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What happens when Workers’ Compensation is denied?

If you are injured on the job, the first thing you should do is seek medical attention, especially if your injury is severe.  Second, your employer should be notified about your injury and the way in which it occurred. Next, you should complete the appropriate forms to participate in the workers’ compensation system. 

Once you have reported an injury, BWC  assigns a claim number. You, your doctors, and your employer can use this number to track the status of your claim.  The BWC then gathers facts and makes a decision whether to allow or deny the claim within 28 days. Self-insuring employers make an initial decision whether or not to pay the claim within 30 days.

Injured workers may receive necessary medications while the future of their claim is being determined. The first fill rule ensures that injured workers immediately receive prescriptions for their acute injuries.  In cases where the first fill rule is used, if your claim is denied, the medication payment will be charged to BWC’s surplus fund account, rather than to you or your employer. 

The BWC then issues a written legal notice either denying or approving your claim. This is called a BWC order, and it is sent to the injured worker, their employer, and their representative.  If you or your employer disagrees with the decision, either may file an appeal with the Industrial Commission of Ohio within 14 days of the decision.  If your claim is allowed, BWC will pay your managed care organization (MCO) to cover medical services related to the allowed condition.  If you are severely injured and cannot return to work for eight or more days, BWC may also pay a percentage of the wages you have lost. Self-insuring employers will pay medical and compensation benefits.

If your claim is disallowed, you will be responsible for any medical bills that incur as a result of your injury or occupational disease.  In addition, you will not be eligible for any type of compensation available through BWC. 

If the claim was disallowed, the claimant may want to file an appeal within 14 days. “Claimant” includes any employee who sustains an injury or contracts an occupational disease, a dependent or any such deceased employee who had suffered such injury or disease, or any person awarded compensation under the Ohio Workers’ Compensation Act. You may file an appeal online through the Industrial Commission Online Network (I.C.O.N.), or you may file an appeal in writing. To file an appeal in writing, you must print the Notice of Appeal (IC-2) form, fill it out, and send the form to any Industrial Commission service office. Once the Industrial Commission receives your appeal, they will notify you of the time, date, and location of your hearing.

While the workers’ compensation process can be navigated by the injured worker, it is highly suggested that you contact an attorney to help gain the benefits you deserve. If you have been injured on the job and need assistance with your claim, please contact The Bainbridge Firm

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