Breanna R. Norman, Workers’ Compensation Attorney
Gallon, Takacs & Boissoneault
Timing matters. When the Ohio Bureau of Workers’ Compensation issues an appealable order, an injured worker generally has 14 days after receiving the order to file an appeal. Missing that deadline can significantly affect your ability to challenge the decision.
A denial can also create immediate concerns. Who will pay for medical treatment? What happens if you cannot work? Why was your claim denied when the injury happened on the job?
Understanding why the claim was denied is the first step toward deciding what to do next.
“An injured worker should not assume a denied claim means the process is over. Understanding why the claim was denied and what evidence may support the claim is an important first step.” – Breanna R. Norman, Workers’ Compensation Attorney, Gallon, Takacs & Boissoneault
What Should You Do When You Are Injured at Work in Ohio?
What you do immediately after a workplace injury can become important if your workers’ compensation claim is later disputed or denied.
Report the injury to your employer as soon as possible. Be clear about when and where the injury happened, what you were doing, and what parts of your body were hurt.
If someone witnessed the accident, make a note of who was there.
Seek appropriate medical treatment and tell the medical provider that the injury happened at work. Be accurate when describing how the injury occurred and what symptoms you are experiencing.
You should also keep your own records. Save medical paperwork, work restrictions, emails, text messages, photographs, accident reports, and other information related to the injury.
Prompt reporting helps create a clear timeline connecting the injury to the workplace. However, an employer’s internal reporting policy is not necessarily the same as Ohio’s legal deadline for pursuing a workers’ compensation claim.
What If Your Employer Refuses to Report Your Work Injury?
An employer may question how the injury happened, refuse to complete an internal report, or tell you that you missed a company reporting deadline.
That does not necessarily mean you have lost your right to pursue an Ohio workers’ compensation claim.
Ohio law generally gives an injured worker one year from the date of the workplace injury to file or otherwise preserve a claim. A company’s internal reporting policy does not replace Ohio’s workers’ compensation filing requirements.
What Should You Do If Your Employer Will Not Take the Report?
Create your own written record. Document:
- The date and time of the injury
- Where and how it happened
- What parts of your body were injured
- The names of any witnesses
- When you tried to report the injury
- Who you spoke with
When possible, report the injury in writing so you have a dated record. You should also seek appropriate medical treatment and tell the provider that the injury happened at work.
Why Are Workers’ Compensation Claims Denied in Ohio?
Workers’ compensation claims can be denied for many reasons. Often, the disagreement centers on whether the injury or medical condition is sufficiently connected to the worker’s employment.
Common issues include:
- The employer disputes how or where the injury occurred
- Medical evidence does not clearly connect the condition to the workplace injury
- A pre-existing condition creates questions about what caused the current symptoms
- The injury was reported late
- Medical records or other supporting documentation are incomplete
- There are conflicting accounts of how the accident happened
Sometimes the dispute is not whether an accident occurred. Instead, the question is whether a particular medical condition was caused by the workplace accident.
For example, an employee may hurt a shoulder while lifting materials at work. Medical records may also show an older shoulder problem. The issue may become whether the workplace incident caused a new injury, affected a pre-existing condition, or is unrelated to the symptoms being treated.
Medical causation questions like these can become an important part of a workers’ compensation hearing.
A denial does not necessarily mean the worker was not hurt. It means the claim, medical condition, or requested benefit was not approved based on the evidence and legal issues being considered.
Understanding Ohio’s Workers’ Compensation System
Ohio’s workers’ compensation system is different from the systems used in many other states.
For employers insured through Ohio’s state fund, the Ohio Bureau of Workers’ Compensation, or BWC, administers workers’ compensation claims and may issue orders addressing whether claims, medical conditions, compensation, or other requested benefits will be allowed.
Ohio also has self-insured employers that administer many aspects of their workers’ compensation claims directly.
When an issue becomes disputed, the matter may proceed before the Ohio Industrial Commission.
The Industrial Commission is separate from the BWC. Its hearing officers decide disputed workers’ compensation issues after considering medical evidence, employment records, testimony, accident reports, and other relevant information.
Understanding the difference between the BWC and Industrial Commission becomes especially important after a claim is denied and an appeal is filed.
What Should You Do If Your Ohio Workers’ Compensation Claim Is Denied?
Start by carefully reading the order or notice you received.
Look at exactly what was denied and why.
A claim may be denied entirely. In other situations, the overall claim may be allowed, but a specific medical condition, treatment request, compensation request, or other issue may be disputed.
Next, identify the appeal deadline.
Do not assume you have more time. Workers’ compensation deadlines can depend on the particular order and issue involved.
