Unfortunate incidents at work that result in injury of the employees make them eligible for receiving the Workers’ Compensation Benefits. However, individuals do not get to decide the mode or amount of assistance provided to them and therefore might be unhappy with the decision.
If any resident of Ohio is not satisfied with the declared results, s/he can approach the Industrial Commission of Ohio with their appeal.
The Process of making a Compensation Appeal
Employers who have opted for State Insurance rather than private ones have the Bureau of Workers’ Compensation (BWC) determine the amount paid to their employees in case of an injury. In cases where the damage is not significant and no prolonged treatment is required, BWC covers the charges for an emergency checkup and any basic medical costs involved, and the matter is closed there and then.
However, when the situation is a bit more complicated and involves claims regarding the coverage of ongoing treatments, further diagnostic tests, and monetary compensation, there might be a dispute between the affected employee and the Ohio Bureau of Workers’ Compensation.
In circumstances where an individual feels that their claim has been wrongfully denied, they can appeal to the Industrial Commission of Ohio by filling out the IC-12 form and submitting it to the Commission office. On the contrary, s/he may also file the appeal online.
Once the appeal has been made, the affected employee and their employer will receive a notice regarding their hearing at least 14 days in advance. The notice will contain details regarding the location, time, and date of the hearing and an overview of the matter that needs to be resolved.
For those who might be wondering or fretting over the experience, these hearings are not even close to a courtroom trial. They are comparatively informal, much shorter, and have a very limited number of people so the parties involved can express their concerns without getting intimidated. However, it is still important to be on time and observe respectful behavior.
It is not mandatory to hire a legal representative for these hearings, however, if accompanied by a Workers’ Compensation Attorney, it will increase the chances of a decision that rules in your favor. The reason being, these experienced and knowledgeable professionals will be able to advocate your concerns much better.
What would the experience be like?
The Industrial Commission or (IC) judges are qualified attorneys who are trained to resolve such disputes. They are referred to as Hearing Officers.
During the investigation, these judges are seated at one head of the table whereas BWC representatives occupy the other end. The employer and employee along with their representatives (if any) are made to sit on the opposite sides. The party that has appealed is usually allowed to speak first.
There might be instances where an opposing attorney or even your employer might accuse you of lying or faking the aftereffects of an injury. Therefore, when attending the IC hearing one must be mentally prepared for such an experience and not take these accusations to heart. In most cases, the Hearing Officer will intervene and ask the involved party to refrain from making personal attacks.
How to prepare for your IC Hearing?
To increase the chances of a favorable decision, it is recommended that you go to your hearing fully prepared. Therefore, all the latest medical reports should be gathered and taken along as proof of your condition. It is also advisable to get a statement from any witness beforehand and present it along with the medical records to strengthen your case.
Along with the original documents, you should take copies of each record in case you are required to submit them as evidence.
Furthermore, before appealing, it must be kept in mind that the Industrial Commission of Ohio may ask the affected employee to undergo further diagnostic tests and medical examinations and s/he will have to comply with the order. Not only this, but the IC may demand that the examination is carried out by its selected physician rather than the employee’s go-to doctor. Though the employee will not have to pay for the costs of these advanced check-ups, s/he must be mentally prepared to undergo the process.
Besides the willingness to cooperate in any investigative processes, the only considerations one might need to make are regarding their attire and communication style. Although you are not expected to show up in a suit, do ensure that you dress reasonably and respectfully rather than turning up in an extremely casual appearance. Also, you should answer all the questions truthfully, even if they are about your medical records. Remember that information can always be verified and any false statement can only go against your credibility.
Another very important requirement that most people tend to forget is that IC hearings are short and the judges have assigned a limited time to each case. Therefore, rather than telling unnecessarily wrong stories, it would be beneficial if you keep your answers short and to the point. The Hearing Officer can always ask for additional information if required.
The decision is not announced on spot and is usually communicated to all the parties involved via mail or electronic means after a few days.
What if an employee is not satisfied with the IC Decision?
There are 3 levels at which the Industrial Commission hears appeals of applicants. Dissatisfaction with the results of one hearing allows you to file another appeal at a higher level. Below are details of each:
Initial appeal with the Industrial Commission is made at a district level. The hearing is carried out at the Commission office nearest to the affected employee’s residence. The person filing the appeal is allowed to give their statement and either party can share any information regarding the related matter. The Hearing Officer may ask for further medical examination if required.
After the first appeal is heard by a District Hearing Officer (DHO), any party can request a second appeal which is heard by a Staff Hearing Officer. The latter may or may not amend the decision made by DHO because of all the evidence and statements.
Whereas a second hearing is easily granted, IC usually evaluates whether there are reasonable grounds for allowing a Commission level hearing. If this hearing is granted and it rules in your favor, you have the chance to demand your desired benefits and present the case for them again.
However, if this hearing goes against you, there will be no more hearings by the Industrial Commission.
The Last Resort
Even though the chances of your claim being unreasonable are quite high by this time, if you are sure that you deserve the demanded compensation benefits, the last resort to turn to after being rejected by Commission level IC is the court of law. An appeal may be made with the Court of Common Pleas within the county where the injury took place. However, before taking this step do ensure you are prepared for a jury trial, testimony, and depositions.
It is advisable to consult lawyers who specialize in the area of Worker Compensation Benefits before filing a case to ensure that there are no complications or unfavorable circumstances