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Appealing a Denied Workers’ Compensation Claim

If you were hurt in a job-related incident, filing a workers’ compensation claim is the first step to getting the wage and medical benefits you need as you recover.

However, tens of thousands of workers’ compensation claims are denied each year across Ohio, Indiana, and Kentucky. Many of these claims are legitimate but are rejected due to simple mistakes made in the filing process.

If you need help filing for workers’ compensation benefits, or if you believe you have a valid claim that was wrongfully denied, please call Young, Reverman & Mazzei at 513-854-8885 or contact us online to arrange your free consultation. Our Cincinnati workers’ compensation lawyers have extensive experience helping injured workers in the tri-state area recover the benefits to which they’re entitled.

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Reasons Workers’ Comp Benefits are Denied

The most common reasons claims for Workers’ Compensation benefits in Cincinnati, Ohio, are denied include:

  • Inadequate paperwork or improperly submitted paperwork: The process to recover workers’ compensation benefits can be confusing, time-consuming and paperwork-heavy, all of which present obstacles to injured workers. If documentation is not complete and submitted precisely according to instructions, the claim will likely be denied.
  • Filing a claim too late: Missed filing deadlines can result in rejection of benefits. Most states give injured workers between one and three years from the date of injury to file a workers’ compensation claim. In Ohio, claims for benefits must be filed within two years. In Kentucky, you must file a “First Report of Injury” within 30 days, then your compensation claim must be submitted within two years. In Indiana, there is a two-year filing window as well.
  • Disputed workplace injuries: Because workers’ compensation benefits are only available to those who suffer job-related injuries or illnesses, it’s critical that workers report injuries as soon as possible. This helps ensure timely documentation to support your claim and provides ample time to contact an attorney if your employer or your employer’s insurance provider disputes the nature of your ailment.
  • Claim filed after leaving a job: While it’s possible to receive workers’ compensation benefits from injuries acquired during a previous job, it can be more difficult. If you filed the initial claim while you were still working for your prior company, you will need to report that with your appeal. If the injury or illness was not diagnosed until after you left the company where it was acquired, it’s a good idea to discuss your situation with an attorney who can best advise you on how to proceed.

The appeals process for denied workers’ comp claims varies by state. Here’s a brief look at how Ohio, Indiana and Kentucky handle workers’ comp appeals.

Related: Workers’ Compensation Claims Gone Wrong

Related: Why Is Workers’ Compensation So Difficult to Navigate?

Ohio Workers’ Compensation Appeals

The Ohio Bureau of Workers’ Compensation has 28 days to accept or reject your initial claim.

You will receive notification by letter, and if denied you have 14 days to file an appeal, which can be mailed, faxed or delivered in person. The Bureau then has 28 more days to make a decision, and the ruling will be given in a written notice.

Note that each claim must include the right paperwork and forms, as well as proof of employment, proof of accidental injury, and proof of workplace-related injury. If you did not submit this information with the initial application, you will need to do so upon appeal.

If your appeal is denied, the Industrial Committee (IC) can be petitioned to hold a hearing. The IC will hold a hearing for your appeal and then mail written notice of the final decision. You have the right to legal representation throughout the workers’ compensation application and appeals process.


Kentucky Workers’ Compensation Appeals

The Kentucky Department of Workers’ Claims has a slightly different process. Injured employees themselves cannot file a claim, so you will need a representative from your company or the help of a Workers’ Compensation attorney.

Within 30 days of receipt of your claim, the Department of Workers’ Claims will notify you via mail of its decision. If your claim was denied, you can file an appeal to the Administrative Law Judge of Kentucky within 30 days.

You may also appeal the Administrative Law Judge’s final decision to the Workers’ Compensation Board, which must be filed within 30 days of the Judge’s final decision. The Board will mail its final decision within 60 days of the last filing.

Indiana Workers’ Compensation Appeals

If your workers’ compensation claim is denied in Indiana, you will need to submit either: a.) An informal request for assistance or b.) A more formal application for a claim adjustment. Also note that coworker testimony, pay stubs, receipts showing medical care, and other evidence are needed for an approved workers’ compensation appeal in Indiana.

If you file a request for assistance and it is denied, you can then seek an adjustment appeal, which will involve a hearing with the Workers’ Compensation Board of Indiana. If the claim is denied after the hearing, you can file an appeal to the Full Workers’ Compensation Board within 30 days. If your claim is again rejected, you have the option to petition the Indiana Court of Appeals, for which legal representation is recommended.

How a Workers’ Compensation Attorney can Help

Regardless of your state, there is extensive work involved in the workers’ compensation appeals process. Completing the required documentation and gathering adequate evidence to support your claim can be overwhelming, especially while you’re recovering from an injury.

Working with a knowledgeable personal injury lawyer can help ensure your claim is sufficiently detailed and filed on time, and relieve some of the stress you feel so you can focus on getting better. If you were hurt in a workplace accident or suffered a job-related medical condition, it’s a good idea to consult with an attorney as soon as possible after receiving treatment.

The attorneys at Young, Reverman & Mazzei have decades of experience with workers’ compensation claims and appeals. To learn how we may be able to help you, please call us at 513-854-8885 or contact us online.

We offer free initial consultations to help you understand your options, and we have multiple offices to serve injured workers from the greater Cincinnati and Dayton areas, including in Florence, Kentucky, and Lawrenceburg, Indiana. Please see our locations page for a complete list of our offices and directions.