Appealing a Denied Workers' Comp Claim in Ohio

Legal Help for Denied Workers’ Comp Claims in Ohio

If you’ve been injured on the job and filed a workers’ compensation claim that was denied, you are likely frustrated and upset. The good news is that you have the opportunity to appeal the claim so that you can secure the benefits to which you may be entitled.

At Kisling, Nestico, & Redick, we focus on workers’ compensation claim denials and can help you navigate the complicated appeals process and improve your situation. Call us at 1-800-HURT-NOW for a free case evaluation.

Common Reasons for Workers Comp Claim Denials

A workers’ compensation claim may be denied for a variety of reasons. In many cases, claims are denied because they are not filed in a timely manner. In an Ohio workers’ compensation claim, a worker must report their injury right when it is discovered. Their employer must also inform the Bureau of Workers’ Compensation quickly.

Here are several other common reasons your claim may be denied:

• Your injury did not occur on work premises
• The severity of your injury does not warrant benefits
• There is a discrepancy between your documented injuries and accident report
• Your employer is disputing your claim
• You did not seek medical treatment

The Workers’ Comp Appeals Process

If your workers’ compensation claim has been denied, you may still obtain benefits by going through the appeals process.

Filing a Workers Comp Appeal

If the injured worker or the employer disagrees with the BWC claim decision, either party can file an appeal with the Industrial Commission of Ohio (IC).

Appeals must be filed within 14 calendar days from the date the injured worker receives the BWC decision, which is sent in the mail.

To appeal a claim decision, the injured worker or employer can:

• Complete the (IC-12) Notice of Appeal form and fax it to the Industrial Commission of Ohio (IC).
• Do it online via the Industrial Commission Online Network (I.C.O.N) website and complete the IC-12 form.
• Mail, fax or hand-deliver a written notice to the assigned CSS with the injured worker’s name, employer’s name, the claim number, the date that the injured worker received the decision, the reason for the appeal, your signature, and the date you signed your signature.

When submitting the appeal, fax any medical-treatment requests and any other information requested.

Refuting the WC Decision

If the injured worker or employer appeals a BWC claim decision, the Industrial Commission of Ohio (IC) will hear the dispute. This will be an administrative hearing held at an IC location nearest to the injured worker’s home address. The injured worker can choose to represent themselves in this process or hire a lawyer.

In Ohio, there are three levels of administrative appeals which include district, staff, and commission. Hearings at the district, state, and commission levels are informal, far less intimidating than courtroom proceedings, and will still give you the opportunity to present your position.

After filing the appeal, the IC will notify the injured worker and other involved parties about the date, time and location of the hearing. The injured worker will receive the notification about two (2) weeks prior to the hearing date.

Worker Comp Appeal Hearings

All appeals begin at the district level and can proceed further if necessary. At every level, a hearing will take place within 45 days of when the appeal was filed. During this time, you will provide evidence to support why your claim should be approved. An officer will hear your appeal and come to a decision within seven days.

Additional WC Appeals & Court Process

If your claim gets denied again, you’ll have 14 days to file an appeal to the next level. If the commission refuses to hear your appeal, you can take your claim to the Court of Common Pleas of the county in which your injury took place.

If you choose to take your claim to court, you’ll have 60 days to file the court appeal. Claims appealed in court involve a more formal process which may include depositions and expert testimony. In addition, court appeals often lead to jury trials.