Denied Workers’ Compensation Claims

You’ve been injured on the job and have taken all the necessary steps to file a workers’ compensation claim, but your claim was denied. This does not mean your fight is over.

Just because your claim was denied does not mean you should give up. An experienced workers’ compensation attorney can help you through the claims process, appeal or reopen your case to fight for the compensation you deserve.

The workers’ compensation attorneys at Plevin & Gallucci have represented Ohio workers for decades. We are here to help you through the claims process when you are injured on the job.

The process of appealing or reopening workers’ compensation claims can be complicated. There is no room for mistakes or missed deadlines. If you or a loved one has a workers’ compensation claim that needs to be appealed, call us today at 1-855-4-PLEVIN or contact us online. Consultations are free and without obligation.

Common Reasons for Ohio Workers’ Compensation Claim Denial

Here are some of the most common reasons our attorneys see Ohio workers’ compensation claims denied.

Employer Dispute of the Claim

Employer disputes are a common reason for claim denial. This can happen for a number of reasons. The employer can allege that the accident did not happen at work or that your current injury or illness is not the result of the accident. If this happens with your claim, you and your attorney need to collect additional evidence to support your workers’ compensation claim. This includes witness accounts of the accident and/ or a statement from your doctor saying your condition was caused in your workplace.

Employer and insurance companies will look for any reason possible to deny a workers’ compensation claim. Successful claims cost employers insurance expenses and liability.

Failing to File a Claim on Time

One of the most common reasons workers’ compensation claims are denied is because the claim was not filed or reported on time. According to Ohio law, a worker has to report the injury immediately, sometimes in just a matter of days. Just as quickly, the employer must then inform the state and/or its workers’ compensation insurance carrier. It’s critically important to know the deadlines for filing a workers’ compensation claim in Ohio. The statute of limitations for filing a claim has been reduced from two years to just one. The attorneys of Plevin & Gallucci have in-depth knowledge of Ohio law and the workers’ compensation claim process.

Precluded Injury or Illness Conditions

Some states will not consider claims for certain conditions, such as stress-related ailments. Ohio requires that there be a physical injury and in some instances, will allow for psychological injuries that are related to the physical injuries.

Insufficient Injury

A workers’ compensation claim can be denied if your injuries are considered not severe enough to warrant a claim.

If you or a loved one has been denied a workers’ compensation claim, look at your claim denial letter for the reason and talk to the experienced Cleveland workers’ compensation lawyers at Plevin & Gallucci if you are still uncertain why your claim was denied.

Failed Drug Tests

Failing a drug test after a workplace injury can be a significant reason for a denied workers’ compensation claim in Ohio. However, disqualification isn’t automatic—employers must demonstrate that the injury was directly caused by intoxication. It’s important to consult an experienced workers’ compensation attorney to challenge the denial and potentially rebut any presumption that intoxication caused the injury.

Workers’ Comp Appeals Process

Your claim will be referred to the Ohio Industrial Commission and set for hearing on the issue of claim allowance or alternatively, there will be an order issued denying the claim.

The first step of appealing a workers’ compensation claim denial is an administrative hearing. This occurs before an administrative law judge at the Ohio Industrial Commission. Your employer will likely have an attorney present. You should have an attorney present to advocate on your behalf.

At your appeal hearing, you will have to show evidence to support why your workers’ compensation claim should be allowed. This evidence includes factual evidence and medical documentation.

Reopening a Workers’ Compensation Claim

If your workers’ compensation claim has been denied, you can do more than just appeal. Reopening your claim is another option. In fact, even a case that has been closed and awarded damages to the plaintiffs can be reopened.

Reopening a claim is entirely different than appealing one. Reopening a claim is possible under some conditions. Most commonly, claims are reopened because:

• New evidence comes to light proving that your injury claim was legitimate;
• New evidence shows the compensation you were awarded for your injury was inadequate;
• The injury you suffered has recurred, become worse, or become aggravated;
• After you filed your initial claim, you were assigned a job that was less strenuous, but that alternate job or duties no longer exists;
• A legal or administrative error caused your claim to be wrongfully denied;
• It’s discovered that fraud was involved in denying your claim.

There are time limitations for filing a request to reopen your claim. If you are thinking of reopening a closed workers’ compensation claim, be sure to check with the attorneys of Plevin & Gallucci attorney about the time limit for doing so.

Many cases are considered closed when the full and final payment is issued and a release is signed. In these cases, both you and your insurance company cannot reopen the claim.

To reopen a claim, you must file an application with the Ohio Industrial Commission. There are specific forms you will need to file to reopen your claim, so be sure you are filing the appropriate paperwork when you contact the commission.

You must state why you are making your request to reopen the claim and provide supporting documentation. A copy of your denial letter may need to be included. For example, if you filed a workers’ compensation claim for an injury, but your injury has worsened since you filed your original claim, you will need new medical records to back up your claim.

The entire process of reopening a closed workers’ compensation claim can be very complicated and errors can be costly. Deadlines must be met and important information must be collected and presented. For these reasons, it is essential to have an experienced workers’ compensation attorney from Plevin & Gallucci on your side to walk you through the process.

Ohio cities we serve: Cleveland, Columbus and Waverly.