Chapter Four: Handling Denials In Worker’s Compensation

Why Are So Many Claims Initially Denied In Ohio?

It’s surprisingly common for a worker’s compensation claim to be denied, especially early on in the process. Two of the most common reasons:

Lack Of Proper Medical Documentation

If your medical provider doesn’t clearly link your diagnosis to the workplace injury, or if records are missing altogether, the BWC is likely to deny the claim.

Employer Disputes The Claim

If your employer contests the claim, the BWC may side with them unless there’s strong documentation supporting your case. It’s likely they’ll claim the injury didn’t happen at work or isn’t as serious as reported.

If your claim is denied, you have a very limited window to file an appeal. Delaying can cost you the benefits you need and deserve.

Common Reasons For Denial

Early-stage denials typically happen because of:

• Incomplete or incorrect forms
• Missing medical reports
• Employer objections

Later in the process, denials often involve requests for expanded diagnoses or advanced treatments. For example, your claim was allowed for a lumbar strain, but your doctor’s MRI shows a herniated disc. Until the disc injury is officially added to the claim, the BWC may refuse to pay for the necessary treatment.

These kinds of disputes can delay recovery and cause financial strain, but they’re often fixable with the right legal help.

Appeals Timeline

Appeals aren’t instant, but the system moves fairly quickly compared to other types of litigation. The Industrial Commission of Ohio usually schedules hearings within 2 weeks of receiving the appeal. Most disputes are resolved within 4–8 weeks, although some may take longer depending on complexity.

Improving Your Chances Of Success In Disputed Or Denied Claims

This is where experience matters. After more than 35 years in this field, I’ve developed an instinct for spotting problems before they derail a claim. A good attorney will:

• Identify weak or missing documentation early
• Work directly with doctors to strengthen medical reports
• Prepare yourself and your case thoroughly for hearings
• Know how to present your case in front of the hearing officer to get results

In short, we know the system, and we know how to make it work for you.

Advice If You’re Injured And Feel Discouraged

It’s completely normal to feel frustrated, angry, or overwhelmed when your claim is disputed. You’re trying to recover, pay your bills, and move forward, and now you’re stuck dealing with paperwork, delays, and uncertainty. Here’s what I tell every client in this situation:

This isn’t the end. It’s just a bump in the road, and we know how to get over it.

With experienced legal help, most denials can be overcome. The key is to stay proactive, stay in touch with your doctor, and lean on a team that knows how to guide you through the process. You’re not in this alone, and you don’t have to figure it out by yourself!