Potential Problems That Occur During a Workers’ Compensation Claim
Ohio Workers’ Compensation should have little difficulty paying out on claims from people who get injured or become sick at work. Incidents that leave employees unable to do their jobs usually occur in front of witnesses, and the issue of whether the victim was engaged in job-related activities should be simple to decide.
The Cleveland workers’ compensation attorneys with Agee Clymer Mitchell and Portman know from decades of combined experience, however, that hurt and ill workers can encounter many problems when seeking to have claims for medical care and replacement income approved. Employers contest how, where, when, and why the worker became disabled. Questions are asked about whether claims were filed in a timely manner, and also if the disabling condition merits compensation. The workers’ comp office itself can rule that an applicant’s medical evidence is insufficient or unconvincing.
These barriers can be overcome with representation from a dedicated Ohio workers’ compensation lawyer, so let’s look at each.
Problem #1: Facts Are Disputed by Employers
Qualifying for workers’ comp requires showing that you suffered an injury or got sick while working. For instance, injuries from a car accident while driving from the office to a meeting would be what lawyers call compensable; falling at the bus stop while going in to the office in the morning would not be. Also, if you are doing something a supervisor explicitly told you not to do, you could not succeed with a claim for workers’ compensation.
Employers can generally be counted on to do everything possible to try to show that an injury happened offsite, off the clock, or when an employee was acting negligently or recklessly. The way to counter such tactics is to file a formal report with the company as soon as possible that clearly states all the facts. Supporting that filing with witness statements and expert evaluations of working conditions and other relevant factors can also help. Doing these things can be easier with assistance from a workers’ comp attorney.
Problem #2: The Statute of Limitations Always Looms
Employers and the workers’ comp office may also attempt to disqualify claims for being beyond the statute of limitations. This proves particularly effective when a person tries to collect disability payments related to an occupational illness. Under Ohio law, workers’ compensation claims must generally be made within six months of a confirmed physicians’ diagnosis of a disease that left a person unable to do his or her job. This automatically means that problems that can take decades to produce symptoms like cancer and mesothelioma almost never qualify a person for workers’ comp benefits.
The other statutes of limitations that apply are
- Two years from the date of a work-related injury
- Two years from the date when a work-related illness left the person disabled
- Two years from the date of an on-the-job death when the victim’s survivor files
Since the window for filing a workers’ comp claim can be so small, debates can rage over when the clock starts. That is, employers and case officers will question the date of an injury, death, diagnosis, or disability.
Problem #3: Some Conditions Are Precluded
This set of challenges encompasses questions of how and what. First, state law precludes workers’ compensation for any condition found to be self-inflicted, the result of intoxication, or related to illegal activity. Second, with very few exceptions, workers’ comp is not available for psychiatric diseases, aggravation of preexisting physical illnesses, “natural” wear and tear on joints and muscles, or disabilities or deaths suffered while doing work under a waiver of liability. That is, if you sign a disclaimer regarding risks, you generally surrender your rights to collect workers’ compensation benefits.
Blaming the victim, making accusations of criminality, and digging for information that paints a workers’ comp applicant as irresponsible or uninformed are not uncommon.
Problem #4: Medical Evidence Must Be Indisputable
The final challenge facing an injured or ill worker is that Ohio Workers’ Compensation requests reams of medical records. The agency also subjects applicants to physical examinations and in-person assessment by doctors and employment specialists who it chooses. Putting together unassailable medical evidence can be impossible without guidance from a Cleveland workers’ compensation attorney who has navigated the system successfully.
Contacting Agee Clymer Mitchell and Portman to request a free consultation may help you clear the hurdles to your workers’ compensation claim. You can reach out online or call us at (800) 678-3318.