Posted on Wednesday, April 19th, 2017 at 3:16 pm
The following post is part of our Law Student Blog Writing Project, and is authored by Ian Fasnacht, a law student from Ohio State University Moritz College of Law.
Workers’ compensation can include compensation for medical treatment, lost wages, and permanent impairment that occurs during employment. The Ohio Bureau of Workers’ Compensation (BWC) has several steps necessary to file a claim. The steps will be similar for states other than Ohio, but guidelines may vary and information should be verified with each state’s BWC.
If the injury or illness is severe, seeking medical attention should be the primary objective; however, as treatment proceeds it will be important to keep record of all medical bills for filing purposes.
How To File an Ohio Workers’ Compensation Claim
The Ohio Bureau of Workers’ Compensation has strict guidelines, which must be met to qualify for Workers’ compensation. Failure to meet the guidelines may result in a denial.
First, an employee must report the injury to the employer as soon as possible. After the injury is reported a First Report of an Injury, Occupational Disease, or Death (FROI) will need to be completed. The FROI can be completed by the employer, employee, or by the employee with the assistance of their medical practitioner. Claims can be filed online with the BWC.
Submitting an FROI has strict guidelines that must be met. A claim must be filed with the BWC within two years of the date of the injury. If filing for an occupational disease, the FROI must be filed within two years of the date one becomes permanently disabled, or within six months of the date a medical practitioner diagnosed the illness.
Within twenty-eight days of submitting the FROI form, the BWC will notify the employee if their claim has been approved or denied.
Why Was My Workers’ Compensation Claim Denied?
Workers’ compensation claims can be denied for a variety of reasons, and the specific reason an individual case was denied will be listed on the BWC’s decision, which is released within 28 days of filing. Lack of information, employer denial, or severity of the claim is the most common reasons a claim is denied.
First, claims are denied for a lack of information, failure to file on time, or failure to report. One of the simplest ways to help ensure a claim does not lack information is to keep records of medical expenses and doctor’s diagnoses throughout the process.
Another common reason a claim is denied is because an employer may deny that an employee’s injury occurred at work or that the injury is not a result of the workplace accident. Employers often deny claims because successful claims increase their Workers’ compensation insurance premiums, thus defeating the claim will not raise their rates.
Finally, claims may be denied because the injury was not severe enough to be covered by Workers’ compensation. Regardless of the reason a claim was denied, the all claims may be appealed.
How Appeals Work in the Ohio Workers’ Compensation System
After the claim is denied, an employee has 14 days to appeal. To file an appeal a form will need to be completed through the Ohio Industrial Commission. The forms can be filled out online or printed and mailed. Once the appeal request is received, several steps will follow.
First, a district level hearing will take place within 45 days of the initial appeal. Before the hearing, witness affidavits, depositions, and other evidence may be submitted to the Ohio Industrial Commission’s office for review. In addition, the Ohio Industrial Commission may require an independent medical examination. The examination is mandatory, but the results will be made available to both parties. After hearing the evidence, the presiding officer will make a written decision and mail it to both parties within seven days.
After the district level hearing, either party can appeal for a staff level hearing, which will take place within 45 days of the initial hearing. Usually, no new evidence is permitted, but an officer reviews the information and issues a written opinion to both parties.
The first two levels of appeal are guaranteed, but if the parties are still unhappy they may appeal for a commission level hearing. After reviewing the information from the staff hearing, the Ohio Industrial Commission will either grant or deny an appeal. If the appeal is granted a hearing will be conducted within 45 days and a written decision will be mailed within seven days. The Ohio Industrial Commission’s decision may be appealed to the state courts of Ohio. If the decision is denied an appeal can be made to the state courts of Ohio within 60 days.
Why an Attorney Should Help You Get Workers’ Compensation
The appeal process can be long, and it may be in the employee’s best interest to get help from an attorney to receive the benefits they deserve. Due to the multitude of reasons a claim may be denied – failure to file on time, employer dispute – an appeal may be able to provide an opportunity to add additional evidence in support of the claim.
Additional information such as surveillance videos, co-workers testimony, medical history, and doctor testimony may be able to provide the necessary information on appeal. However, it is possible that evidence that should have been introduced originally will not be allowed to be introduced for the first time on appeal. The best way to make sure you don’t have to appeal is to make sure all your evidence and best legal arguments get presented immediately, and continually re-raised throughout the process. Getting an attorney is the best way to make sure you don’t miss anything.
Seeking legal council is advised for an appeals process because deadlines are short and strict, the process can be long, and the Ohio Industrial Commission will expect an appeal to properly follow the rules of evidence. Additionally, an attorney can help decide if an appeal is the best option based on the specific reason an individual case was denied.
If you’ve been injured in an Ohio Work Accident, don’t go it alone. Call Lawrence & Associates for a free consultation today. We’re Working Hard for the Working Class, and we want to help you!