No two people ever suffer exactly the same on-the-job injury or work-related illness in exactly the same way. Despite this, disability case reviewers at the Ohio Bureau of Workers’ Compensation treat the majority of applicants identically by initially denying their requests for benefits. The bureau’s 2014 annual report indicates that the approval rate for new claims was about 1 in 9.
Appealing a denial of workers’ comp benefit is possible—likely, necessary for the hurt or sick person currently unable to work—but doing so without the assistance of an Ohio workers’ compensation attorney is ill advised. The system is structured to make qualifying for benefits difficult, to limit payments in dollar amount and duration, and to preserve a positive flow of revenues to the state agency rather than to people in need of medical care and supplemental income .
We at Agee Clymer Mitchell & Portman could list dozens of reason why individuals who fall into the roughly 89 percent of workers’ comp applicants who get turned down should contact us to help them fight their claims denials. Here, we focus on five of the most important.
As explained on the BWC website, with emphasis added, “If you and/or your employer disagree with a decision made on your workers’ compensation claim, you may file an appeal … within 14 days of the decision.” The request for a rehearing must be made in writing and include a reason for reconsideration. In other words, filing an appeal must be done immediately and in terms that display a firm understanding of both why a negative decision was reached in the first place and what evidence could be used to support having the denial overturned.
Leading reasons for denying a workers’ compensation claim include determining that a diagnosis, course of medical of care, and rehabilitation plan were inappropriate; believing arguments from employers that an employee did not get hurt or sick at work; and believing that an applicant suffered from a preexisting condition that was not made worse by anything that happened on the job.
Countering those justifications for a workers’ comp claim denial requires collecting and presenting new evidence from physicians and other health care providers, testimony from co-workers and family members, and descriptions of worksite conditions. Much of this information may have been missing from an initial application, and gathering it in ways that the BWC will accept and consider convincing is usually beyond the ability of an injured or ill applicant.
Lawyers with Agee Clymer Mitchell & Portman have decades of experience helping people fight through the roadblocks BWC case reviewers construct. We have seen every kind of claim denial notice, and we can quickly begin putting together the information that should satisfy reviewers who believe evidence is lacking.
Beyond knowledge of how to navigate the workers’ compensation process successfully, taking on the bureaucracy simply requires time and peoplepower. Filling out and filing forms, reviewing and corroborating medical records and accident reports, interviewing witnesses, and attending administrative hearings require hours probably better spent focusing on recovering. Missing a therapy appointment or risking making an illness worse to jump through yet another hoop hung by the BWC makes little sense. Let our workers’ compensation attorneys handle the heavy lifting.
As you work with Agee Clymer Mitchell & Portman, we can put you in touch with our network of health care providers who specialize in helping people hurt at work and point you toward disability benefits programs other than workers’ compensation. Figuring out one’s eligibility for Social Security supplemental income, disability through pension plans, and compensation from private insurance plans is often no easier than plodding through the workers’ comp system.
Do not let the two-week deadline for appealing a workers’ comp denial expire without at least requesting a free case evaluation by an Agee Clymer Mitchell & Portman disability benefits lawyer. Even if we cannot take you on as a client, we can answer your questions. Share your story by using this contact form, and we will get back to you.