What to Do If Your Workers’ Compensation Claim Is Denied

John Larrimer
16 minutes ago
5 min read

In Ohio, when you get a work-related injury, the workers' compensation system is designed to offer financial and medical assistance during recovery. However, sometimes, a workers' comp claim is denied. This can be a surprise to people who have an injury claim, and it can be very discouraging. You have the right to challenge a denial, present more evidence, and pursue the benefits you deserve.

Larrimer & Larrimer is a respected workers' comp firm based in Columbus, OH. If you have a denied workers' compensation claim, and you are looking for answers on what to do next, you should reach out for a free consultation. They can also provide insight on what to do if you’re injured at work.

Understand Why There is a Denied Workers Compensation Claim

The first thing to do with a denied workers comp claim is to understand the reason it was denied. The Ohio Bureau of Workers' Compensation, or BWC, or your employer's managed care organization, or MCO, will offer a written explanation.

Common Reasons for a Denied Workers Comp Claim

Late reporting or filing: Waiting too long to report the injury or submit paperwork. It's best to report the injury immediately to avoid missed deadlines.
Lack of medical evidence: Insufficient documentation linking the work injury to the workplace. Medical documentation is very important.
Disputed cause of the injuries sustained: The employer or insurer argues that the injury did not occur at work. If the employer denies this, and the injury happened at work, try to find documentation of it.
Pre-existing condition: The insurer claims the injury was not caused by job duties. Injuries or occupational disease sustained at work, even if they are pre-existing, can sometimes be covered.
Non-compliance with treatment: The employee missed appointments or failed to follow medical advice. Seek medical treatment ASAP and always follow the doctor's orders.

Understanding the denial reason helps determine the next steps in the workers compensation claim process.

Review All Documentation Carefully Following a Denied Claim

Once you get a denial letter that your workers compensation benefits were denied, you should gather and review all of the documents that support the workers compensation claim. Denied Ohio workers compensation claims can be appealed.

Some of the documentation that should be reviewed include:

The official BWC decision letter.
Copies of medical records and doctor’s notes.
Any incident reports filed with the employer.
Correspondence with the insurance company, employer, or BWC.

When you review these materials, it can help identify the missing details and inconsistencies that contributed to the denial. In some cases, a small clarification can turn a wrongfully denied claim into one that is approved.

Consult an Experienced Workers’ Compensation Attorney

The workers comp appeals process is confusing, and that's why it's always recommended that people work with an experienced workers comp lawyer. This can make a huge difference in the outcome of the case.

An experienced attorney can offer the following legal help:

Look at the reason for the denial and identify any weaknesses in the claim
Gather medical evidence, supporting documentation, and other appropriate paperwork
File an appeal in a timely manner
Represent the injured workers in administrative hearings
Negotiate with insurance carriers to reach a settlement
Fight to prove the illness or injury was done at work

A lawyer on your side will help to level the playing field in most cases. This is especially true when facing large insurance companies. They can consult on what to do if your employer won’t report your injury.

File an Appeal with the Industrial Commission of Ohio

If your claim is denied, you have the right to appeal through the Ohio industrial commission. You must do this within 14 days of getting the notice. Missing the deadline can be the end of your claim.

The appeal process involves the following:

Filing the appeal: Submit the written appeal to the IC, explaining why the denial should be reconsidered.
District Hearing: The first level of review where both the employee and employer present evidence.
Staff Hearing (if needed): If either side disagrees with the district decision, the case can move to a staff hearing.
Commission-Level Review: The final level of administrative appeal before taking the case to court.

Having an attorney who is familiar with the process as your advocate will give you a much better chance of getting approved.

Gather Additional Medical Evidence

One of the most common reasons a claim is denied is because there is no enough medical information or proof that the injury was work-related. In many cases, strengthening this is the key to a successful appeal.

Injured workers should:

Obtain detailed medical opinions linking the injury directly to workplace activities.
Request updated records from doctors, physical therapists, or specialists.
Ask their physician to complete specific BWC forms accurately and thoroughly.
Seek a second medical opinion if necessary.

A medical file that is well-documented helps establish the connection between injury and employment duties. This is critical in overturning a claim denial.

Collect Witness Statements and Supporting Evidence

If possible, employees should gather witness statements from coworkers who saw the accident. This can help to confirm that conditions at the workplace has led to the injury. Other materials may include:

Surveillance footage from the workplace.
Safety reports or maintenance logs showing hazardous conditions.
Accident scene photos or equipment inspection reports.

This all helps to provide additional credibility to the worker’s account and can counter any claims made by the employer disputing the incident.

Stay Organized and Meet All Deadlines

In most cases, the appeals process is very strict. There are deadlines to consider and detailed paperwork to fill out. Missed deadlines, failing to submit requested documents, or not attending a hearing can result in the automatic dismissal of the appeal.

To stay organized, keep track of important dates, save copies of all forms and documents, and contact your lawyer and medical providers to keep the lines of communication open.

Prepare for the Hearing

During a hearing, both sides will present evidence and then a hearing officer will make the decision on if the appeal is successful or not. Injured workers should be prepared to discuss how the injury occurred, what time to treatment was necessary, and how the injury affected their ability to work.

Having someone familiar with workers comp law on your side is highly recommended. Consider top-rated workers comp lawyers in Columbus for help with this. Hearings can become very technical and involve complex medical testimony. When you hire legal representation, they will help prepare statements, present medical records, and ensure all facts are clearly communicated.

Continue Medical Treatment

While the appeal is pending, it’s important to keep receiving medical care. Consistent treatment not only supports recovery but also shows that the injury is still serious and affecting your life.

Failing to follow prescribed treatment can undermine the claim. It can also give the impression that the injury has resolved or was exaggerated. Keeping appointments and documentation of progress helps build a strong case for benefits.

Consider Further Legal Action if Necessary

If the Industrial Commission upholds the denial after all administrative appeals, employees still have options. The decision can be appealed to the Court of Common Pleas within 60 days. At this stage, the case becomes part of the civil court system and follows different legal procedures.

An experienced workers’ compensation attorney will evaluate whether pursuing a court appeal is in the client’s best interest and advise on the likelihood of success.

Reach out to Larrimer & Larrimer for help if you have found yourself in a position where your claim was denied. Free consultations are available.