Workers’ compensation protections are essential to the health, recovery, and well-being of employees who get injured on the job. Unfortunately, navigating workers’ comp law can be confusing and daunting.
Finding a qualified lawyer who can answer your questions can make reaching a resolution for your work injury claim easier. Here are the most common questions we get from workers, along with detailed answers, some of which pertain to the Ohio Bureau of Workers’ Compensation (BWC).
Why was my claim denied?
The BWC can deny your claim for many reasons, one being that your medical provider did not submit the necessary medical documentation. Another possibility is that a BWC or your employer’s claim reviewer did not find enough evidence to tie your injury to your work-related incident. Still, another reason may be that the person reviewing your claim was not convinced that your injury or illness occurred during the scope of your work or while you were on your shift.
If your claim is denied, you have the right to appeal the decision to settle your workers’ comp case. This is where an experienced lawyer can be your strongest advocate. Decisions for which you can appeal typically center on the allowance or denial of a claim, treatment approval, or compensation payments.
There are specific deadlines to remember when filing an appeal, and your lawyer should be familiar with them. Also, it is imperative that you not delay contacting an attorney for an appeal. You may only have 14 days from receipt of a denial to file.
Why is my claim going to a hearing?
If you or your employer appeal a decision on your workers’ comp claim, that appeal will likely be set for a hearing in front of the Industrial Commission. At the hearing, a hearing officer who is a licensed work injury attorney will review the evidence related to the case and render a decision.
During the hearing, the injured worker—or their lawyer—must present evidence for reversing the initial decision, which could be setting payment at an amount lower than requested or denying medical treatment coverage. In most hearings, the burden of proof is on the injured worker to show that the initial decision was in error and should be reversed.
Why haven’t I received compensation?
The reason may be in the answer to this question: Have you filed your claim? This may seem simple, but many payment delays are because of missing forms or incomplete filings. Employers and the BWC can only pay you compensation if you have submitted the proper paperwork before the appropriate deadlines.
A workers’ compensation attorney can help you with this process. Missing time from work and paying medical bills present substantial financial burdens. Hiring an experienced worker’s comp lawyer can help resolve your work injury case before expenses become too daunting.
My doctor said my treatment had not been approved yet. How can I get an answer to my doctor’s request?
Another common reason for nonpayment or delays is that the BWC does not have your doctor’s request for treatment. Remember that injured workers have the right to seek care from the physician of their choice, and office visits do not require pre-approval. However, diagnostic tests, consultations with specialists, therapies, injections, and surgeries do need pre-approval in most situations.
A qualified workers’ comp lawyer will make sure your medical provider’s requests are being submitted with the proper documentation. You can also count on your attorney to appeal treatment denials and appear at appeals hearings on your behalf if necessary.
Why aren’t my medical bills being paid?
To receive workers’ compensation for medical bills, treatment must be for a work-related incident that occurred within the scope of your employment or while on the job. More specifically, approval of and compensation for treatment is typically based on three criteria:
- The treatment is related to the allowed conditions/diagnosis of the claim.
- The treatment is reasonably necessary for the allowed conditions or diagnoses.
- The cost of the treatment is reasonable.
On the contrary, you may only receive payment if your doctor treats a condition or diagnosis that your claim allows or recognizes. Until your claim includes the diagnoses your doctor is treating, treatment will continue to be denied because it is for a “disallowed” injury; in other words, a non-work-related injury.
The BWC may also deny treatment because a different medical provider claims it is unnecessary or not connected to your work-related incident. It sometimes happens that, after you submit a treatment request, a nurse or medical provider for the State or your employer will review your request. If that provider decides that the requested treatment does not meet the three aforementioned treatment criteria, the BWC or employer will deny the treatment.
Another situation we often see is that an injured worker has had one course of physical therapy approved, but their doctor wants to request additional appointments. A claims reviewer may disagree even if your provider determines that additional treatments are necessary or beneficial.
Suppose you receive another diagnosis related to your injury or condition or need additional treatment or care not documented in your initial claim. Your attorney can file a motion to amend or add conditions in that case. They will also gather evidence from your providers to support any motions they file.
A Cincinnati Workers’ Comp Lawyer Can Answer All Your Questions
At Clements, Taylor, Butkovich & Cohen LPA, Co., we would be happy to meet with you to review your case’s specific facts and answer your questions. We can also help you if any part of your claim was denied, file an appeal or motions on time, and secure the appropriate evidence to support your claim. Our lawyers have experience with all phases of the appeals process, including Industrial Commission Hearings, Common Pleas Courts, and all aspects of the litigation process.
Getting answers to your workers’ comp questions can alleviate confusion and help you feel more in control of your situation. Let the personal injury attorneys at Clements, Taylor, Butkovich & Cohen LPA, Co., help you by handling your claim, filing the necessary appeals, and gathering sufficient evidence to strengthen your claim. Call us today at 513.621.7500 to speak to a member of our team. You can also leave us a message or fill in the online contact form.