Continue your medical treatment and keep documenting your injury. Save work restrictions, medical records, employer communications, information about time missed from work, and documentation showing how the injury affects your ability to perform your job.
The reason for the denial will often determine what additional evidence may be important during the appeal.
What Happens After You Appeal a Workers’ Compensation Denial?
When an appealed BWC order proceeds to the Ohio Industrial Commission, the first hearing is generally held before a District Hearing Officer, or DHO.
The DHO considers the disputed issue and the evidence presented by the parties. A written decision is issued after the hearing.
If either party disagrees with the DHO’s decision, the order generally may be appealed within 14 days after it is received.
The next level is a hearing before a Staff Hearing Officer, or SHO. The SHO considers the dispute and issues another written decision.
If a party disagrees with the SHO decision, another appeal may generally be requested within 14 days.
The next stage is different.
Review by the three-member Industrial Commission is discretionary. This means the Commission may agree to hear the appeal or may refuse it.
Certain Industrial Commission decisions may also be appealed to an Ohio court. However, court appeals are limited under Ohio law and are not available for every type of workers’ compensation dispute.
What Happens at an Industrial Commission Hearing?
Industrial Commission hearings are less formal than traditional courtroom trials, but they are still legal proceedings that can directly affect whether a claim, medical condition, or requested benefit is allowed.
The hearing officer focuses on the specific issue listed for the hearing.
Depending on the case, the evidence may include medical records, physician reports, workplace documentation, accident reports, job duties, witness information, and testimony about how the injury occurred.
The employer or its representative may also present evidence or arguments disputing the claim.
Many denied claims involve medical causation. In those cases, the medical evidence may need to do more than establish a diagnosis. It may also need to explain how the diagnosed condition is connected to the workplace accident.
Preparation is important because the hearing officer considers the evidence and arguments presented when deciding the disputed issue.
What Evidence Can Help After a Workers’ Compensation Denial?
The evidence that matters most depends on why the claim was denied.
If there is a dispute about whether an accident occurred at work, helpful evidence may include an accident report, witness statements, photographs, video, work records, or written communications with a supervisor.
When medical causation is disputed, medical evidence may become the primary focus. Physician opinions, diagnostic imaging, treatment records, and documentation of symptoms before and after the workplace incident may help explain the relationship between the injury and the employee’s work.
Consistency also matters.
Workers should be as accurate as possible when describing how an accident occurred and when discussing symptoms with employers and medical providers.
Significant differences between an accident report, medical history, and later statements can become an issue when a claim is disputed.
What If You Had a Pre-Existing Condition?
Having a previous injury or medical condition does not automatically prevent someone from pursuing an Ohio workers’ compensation claim.
However, it can make the medical issues more complicated.
An employer may argue that current symptoms are related to an older injury, degenerative condition, or unrelated medical issue rather than the workplace accident.
Medical evidence may be needed to establish what condition resulted from the workplace event and how the worker’s condition changed after the injury.
Workers should be accurate about prior medical problems when speaking with their doctors and attorney. A complete medical history can help distinguish an existing condition from what happened after the workplace injury.
Common Mistakes After a Workers’ Compensation Denial
One of the biggest mistakes an injured worker can make is ignoring the denial because they assume nothing else can be done.
Missing an appeal deadline can also create serious problems. Review any order immediately and determine when an appeal must be filed.
Another mistake is relying entirely on the employer to document the accident. Injured workers should keep their own records, especially when there is already disagreement about what happened.
Medical treatment matters too. Gaps in treatment or missed appointments may create questions in the medical record.
Workers should also keep copies of work restrictions, correspondence, medical records, and information about lost time from work.
Be cautious about social media while your workers’ compensation claim is pending. Photos, videos, check-ins, comments, or posts about your injury, activities, medical treatment, work, or employer may be viewed without the full context and could be used to question your symptoms, restrictions, or ability to work. Privacy settings do not necessarily mean information will remain private. Avoid posting about your claim or injury, and do not delete or alter existing posts without first discussing it with your attorney.
Finally, be careful about providing statements or signing documents you do not fully understand. Statements about the accident, your medical history, your symptoms, or your ability to work may become part of the workers’ compensation record.
How Can a Workers’ Compensation Attorney Help After a Denial?
A denied workers’ compensation claim may involve much more than filing an appeal form.
A workers’ compensation attorney can review the order to determine what was denied, identify the applicable deadline, examine the medical and factual issues involved, and determine what additional evidence may be needed.
An attorney may also communicate with the BWC, employers, third-party administrators, medical providers, and other parties involved in the claim.
