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Appealing the denial of a workers' compensation claim

An injured Ohio worker who applies for workers' compensation benefits may find that the claim has been denied. A common question in such cases is, "What next?" In other words, is there an appeal process? And what agency hears such an appeal? Can the worker take the case to court? The post will review the appellate processes available under the Ohio workers' compensation system.

If the Bureau of Workers' Compensation denies a claim for any reason, the worker can file an appeal with the Ohio Industrial Commission. The IC has three levels of appeals. In the first level, the claim is set for a hearing before a district hearing officer. The hearing is held at the IC office nearest the injured worker's residence. The DHO reviews the entire case and any additional evidence that is submitted at the hearing. After completing the review, the DHO is required to prepare a written order and mail it to the parties. If either party is dissatisfied with the decision of the DHO, the party can request further review by a Staff Hearing Officer. The SHO will conduct a hearing, review the evidence and prepare and serve a written decision.

The next level is a bit different. If either party is unhappy with the decision of the SHO, the party may request further review by the Industrial Commission. However, the IC is not obligated to accept every such request. The workers' compensation statute gives the IC discretion to either accept or reject the claim for review. If the IC accepts the case, it will conduct a hearing and issue an order. If the IC rejects the case, the decision of the SHO is final unless either party elects to challenge the decision in court. A party that disagrees with the order of the SHO, with the decision of the IC to reject a request for review or with the decision of the IC after granting review may file an action seeking judicial review of the case in Ohio state court.

The workers' compensation appellate process is governed by both statutes and rules, and the process involves a number of strict deadlines. Anyone who is considering appealing an adverse decision on a claim for workers' compensation benefits may wish to consult an attorney who handles such claims. Such a consultation can produce a helpful evaluation of the case and an estimate of the likelihood of prevailing on appeal.

Source: Ohio Industrial Commission, "Appeals Process," accessed on Jan. 23, 2017

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Philip J. Fulton Law OfficeRepresenting Victims Of Workplace Injuries And Disability

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