Many times, employees who suffer serious injuries or develop medical conditions in the course of employment are shocked to discover their claim is denied. While you can appeal these decisions, it is crucial to have the help of an experienced workers’ compensation attorney who can help identify why the claim was rejected. Here are some of the most common reasons for denying a workers’ compensation claim.
You Didn’t Report Your Injury in a Timely Fashion
If you’re injured on the job, it is very important to report it to your employer as soon as possible and fill-out an incident report, including witness statements if possible. Many injuries suffered in the workplace do not seem severe at first yet turn out to be serious medical conditions. For example, you may injure your back while performing a task but assume it’s only a sprain and will improve on its own. In these cases, an employer will contest your claim for failure to timely report an injury.
Your Medical Records Don’t Match Your Report
The BWC or your employer will question your claim if your reported injuries don’t match your medical records. It is important to be consistent when discussing your injury with your physicians, as any discrepancies will be major red flags for the BWC or your employer.
You Had Illicit Drugs in Your System
If your accident sent you to the emergency room, and those medical records found illicit drugs in your system, the BWC or your employer will almost always deny your claim. It is important to know the law allows you to rebut the presumption of being under the influence of illicit drugs and an experienced attorney can protect your rights.
Request a Different Doctor
You may see a doctor of your choice as your treating physician. This requires filing a C-23 Notice to Change Physician of Record form with the BWC.
Benefits Available from the Bureau of Workers’ Compensation (BWC) or Your Employer
1. Temporary Total Compensation. This compensation is for a worker who is totally disabled and unable to work for a specific period of time due to a work-related injury or occupational disease. Generally, this is the initial award of compensation paid to compensate for lost wages.
2. Percentage of Permanent Partial Disability. When a certain amount of permanent damage is caused by a work-related injury, a worker may be eligible for this compensation. For example, if an injured worker sustains a broken arm and can no longer extend it to the full degree, he/she would be eligible for an award based upon the residual loss. The permanent impairment may be physical or psychiatric, but the psychiatric condition must accompany a medical condition. The determination must be supported by an independent medical exam.
3. Lump Sum Settlement. This is an agreement between the employee, employer and the BWC to settle a claim for a one-time payment of a specific amount of money. A lump sum settlement forever resolves all past, present, or future medical and compensation issues and liabilities in the claim, whether known or unknown. This means you cannot receive any additional compensation after agreeing to a lump sum settlement.
4. Scheduled Loss. This applies when a worker suffers amputations or loss of use of a body part, including vision and hearing. A scheduled loss award is based on the loss suffered by the injured worker prior to treatment, not on the injured worker’s condition after treatment.
5. Living Maintenance. This compensation is for injured workers who are actively participating in a rehabilitation plan. The BWC will issue this compensation for a period not to exceed six (6) months, unless a review by the BWC finds the worker would benefit by an extension.
6. Living Maintenance Wage Loss. This compensation is only paid to a worker who has finished a rehabilitation plan and continues to have physical restrictions causing a wage loss upon return to work.
7. Permanent Total Disability (PTD). This form of compensation is for workers injured so severely they are permanently disabled and unable to work. The worker must attend an Industrial Commission of Ohio examination and hearing to determine if he/she meets the eligibility criteria. If approved, he/she could receive Permanent Total Disability compensation for life.
8. Wage Loss. Applicants must prove they lost wages or their wages were decreased and this was caused by the work-related injury. There are two forms of wage loss compensation:
a. Working Wage Loss is paid when the injured worker returns to a job other than his or her former position, whether at the same employer or a new one, resulting in fewer hours and less pay due to physical restrictions.
b. Non-Working Wage Loss is paid when the injured worker is released to return to work with restrictions but is unable to find suitable employment. It is important to note the injured worker must show he/she is making a good faith effort to secure employment within his/her physical restrictions.
9. Death Benefits. This type of claim is filed by the dependents of a worker who died as a result of an on-the-job injury. The amount paid to claimants depends on the level of support they received while the worker was alive. There are many ways to apply for these benefits, but the claim must be filed within two years of the worker’s death.
10. Facial Disfigurement. This is a one-time award granted for visible damage to the face or head that will impair the injured worker’s ability to secure or retain employment.
11. Change of Occupation. If a worker was diagnosed with an occupational disease such as silicosis, coal miners’ pneumoconiosis or asbestosis, he/she may be entitled to a change of occupation award. Firefighters and police officers who have contracted a cardiovascular and pulmonary disease may also be entitled to a change of occupation award. The worker must prove he/she was advised by a physician to change occupations to decrease further exposure.
12. Lump Sum Advancement. This is the prepayment of future compensation. Applications can be made by an injured worker or surviving spouse currently receiving permanent total, scheduled loss or death benefits. Requests can include household bills, emergency repairs, school tuition, handicap lift installed in an existing or new van, but supporting documentation must be included.
With more than 25 years of legal experience, our office will work to get your claim started and moving forward as quickly as possible. Schedule a free consultation to discuss your claim and learn how we can help. We do not charge anything to get started and we don’t get paid until we recover benefits for you.