When a workers' comp claim is denied in Ohio, injured employees have the right to appeal the decision. Unfortunately, this process can be frustrating and time-sensitive, so understanding each stage and the expectations involved is essential. Jim Monast, an experienced workers' compensation attorney and founder of Monast Law Office, knows every aspect of the workers’ compensation appeal process and how to enhance your chances of a successful claim.
5 Stages of the Ohio Workers' Compensation Appeal Process
The Ohio Bureau of Workers' Compensation (BWC) and the Ohio Industrial Commission (IC) oversee workers' compensation claims and appeals. You can challenge the decision through a structured appeals process if your claim is denied. Below is a detailed timeline and what to expect at each stage.
Step 1: Initial Claim Denial
When you file a workers' compensation claim, the BWC or your employer’s third-party administrator (TPA) reviews the case. If they deny it, you’ll receive a written order or letter outlining the reasons why, which might be:
- Missed filing deadlines.
- A discrepancy between the accident report and documented injuries.
- The injury did not happen at work.
- The injury wasn't reported.
- The employer is disputing the claim.
- Medical treatment was not sought.
Upon receiving the denial, you have 14 days to file an appeal with the IC.
Step 2: Filing an Appeal With the District Hearing Officer
Your first level of appeal is before a District Hearing Officer (DHO) at the IC. To begin, you must submit an IC-12 Notice of Appeal form, which can be filed online, in person, or by mail. The DHO hearing is typically scheduled within 45 days of filing the appeal.
You can present medical records, expert testimony, and other evidence supporting your claim at the hearing. A skilled Monast Law Office attorney ensures your case is well-prepared and argued effectively. The DHO will issue a decision, known as an order, within seven days after the hearing.
If you disagree with the ruling, you once again have 14 days to appeal to the next level.
Step 3: Staff Hearing Officer Appeal
If the DHO denies your appeal, you can request a hearing before a Staff Hearing Officer (SHO). The process mirrors the DHO hearing, but the SHO provides a second level of review. The hearing is usually scheduled within 45 days of filing the appeal, and the decision is issued within seven days after the hearing.
If the SHO denies the claim, you have 14 days to file a written notice of appeal to the IC.
Step 4: Industrial Commission Review
The final administrative level of appeal is the Industrial Commission itself. However, the IC isn’t required to hear every appeal. If the IC accepts your case, a hearing will be scheduled, and a final decision made. If the IC refuses to hear the case or denies the claim again, your next step is to file an appeal in court.
Step 5: Court Appeals
If all administrative appeals fail, you have 60 days to file your case with the Ohio Court of Common Pleas. This step involves a formal lawsuit against the BWC or self-insured employer—and we can’t stress strongly enough how important it is to have an experienced workers' compensation attorney on your side. Court proceedings involve depositions, witness testimony, and additional legal procedures that can be overwhelming without legal representation.
How Monast Law Office Gives You a Legal Advantage
Receiving Ohio workers’ compensation benefits after a job-related illness or injury offers essential medical care and financial support during a challenging and stressful period. When those benefits are denied, the well-being and security of you and your family may be jeopardized.
Jim provides you with more than 30 years of workers’ comp experience. He and the entire staff at Monast Law Office get to work right away to help you prepare for the appeals process with comprehensive:
- Case evaluation. We analyze your claim and identify the best strategies for appeal.
- Legal guidance. Our team ensures all deadlines are met and filings are completed accurately.
- Evidence gathering. We also work on your behalf to collect and present compelling medical and expert testimony.
We’re also your strongest advocates in all hearings before the IC and, if necessary, in court. So if your claim is denied, call us. We’re committed to fighting for injured workers' rights and securing the benefits they deserve.
