Workers’ compensation operates like an insurance policy. An employee who gets injured or falls ill on the job must file a claim, and the program can reject that request for medical coverage and replacement wages. The reason any particular claim gets denied varies, but with experience as a workers’ compensation lawyer in Columbus, Ohio, I’m convinced that applicants typically encounter one of three problems.
The Claim Is Submitted After the Statute of Limitations Expired
Ohio gives an injured or ill employee one year to submit a claim for workers’ comp benefits. The clock starts ticking on either the day that the incident occurred or the day when a definitive diagnosis was made.
It is pretty easy to figure out the day on which a workplace accident happened. A crate falls, a chemical spills, a machine malfunctions, a fire breaks out, or a vehicle crashes at an explicit time. After that moment, the injured employee has exactly 12 months to file a claim with the Ohio Workers’ Compensation program.
It is much more difficult to determine when to start the statute of limitations clock for a claim related to an occupational illness. Symptoms of cancer or lung disease from work-related exposures to chemicals and harmful materials may not show up until decades after a person leaves a job. Consulting with a Cleveland workers’ comp attorney after getting diagnosed with an occupational illness will help clarify whether it is possible to have an application considered.
The Applicant Submitted Too Little Medical Evidence
The Ohio Workers’ Compensation program will only award benefits to employees who experience a significant injury or disability while doing their jobs. One of the biggest things this means is that the person who files a workers’ comp claim must have required hospitalization and either missed work for long periods or have become unable to work.
A workers’ comp claim must be supported with medical records and prescription orders. Speaking with an attorney who has guided other injured and ill employees through the process will help an applicant understand exactly what types of documentation are needed.
The Injury or Illness Is Declared Not Work-Related
Employers can challenge workers’ comp claims on the grounds that the employee was not working or not engaged in authorized activities at the time that the injury occurred or the illness developed. For instance, an accountant who suffers electric shock burns while trying to fix a buzzing overhead light could be denied workers’ compensation benefits because she was not trained, equipped, or designated to make such a repair.
Similarly, a person driving his own car to a scheduled business meeting could receive workers’ comp benefits following a crash. That same person would be denied benefits if the crash happened on his way to the office on the morning of that the meeting was scheduled. The commute to work is not work activity.
Working with a Cleveland workers’ comp attorney to establish the fact that an injury or illness was work-related is often necessary. This is especially true when an employer raises technical issues like whether the employee wore protective equipment or asked a manager for permission to do something that put the employee at risk.
Gregory R. Mitchell is a Cleveland workers compensation attorney and partner at Agee Clymer Mitchell & Portman represents clients in workers comp appeal hearings.