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My Ohio Workers’ Compensation Claim was denied. What do I do now?

The following post is part of our Law Student Blog Writing Project, and is authored by Sarah Kiefer, a 2020 Juris Doctorate Candidate at the University of Dayton School of Law.

If your Ohio Workers Compensation Claim has been denied, first of all, my sympathies are with you and your family as you navigate this confusing process. Second, this may not be the end of the road for your claim. There are options for you if you disagree with the decision made by the Bureau of Workers’ Compensation (BWC). The Industrial Commission of Ohio (IC, or “Commission”) is in charge of hearing appeals from the BWC. Once you have received a decision from the BWC about your claim, you only have fourteen days to appeal to the Industrial Commission. The fourteen-day countdown begins on the day you receive the BWC decision in the mail. (So be watching your mailbox!)

How To Appeal a Denied Ohio Workers Comp Claim: Pre-Hearing

To begin the appeals process to the Industrial Commission, you need to complete a form called an “IC-12 Notice of Appeal Form” which you can find on the Industrial Commission Online Network website. For convenience, you can fill it out online, print and fax it, or mail the completed form to the IC. Be careful: if you send the form incorrectly or incompletely, it can cost you the appeal and your right to win, forever!

If you are near an IC office, you can go in and fill it out there as well. Some things you need to include will be your name, (or if you are filling it out for a family member, the injured person’s name); the employer’s name, claim number, date you received the BWC decision, and the reason you are appealing the decision. The IC may also ask you to submit additional medical information. Additionally, you have to attend the employer’s medical examinations. If you don’t, you could lose out on the opportunity to get a hearing. If your employer is self-insured, you need to discuss with them which documents should be submitted.

The Hearing

After you’ve sent in your appeal, the Commission will hold what’s called an “administrative hearing” where they will review the decision of the BWC and your reasons for appealing. The Commission will let you know the details about where and when the hearing will be held about two weeks before the hearing date. If you can’t make it on that day, you can request a continuance, which is a just fancy word for rescheduling the hearing at a later time. To get the continuance approved, you need to have a really good reason. The hearing will be held at an IC location closest to where you live. If you have ever seen any courtroom or crime tv show, you might be thinking that is the kind of hearing you will experience. That is not the case. Normally, a hearing will be in a small room with just a few people there. You have the choice of representing yourself at the administrative hearing, or hiring a lawyer to represent you, however, you will be responsible for paying your attorney. Most attorneys charge contingency fees, meaning you don’t have to pay the attorney unless you actually win money. These fees are generally a percentage of the total amount won. It is rare to have to pay an attorney upfront, or out of pocket.

Three Levels of Appeal

If you are not happy with the decision made at your first hearing with the Industrial Commission, you can appeal for another hearing. The appeals process has three levels: You will begin at the District Level, where a District Hearing Officer (DHO) will listen to your side of the story, as well as your employer’s. You will go home, and the Hearing Officer’s decision will send you his or her decision in the mail. If you are still not happy with the decision of the DHO, you have a right to appeal again, this time to a Staff Hearing Officer, by filling out and sending in the IC-12 form again. You have fourteen days to do this. You are guaranteed a right to hearings at the District and Staff Level. If you want to take your appeal farther than that, the Commission MAY grant you a hearing, but they are not required to.

Once you go through the Industrial Commission’s appeals process, whether or not you are granted a hearing at the Commission Level, you can appeal the Commission’s decision by filing a lawsuit in your local court of common pleas. The process will be a lot easier for you if have some legal advice from someone qualified instead of doing it yourself. However, there are no rules saying you absolutely have to hire a lawyer, and you could represent yourself. (This is called pro se, which means you do not hire a lawyer and represent yourself in court.) However, this is generally not recommended because you only get one chance to win your case, so any mistake can cost you.

Three Things to Keep in Mind

The process for each level of appeals within the Commission takes a long time. The Ohio Revised Code requires each hearing to be scheduled within forty-five days of the day the IC-12 form is received. Combine this with the time needed to send out their decision, and you could be waiting for a while.

If you are appealing because you have a Permanent Total Disability, (PTD) you will most likely have to go to a pre-hearing conference with the hearing administrator to make sure your application is properly filled out and all of the medical documentation is in order. A PTD claim has some different guidelines for getting all of the medical evidence needed for the Commission to make their decision. Please contact the IC or visit their website for these requirements.

Besides working directly with the Industrial Commission, you can also discuss your questions and concerns with the Office of the Ombudsperson. They are a neutral party that will work with you, the employer, the Commission and the BWC. Talk to them, especially if you think your claim is not being handled in the way you think it should.

What about my Money?

As soon as the Commission rules in your favor, you will be paid, even if your employer or the BWC appeals the decision. However, if the decision of the District Hearing Officer is appealed, (the first appeals level) then your medical benefits won’t be paid until the appeal at the Staff Hearing Officer level (the second level) is decided. If you move out of Ohio, you will still be paid, but the hearings will be held in Ohio, so you might be doing a bit of traveling if you move out of the state.

The process of appealing your workers compensation claim is understandably daunting. However, it can be worth it for you and your family to get the compensation you deserve. Use the resources included in this this broad overview to help direct your research. Best of luck!

Have you been injured in a workplace accident, and had a claim denied? Lawrence & Associates can help! We have offices in West Chester, Ohio and Fort Mitchell, Kentucky, and we handle hundreds of Workers’ Compensation claims in Kentucky and Ohio every year. We’re Working Hard for the Working Class, and we want to help you!