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What Does the Workers’ Comp Board Look for When Reviewing Claims?

March 15, 2021

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If you get hurt on the job, whether the accident is your fault or not, you’re eligible to file a workers’ compensation claim. And if you get approved, you’ll get money that helps replace some of your lost income while you’re recovering from your injury. There’s just one catch: getting approved isn’t guaranteed.

Workers’ compensation fraud is widespread, and it costs the state of Ohio big money every year. Because of that, the Ohio Bureau of Workers’ Compensation (BWC) is strict when it comes to approving new claims. However, sometimes that strictness means that valid claims are overlooked or rejected.

Getting approved often comes down to two things: having an experienced Ohio workers’ compensation lawyer on your side, and knowing what the BWC looks for in applications. Keep reading to find out more about the second part of the equation.

Is There Proof the Injury Occurred at Work?

Above all else, the BWC wants proof that the injury in question happened at work or during the course of activities related to the injured worker’s employment. When evidence is lacking, or when there’s evidence suggesting that the injury was pre-existing, it can be much more difficult to get approval.

Things that constitute evidence include security camera footage, witness statements from coworkers, and accident reports filled out and signed by supervisors or managers. It’s also important for injured workers to both report their injuries and see a doctor right away. This helps further establish that their injuries happened on the job and weren’t caused by accidents at home or elsewhere.

Did the Employer Take the Right Steps?

First, injured employees must report their injuries to their employers. Then, their employers must report the injuries to their workers’ comp insurance provider and also provide the injured workers with the required paperwork to report their injuries to the BWC. This information should be provided to employees upfront, but if it isn’t, it should be given to them as soon as possible after they report their injuries.

Are There Inconsistencies Between the Accident Report and Medical Records?

The BWC requires that injured workers get treated by a doctor right away after their on-the-job injuries. This requirement ensures that their injuries are properly diagnosed and documented, and it also helps verify that their injuries are work-related. It also ensures that the injured workers are telling the truth about their injuries.

For example, a worker who describes their injuries as being completely disabling, but whose doctor disagrees, may have difficulty getting their claim approved or receiving full benefits. Another worker whose story concerning how their injury occurred doesn’t correlate with their doctor’s findings during their examination also may have their claim rejected.

Was the Employee Under the Influence of Drugs or Alcohol?

Although workers can get benefits even for injuries that weren’t anyone else’s fault, those benefits are negated if they were under the influence of drugs or alcohol when they got hurt. After on-the-job injuries, workers may be tested by their employers to determine if they were impaired at the time of their accidents. If those tests return positive, they may be unable to get workers’ compensation benefits.

Will the Injury Result in At Least 8 Missed Days of Work?

Not all injuries make employees eligible for workers’ compensation benefits. For example, relatively minor injuries with short recovery periods aren’t eligible for workers’ compensation. Employees who get hurt and can return to their jobs within one week of the date of their injuries aren’t eligible to receive benefits.

An Experienced Ohio Workers’ Comp Lawyer Can Help You Get Approved

These are just a few of the things the BWC looks for when reviewing and approving claims. Having an experienced law firm on your side is essential for maximizing your chances of getting approved and expediting the approval process. At Nurenberg, Paris, Heller & McCarthy, our lawyers have more than 90 years of experience assisting injured victims, and we know what the BWC looks for when reviewing claims.

Don’t be stuck without a paycheck while you recover from a workplace injury, and don’t let your claim fall through the cracks because of minor oversights. Contact us today for a free consultation. We’re here to help.

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