You will need to submit a workers’ comp. claim called First Report of an Injury (FRO) with the Ohio Bureau of Workers’ Compensation (BWC). This has to be done within 2 years of the injury date. If it’s an industrial illness the claim must be made within 6 months of the diagnosis. There are strict deadlines for filing your claim. You must make sure that the FROI form is filed with the BWC within two years of the date of your injury. For occupational diseases that develop over time, you must file within six months of the date your doctor diagnosed the disease. The BWC will let you know its decision within 28 days of being in receipt of your request for workers’ comp. The benefits include loss of earnings, the cost of medical treatment and covers permanent disabilities. You can select a doctor who has been approved by the BWC to treat you. Any medical treatment costs will be paid directly to the doctor. Why Can a WC Claim Be Denied The benefits from workers’ comp. help to keep you from struggling financially until you can return to work but the problem sometimes arises that your workers’ comp. claim may be denied. There are a number of reasons for this including: an incompletely filled FRO1 form or it was illegible in places; insufficient evidence to prove the sickness or injury took place at work; poorly or wrongly calculated average weekly earnings; employer has no workers’ comp. cover for you. If your workers’ comp. claim is denied, that’s not the end of it for you as the BWC allows you to file an appeal. Appealing a WC Denial in Ohio You will hear in writing what the decision is about your workers’ comp. claim. If it has been denied you have the right to appeal within 14 days to the Industrial Commission of Ohio. Eventually the Industrial Commission will send you a notice indicating the date, place and time of the District Level Hearing. A Commission Officer will be responsible for presiding over the hearing. You will need to provide documents such as witness’s affidavits and deposition transcripts. The Commission might ask you to have an independent medical exam at this point. At the hearing it’s a good idea to have your witness to your accident present as well as the doctor treating you. You will be told the result within 7 days of the hearing date. Either you, your employer, or your employer’s insurer may appeal the decision which then goes to the Staff Level. If you lose at this point you can appeal at a hearing at Commission Level. If all is lost for you at this point you may appeal at the state Courts of Ohio. Hiring an Attorney To Appeal a WC Denial in Ohio The process of appealing can be difficult, exhausting and hard to fully understand so it’s wise to seek help from an experienced worker’s comp. attorney who will not only know what chance you have of winning an appeal but will work hard on your behalf to get the workers’ comp. you may be entitled to receive.
