Even valid Ohio workers' compensation claims can be denied. Here’s why that happens—and what you can do to protect your rights.
Why Ohio Workers’ Comp Claims Get Denied: Common Pitfalls to Avoid
Employees injured on the job in Ohio often assume that workers' compensation is a straightforward process. After all, it’s designed to protect workers, right? Unfortunately, many claims are denied—not because the injury wasn’t real, but because of preventable missteps, missing details, or disputes over eligibility. Understanding the most common reasons claims are rejected can help injured workers avoid costly delays or outright denials.
Missed Deadlines Can Sink Your Workers’ Compensation Claim
Failure to Report the Injury Promptly
In Ohio, employees must report a work-related injury to their employer as soon as possible. While there isn’t a strict deadline in the law for informing your employer, waiting too long can cast doubt on whether the injury truly happened on the job. Insurance administrators and the Ohio Bureau of Workers’ Compensation (BWC) often scrutinize late reports more closely.
Delays in Filing the First Report of Injury (FROI)
The FROI must be filed within one year of the injury or diagnosis of an occupational disease. If you miss that deadline, your claim could be automatically denied, regardless of how legitimate your case may be.
Insufficient Medical Evidence Hurts Your Case
No Medical Documentation Linking the Injury to Work
You must prove that your injury is work-related. If your medical records don’t clearly state that your condition was caused or aggravated by your job duties, your claim will likely be denied. Vague or incomplete documentation is one of the top reasons workers' comp claims are rejected in Ohio.
Using the Wrong Medical Provider
In many Ohio cases, injured workers must see a BWC-certified healthcare provider for treatment and evaluations. Visiting a provider not certified by the BWC could result in treatments that aren’t covered and opinions that aren’t considered valid in the claim review process.
Employer Disputes Can Lead to Rejection
The Employer Denies the Injury Happened at Work
If your employer claims that your injury did not occur at work or wasn't related to your job, that can trigger an investigation and potential denial. Discrepancies between your version and your employer’s account—especially if there were no witnesses—can weigh heavily against you.
Allegations of Misconduct or Intoxication
Ohio law bars compensation for injuries sustained while the worker was under the influence of drugs or alcohol, or while engaging in “willful misconduct.” If the employer alleges such behavior, even without solid evidence, it can derail your claim.
Pre-Existing Conditions Can Complicate Eligibility
In Ohio, a pre-existing condition does not automatically disqualify a claim, but it must be shown that the work injury worsened that condition. If your medical provider fails to explain how the work incident aggravated the existing issue, the BWC may deny your claim on the grounds that it was not occupationally related.
Independent Medical Exams (IMEs) Can Undermine Your Claim
The BWC or Managed Care Organization (MCO) may schedule an Independent Medical Exam with a third-party doctor. If this doctor concludes that your injury is not job-related or that you’re already fully recovered, their opinion can heavily influence whether your claim is approved—even if your own doctor disagrees.
Lack of Witnesses or Surveillance Contradictions
No Witnesses at the Time of Injury
Although not required, having a coworker who saw the injury occur adds credibility. In cases where no one else witnessed the incident, the claim becomes harder to prove—especially if there’s any delay in reporting it.
Video Footage That Contradicts Your Statement
If surveillance footage shows you acting in a way that contradicts your injury claim—or doesn’t show the injury at all—it can be used to dispute your version of events. Investigators and employers may use this to argue the injury did not happen on the job.
Administrative Errors or Incomplete Forms
Even simple paperwork mistakes—misspelling a name, entering the wrong date, or failing to sign a form—can lead to delays or denials. The Ohio BWC system is document-heavy, and even small omissions can stop a claim in its tracks.
What to Do if Your Workers’ Compensation Claim is Denied in Ohio
You Have the Right to Appeal
If your claim is denied, you have 14 days to file an appeal with the Industrial Commission of Ohio. This tight timeline makes it critical to act quickly and consult with a workers' compensation attorney if you’re unsure about the process.
Gather Strong Supporting Evidence
Include detailed medical records, written witness statements, and any other supporting documentation that clarifies the cause, timing, and extent of your injury.
Correct Any Paperwork Issues Immediately
Carefully review all documentation you submitted. If you identify errors or omissions, address them in your appeal to avoid another denial.
How a Workers' Compensation Attorney Can Help
An experienced workers’ comp lawyer can:
- Help collect and present strong medical evidence
- Cross-check employer claims and company policies
- Represent you at Industrial Commission hearings
- Challenge unfavorable IME reports
A strong legal advocate can make a major difference in getting a denied claim overturned—especially when your injury prevents you from returning to work or requires ongoing treatment.
Conclusion
Getting hurt on the job in Ohio should not mean battling for basic benefits, yet many workers find themselves facing denials for reasons that are preventable or disputable. From missed deadlines to unclear medical evidence and employer pushback, there are many reasons a workers' comp claim can be denied in Ohio. By recognizing the pitfalls and taking proactive steps, injured workers can protect their rights—and their recovery.
Need Legal Help? Brandon J. Broderick, Attorney at Law is One Phone Call Away
Navigating Ohio Workers Compensation claims can be challenging. Fortunately, you don't need to do it alone. The experienced lawyers at Brandon J. Broderick, Attorney at Law, are available 24/7 to help you understand your legal options, gather necessary evidence, and build a strong case to secure the settlement you deserve.
Contact us now for a free legal review.