What can you do when your workers’ compensation claim is unfairly denied?
You don’t have to give up. In fact, you shouldn’t. Denials are a common issue because employers generally don’t have a lot to lose if they dispute a claim.
Generally, the first thing you want to do after your claim is denied for any reason is file an appeal with the Industrial Commission of Ohio, or IC. Hearings before the Industrial Commission are usually informal — but don’t let that fool you into thinking that they aren’t very concerned with the laws and regulations involved. Attorneys aren’t required during workers’ comp appeals with the Industrial Commission, but you can bet that your employer will have one in attendance.
Both you and your employer (since most likely that’s the root source of the denial) will be given an opportunity to explain your points of view. In addition, the IC may require you to have a consultative medical examination — at their expense — for the sake of getting another medical opinion on the extent of your injuries. This is most likely to happen when the nature of the claim’s denial is medical.
If the IC denies your appeal based on the idea that your injury or disability isn’t as severe as you allege, you can file a mandamus action. If the denial alleges that you don’t have a right to workers’ comp whatsoever, for whatever reason, you have to file a civil lawsuit in court. For example, you might file a mandamus action when you are awarded permanent partial disability benefits instead of the permanent total disability benefits you expected.
In Ohio, mandamus actions are all filed in Franklin County where the state capital is located. To win your case, you have to show that the IC overstepped its authority or “abused its discretion” by deciding that your injuries or disability aren’t as severe as you say.
Mandamus hearings are also fairly informal. They don’t operate like a trial. However, your case rests heavily on the argument that you present in writing, which is why it’s wise to involve an attorney.
Source: OhioAttorneyGeneral.gov, “Mandamus Actions,” accessed May 11, 2018