There are many reasons why a valid workers’ compensation claim may be denied. Thankfully, in Ohio, a workers’ compensation claim denial does not mean the injured worker is without a remedy.
A Closer Look at Ohio Workers’ Compensation Denials
When a Claims Service Specialist (CSS) makes their decision about an Ohio workers’ compensation claim, they then issue a BWC “order” (a written notice) showing the decision as allowed, denied, or dismissed. To better understand how to appeal an Ohio workers’ compensation claim denial successfully, you must first understand why the claim was initially denied.
Some of the most common reasons for Ohio workers’ compensation claim denials include, but are not limited to:
Lack of Evidence
If the claim has been denied due to “a lack of evidence,” or if no medical records were ever filed with the BWC to support the claim, the injured worker may still be able to file the claim under the law set forth in the “Linda Greene” court case. It’s best to contact an experienced workers’ compensation attorney to discuss your rights if you’re facing a claim denial due to a lack of evidence, as fighting the denial can become complex very quickly.
Self-Insured Claim
If a workers’ compensation claim was never filed with the Ohio BWC, but the employer was “self-insured,” and the self-insured employer denied the claim, the injured worker may then file the claim with the Ohio BWC and ask for a hearing to be scheduled with the Industrial Commission of Ohio.
Wrong Address
If the Ohio BWC denied the claim by issuing an “order,” and the order was mailed to an address other than the injured worker’s address, and the injured worker never received the order and did not know that an order had been issued, or that the order had denied the claim, then the injured worker can ask the Industrial Commission of Ohio to allow them to file a late appeal.
The parties involved are entitled to notice of all decisions and hearings; if the injured worker never received an order or notice of the hearing, the injured worker can ask for relief under Ohio Revised Code 4123.522.
If a workers’ compensation claim was denied, and none of the above circumstances apply, then the injured worker may have no remedy for that particular injury.
Pre-Existing Conditions
However, Ohio workers’ compensation law recognizes the principle of “substantial aggravation of pre-existing conditions.”
For example, if the claim was denied for an event (injury) that occurred on January 10, 2019, and the injured worker had a recovery and did well afterward (and had no medical treatment), the injured worker might sustain a new injury in the future to the same body part.
If a body part was injured in the past and the claim was denied, but the injured worker sustains a new injury and substantially aggravates that pre-existing and previously denied condition, then the injured worker may file a new workers’ compensation claim. This is true even though the medical condition had been denied in an earlier claim. Of course, there would need to be medical evidence to support this new injury claim.
Get the Help You Deserve Today
Following a workers’ compensation denial, you may feel as if there are no options left and that your injury will become a permanent part of your life. However, there are options available to help you pursue the compensation you rightfully deserve.
At the Law Office of Charles Zamora, our team of trusted Ohio workers’ compensation attorneys has been helping those injured at work return to their best lives possible for countless years. We provide personal attention to your claim and keep our lines of communication wide-open to ensure any questions or concerns you have are answered with urgency.
Don’t let a claim denial stop you from pursuing what you deserve. Our team can help. Call us today (614) 344-6822 to learn more over a free consultation.