Brian, Zwick, Stone & Associates
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Why are workers' compensation claims denied?

While we don't often think about being injured in the workplace, it is comforting to know that there are options available. Even though many workers in Ohio have had no encounters with the workers' compensation system, many are aware of its purpose and availability to employees if they are injured on-the-job or suffered a work-related illness. Although it seems straightforward when it comes to applying for workers' compensation, the fact is that employee applicants can still be denied these benefits.

Why are workers' compensation claims denied? While there is a wide range of reasons for denial, a workers' compensation application could be denied simply because the applicant does not meet the eligibility requirements laid out by the program. However, denials could be made in error, giving reason to appeal the decision.

Common reasons an application is denied include not reporting an injury in time, not filing a claim in time, the employer disputes the claim, the injury suffered is not compensable, no medical treatment was required or there was insufficient evidence that the injured suffered was work related.

By understanding why a claim was denied, an applicant can better prepare their actions for an appeal. The appeals process can vary; however, this typically means having a hearing before an administrative law judge. This can be either through the labor department or the state's workers' compensation board. There can be multiple levels of appeal. When initiating an appeal, it is important to collect necessary documentation, such as medical records and anything else that can address the denial.

Obtaining workers' compensation benefits can be very necessary for injured workers. Because an injury could keep an employee out of work for some time as they recover, this can cause financial hardships. These benefits could help offset this, helping to cover medical bills, rehabilitation and lost wages.

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