In Ohio, workers file all workers’ compensation claims with the Ohio Bureau of Workers’ Compensation (BWC). Each year, the BWC evaluates thousands of claims to determine their validity and eligibility for benefits. The BWC approves some claims and denies others.
In case of a denial, the BWC must explain why they denied the claim. This notice typically includes the specific reason for the denial and information about the injured worker’s right to appeal the decision.
Below are some common reasons why the BWC might deny a claim. Understanding these can help you if your claim faces challenges.
Reasons for a claim denial
The BWC may deny a workers’ comp claim for various reasons. Here are some common grounds for denial:
- Insufficient work connection: The injury wasn’t clearly related to job duties
- Incomplete medical documentation: Lack of proper medical evidence supporting the claim
- Missed deadlines: Failing to report the injury or file the claim within the required timeframes
- Disputed accident details: Disagreement about how or where the injury occurred
- Non-compliance with treatment: Not following prescribed medical care or rehabilitation
- Employer challenges: Your employer contests the validity of the claim
These reasons for denial may or may not be valid. It can be beneficial to look into the reasons mentioned in the notice, address any issues, or provide additional information to support your claim.
Filing an appeal with the OIC
If the BWC denies your claim, you can appeal to the Industrial Commission of Ohio (OIC). To start the appeal process, file a “Notice of Appeal” with the OIC within 14 days of receiving your denial notice. A District Hearing Officer will then hear your appeal, giving you the opportunity to present your case and any new evidence. You can bring medical records, witness statements and other relevant documentation to support your claim.
If the initial appeal is unsuccessful, you can request more reviews of your case. There are multiple levels of appeal available, each with specific deadlines and procedures. It’s essential to act quickly on these deadlines and prepare for each stage.
Proper preparation can improve your chances
The appeals process can be complex, but the OIC approves many initially denied claims. To assert your right to workers’ comp benefits like medical treatment and lost wage compensation, you should understand why the BWC denied your claim, know how the appeals process works and prepare thoroughly for each appeals stage.
Each case differs from the last, and a denial doesn’t necessarily mean your claim lacks merit. You can appeal and overturn an initial denial with the right approach and evidence.