As an employee, your expectation when you go to work is that you will be in a safe environment and be free from harm. If you have been injured while on the job, you could file a workers’ compensation claim. If you have done so, and the claim was denied, you should consult a lawyer. If you want to know more about the process of appealing a workers’ compensation decision in Toledo, speak with a distinguished workers’ compensation attorney that could advocate for you.
Essential Components of a Successful Claim
The plaintiff must be truthful. Witnesses or witness statements that back up what the plaintiff is saying/their version of the facts are crucial. Medical evidence and opinions that show with a reasonable degree of medical certainty what the diagnosis of the injury is. It is also necessary that those opinions give a prognosis, what limitations the individual now has, and that the injury was proximately caused by the industrial claim.
Why a Workers’ Compensation Claim Might Be Denied
Denial of a workers’ compensation claim could be based on a lack of medical evidence supporting that the work injury was proximately caused by the accident. It could be shown that the injury was actually due to an individuals’ preexisting conditions. Also, a person could be shown to have been under the influence of drugs or alcohol at the time of the injury.
Finally, a claim can be denied because the person was not acting within the scope of their employment during the time of the injury.
A person should consider appealing a workers’ compensation decision in Toledo if they have a legitimate work injury and they need additional treatment. They should be sure that they were not under the influence of alcohol and that their injury is not related to a pre-existing condition. An individual might not be able to appeal a denied claim if they miss the statute of limitations. Everyone has an automatic right of appeal, but only within that 14-day time period. If notice of the hearing and right to appeal was received but the individual failed to file an appeal within 14 days they will be barred from appealing the decision.
Process of Appealing a Denied Claim
Initially, a claimant files what is called a PPL within the 14-day time period allowed for appeals. This is the time period for them to work with their attorneys to strengthen medical and other evidence. After that, a DHO or District Hearing Office Hearing is set. This is an oral argument and hearing with representatives from both sides present, presided over by a district hearing officer.
The first stage is the district hearing where both sides present evidence and the district hearing officer makes a decision. Either party then has the ability to file an appeal of that decision. The next appeal will be heard by the SHO or the Staff Hearing Office. A staff hearing officer will hear the same issues, consider the old evidence, any new evidence, and issue a ruling. There is another potential level of appeal after the SHO, however, about 99% of those appeals are denied.
As a last resort, either side can appeal the issues to the Common Pleas Courts in the county of where the injury happened.
Role of a Toledo Workers’ Compensation Lawyer
If you have been injured while on the job, you have the right to file a claim. Appealing a workers’ compensation decision in Toledo is difficult to do alone, which is why you should consult a skilled attorney. Workers’ compensation lawyers understand the law, the appeals process, the evidence that is necessary to obtain, and what strategic decisions to make. A qualified workers’ compensation attorney could help you navigate this complicated process.