When a dispute proceeds to the Industrial Commission, an attorney can prepare the evidence and arguments and represent the injured worker at the hearing.
“A denial from the Bureau of Workers’ Compensation is not necessarily the final answer. In many cases, the focus shifts to presenting stronger medical evidence and explaining the facts clearly before the Industrial Commission. Every denied claim has its own circumstances, and understanding why the claim was denied is often the key to determining the best path forward. – Breanna R. Norman, Workers’ Compensation Attorney, Gallon, Takacs & Boissoneault
Every workers’ compensation claim has its own circumstances. The reason for the denial, the medical conditions involved, the evidence already in the claim file, and the applicable deadlines can all affect what happens next.
Frequently Asked Questions About Denied Workers’ Compensation Claims in Ohio
Does a denied workers’ compensation claim mean I cannot receive benefits?
No. A denial does not necessarily mean the claim is over. Depending on the issue involved and the applicable deadline, you may have the right to appeal and present additional evidence.
How long do I have to file a workers’ compensation claim in Ohio?
For most Ohio workplace injury claims, the claim generally must be filed or otherwise preserved within one year after the injury. Ohio law contains exceptions and specific requirements, so injured workers should not wait until the deadline approaches to determine whether a claim needs to be filed.
Can my employer stop me from filing a workers’ compensation claim in Ohio?
For state fund claims, the employer does not have exclusive control over whether a claim can be initiated. An employee, employer, medical provider, or another interested party may complete a First Report of Injury.
Ohio rules also provide that if an employer refuses, neglects, or unduly delays completing its part of the report, the report may still be filed without the employer’s portion completed.
What if my employer says I missed the company’s deadline for reporting an injury?
An employer’s internal reporting policy does not necessarily determine Ohio’s legal filing deadline for a workers’ compensation claim.
However, you should still report a workplace injury as soon as possible. A delay can create disputes about when, where, or how the injury happened.
How long do I have to appeal a denied workers’ compensation claim in Ohio?
Many appealable BWC orders must be appealed within 14 days after the order is received. DHO and SHO decisions also generally have 14-day administrative appeal periods.
Review the order carefully because the deadline and available appeal rights can depend on the specific issue involved.
Where does a workers’ compensation appeal go in Ohio?
An appealed BWC order generally proceeds to a hearing before a District Hearing Officer with the Ohio Industrial Commission.
A DHO decision generally may be appealed to a Staff Hearing Officer. After the SHO level, further Commission review is discretionary.
What evidence can help after my workers’ compensation claim is denied?
Helpful evidence may include medical records, physician opinions, diagnostic imaging, accident reports, witness statements, photographs, work records, communications with your employer, and documentation of work restrictions or lost time.
The evidence needed depends on the reason the claim or condition was denied.
Can my workers’ compensation claim be denied because I had a previous injury?
A prior injury or medical condition can create a dispute about what caused your current condition, but it does not automatically prevent you from having an Ohio workers’ compensation claim.
Medical evidence may be needed to explain how the workplace accident relates to the condition being claimed.
Do I need a lawyer to appeal an Ohio workers’ compensation denial?
Ohio does not require every injured worker to hire an attorney.
However, workers often seek legal help when a claim is denied, medical conditions are disputed, an employer challenges the claim, additional evidence needs to be developed, or the case is headed to an Industrial Commission hearing.
Was Your Workers’ Compensation Claim Denied in Ohio?
A denied workers’ compensation claim in Ohio can leave you worried about much more than the denial itself. You may already be missing work and losing income while medical bills continue to arrive. One of the questions we hear often from injured workers is simple: How am I supposed to pay for treatment out of pocket when I am not even receiving my normal paycheck?
Many people are also hesitant to call a workers’ compensation lawyer because they are worried about what legal help will cost. If you are already losing wages, the thought of another bill can make it even harder to ask for help.
Gallon, Takacs & Boissoneault represents injured workers throughout Toledo and Northwest Ohio. Our team can review why your workers’ compensation claim was denied, identify important appeal deadlines, evaluate the medical and workplace evidence, and represent you through the Ohio Bureau of Workers’ Compensation and Industrial Commission process.
We handle workers’ compensation cases on a contingency-fee basis. That means you do not pay us an attorney fee upfront. If we do not recover money for you, we do not get paid an attorney fee.
If your workers’ compensation claim was denied, do not assume you have to pay medical expenses yourself, go without income, or avoid calling a lawyer because you are worried about the cost. Getting answers about your options should not add another financial burden.
Call 419-843-6663 for a free consultation with our Ohio workers’ compensation team.
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