Workers’ compensation challenges such as strict requirements, insurance company tactics, high claim volumes, and employer disputes make it difficult for many workers to get benefits in Cincinnati. These complications and others also increase the odds of workers mistakenly self-sabotaging their efforts.
A workers’ compensation lawyer can help. Call Young, Reverman & Bolotin at 513-400-0000.
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Common Challenges Workers Face When Filing for Workers’ Compensation Benefits
What is workers’ compensation, and how does it work? The answer to this question can be tricky, depending on who you ask, as well as their knowledge and intentions. Unfortunately, major hurdles are common when workers try to get benefits such as medical treatment and wage replacement.
- Strict deadlines and paperwork requirements: Ohio has deadlines to report injuries and submit workers’ compensation claims. Not meeting a deadline can mean claims denial.
- Employer contests: Various employer claims can make the approval process trickier. For example, employers might say an injury did not occur at work or that a preexisting medical issue caused it.
- Medical documentation: Incomplete medical records or unclear doctor’s notes can lead to a claim being denied.
- Not following treatment: If workers do not show up to appointments or fail to follow treatment plans, it could hurt their chances of getting compensation.
Other workers’ compensation claim issues can be a lack of knowledge about workers’ compensation and employers who make it harder to seek compensation. The answer to, “what should I do if I’m injured at work,” can vary depending on employer and supervisor. One manager in a company might give a different number of days to follow steps compared with another manager. The discrepancies could be due to erroneous knowledge or fraud, but can delay the process.
Why Are Workers’ Compensation Claims Often Denied?
Workers’ compensation benefits are often denied due to lack of evidence linking the injury to workplace duties. Another major reason is when a worker does not get medical attention right away. This can suggest an injury that is not serious or that is not related to work.
Suspicions of fraud may result in denials, too. Workers’ stories should be consistent, with no evidence suggesting exaggerated or fabricated claims. Missed deadlines are another primary reason claims get denied.
Common Reasons for Delays in Workers’ Compensation Benefits
Delays in receiving benefits are common and can increase workers’ financial headaches. The Ohio Bureau of Workers’ Compensation processes high volumes of claims, which means approval can be slow. Workers’ paperwork errors, even simple mistakes, add to the likelihood of delays or rejections.
Moreover, if cases include employers or insurance companies suspecting fraud, the resulting investigations to verify the claims take time and delay the approval process. In fiscal year 2024, the Special Investigations Department, which detects and deters fraud, received 2,338 allegations.
Insurers also sometimes dispute whether treatments are necessary and may require workers to go through extra medical reviews. If a worker appeals a denied claim, the appeals process can add at least a few months’ wait time to get benefits.
How Insurance Companies Try to Minimize Workers’ Comp Payouts
One way insurance companies try to reduce payouts is to question the medical evidence. Insurers may say that injuries are not as serious as claims state, or that they are not job-related. Sometimes, insurance companies even surveil injured workers in hopes of finding evidence that conflicts with their claims. An investigator may hope to spot an injured worker lifting boxes or going for a run when the worker ostensibly should not be able to do either.
Another tactic is to encourage light-duty work before workers are fully recovered. Returning to work means a lower amount that insurers pay in benefits. Furthermore, some insurance companies put off approving claims. They hope that these delays cause workers to give up on their claims or accept lower settlement offers.
What to Do If Your Workers’ Comp Claim Is Denied or Delayed
With workers’ compensation benefit denials, read the denial letter to see the reasons given. For instance, if lack of medical evidence is the reason, you might be able to work with your doctor to provide more medical records or evidence supporting the claim.
Workers in Cincinnati and the rest of Ohio have the right to appeal denied claims. A lawyer can help with the process, which may involve looking for new evidence and preparing for hearings.
Lawyers can help with delays, too. One possible step is to contact your employer, the Ohio Bureau of Workers’ Compensation, or the insurance company for an update. If paperwork errors or missing evidence are stalling a claim, you may be able to fix that quickly.
If the delay is due to an investigation of your claim, cooperate while staying cautious. Keep records of your medical visits, communications with various parties, your work restrictions, and other matters. That way, you may have evidence handy to counteract claims the insurer makes in attempts to reduce payouts.
For delays that continue, two options are to file a complaint with the Ohio BWC or request a hearing. Another is to consult with a workers’ compensation lawyer.
How a Lawyer Can Help You Overcome Workers’ Compensation Challenges in Cincinnati
Workers’ compensation lawyers can boost the odds of getting compensation. They help with applications, employer disputes, appeals, denials, settlement negotiations, and more. For example, if you need to know what workers’ compensation does not cover, a lawyer can explain what is and what is not covered to help you set expectations.
Lawyers can help with appeals by presenting arguments as to why workers need benefits. In situations involving employer disputes, a lawyer can help gather and present evidence against employers’ arguments. If insurance companies offer settlements, lawyers can make sure these settlements are fair and help with negotiation if the offers are unfair. Young, Reverman & Bolotin may be able to assist you, so contact us today.
