Why Your Ohio Workers’ Compensation Claim Could Be Denied
First, do not panic over a denied workers’ comp claim. The Ohio Bureau of Workers’ Compensation rejects many first-time applications, and multiple rounds of appeals are built into the process. If the rejections just keep coming, you have the right to take the workers’ comp program to court.
Succeeding with an appeal requires understanding exactly why workers’ comp is not paying. The reason will be stated in the decision letter the program sends you, but knowing why a claim could be denied can reduce the chances of having your application denied in the first place.
Over the many years that we have handled workers’ comp appeals for people in and around Cleveland, Ohio, we’ve most often seen applications for short-term disability benefits denied for one of the following five reasons.
- The injured or ill worker waited too long to file their claim. Ohio enforces a one-year statute of limitations for submitting workers’ comp claims. Except in very rare circumstances, the clock starts ticking on either the day of a workplace accident or exposure to a toxic substance, or on the day that symptoms from an occupational illness are diagnosed or became debilitating.
- The worker initially failed to prove that their injury or illness was work-related. Workers’ comp will only cover disabling injuries or illnesses that are incurred while the person is engaged in tasks that are part of their job. Employers often contest this, arguing that the person who filed a claim was off the clock or doing something that was outside of their job description and which their supervisor never authorized.
- The worker did not need to spend significant time off the job. The Ohio workers’ comp program generally will not approve claims for people who missed fewer than three consecutive days of work. Doctors’ notes and leave requests can clear up questions about time spent off the job.
- The worker submitted insufficient medical documentation. Each claim for workers’ comp benefits must be supported by medical records, therapy notes, bills for medical care and prescription orders. The more information of this type that an applicant can provide, the more likely they are to have their claim approved.
- The worker’s employer convinced the workers’ comp program that the worker caused the accident that left them injured or ill. Workers’ comp benefits cannot be approved for individuals who intentionally harmed themselves, suffered harm while trespassing or engaging in illegal activities, acted recklessly, or completely ignored safety procedures. An employer may try to derail a workers’ comp claim by accusing its employee of engaging in one or more of these disqualifying actions.
If you receive a notice that your workers’ compensation claim has been denied, read the letter carefully. It can also help to bring the rejection letter to a knowledgeable and experienced workers’ comp attorney who can further interpret what the supposed problem is. Be aware, however, that you must act quickly. You may have less than a month to inform the workers’ comp program that you intend to appeal and respond directly to the issues raised in the denial of benefits letter.
Workers’ compensation attorneys in the Cleveland offices of Agee Clymer Mitchell & Portman welcome opportunities to help fellow Ohioans who have been denied workers’ comp benefits. We offer free consultations, and you can schedule an appointment online. If you would prefer to speak with a lawyer directly, call us at (800) 678-3318.