When an Ohio worker becomes ill or is injured on the job, workers' compensation can be a key to receiving treatment and surviving while unable to work. This is where workers' compensation benefits and understanding the process of how claims are approved or denied comes in. It is important to have a grasp on what steps can be taken to lodge an appeal if there is a denial.
After a worker makes a claim for workers' compensation benefits, the Bureau of Workers' Compensation in Ohio will make a decision as to whether the claim is approved or denied. Claimants can help expedite this process by responding quickly to requests made by the BWC or the managed care organization. Either the claimant or the employer can disagree with the decision made by the BWC. An appeal can be filed with the state's Industrial Commission within 14 days. If the claim is approved, the MCO will reimburse either the claimant or the insurer for medical expenses. Those who cannot work for eight days or more will be paid a percentage of their wages.
The IC will hear an appeal made by the employer. There are three levels for this. They are: district level hearings, staff level hearings, and commission level hearings. At the district level, the hearing will occur within 45 days of the appeal having been filed. The decision will be made within one week. If it is disagreed with, the next level of appeal must be applied for within 14 days. The same time frame as the district level is in effect for the staff level. If there is a disagreement with the staff level decision, it can be appealed to the commission level.
The commission can refuse to hear the appeal entirely after examining the decision made by the staff hearing officer. If it is accepted, the appeal will be within 45 days and a decision made seven days after that. It might be possible for the claimant to appeal the decision on the part of the commission not to hear the appeal. This must be done within 60 days.
Those who have questions about workers' compensation claims and how the process works with filing and appealing at various levels need to make sure they have legal assistance with the claim. After a workplace injury, the first call after receiving medical treatment should be to a qualified lawyer.
Source: BWC.Ohio.gov, "Handbook for Injured Employees -- page 5," accessed on Dec. 8, 2015
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