A recent case that Green Haines Sgambati (GHS) is involved in illustrates how a simple mistake of an unrepresented injured worker’s self-representation caused major problems.
Theoretically, the workers’ compensation system is set up so that an injured worker can go through the process without an attorney. However, the reality is quite different. Often injured workers make mistakes at the beginning of their claim that make it much harder for them to succeed.
A case in point follows. A person is injured while walking back inside the employer’s building from a paid break. The break area is in disrepair with crumbling cement in the area where they walked. They sustained serious injuries from a fall and were transported to a hospital for treatment. They file a claim with the Bureau of Workers’ Compensation (BWC). After the claim is denied, they call to get information on how to appeal and what they should do next.
They go online as instructed and attempt to appeal the decision. To do this, they needed to use an IC (Industrial Commission) IC-10 form to appeal the BWC decision. Instead, they get a C-108 form from the BWC website. That form is a “Waiver of Appeal”. Essentially, they waived their right to appeal the decision which had been rendered in favor of their employer. They did the opposite of what they were intending to do which was contest/appeal the BWC decision.
After the time period to appeal had lapsed, the injured worker calls the BWC again and realizing their mistake files the appropriate form.
The matter goes to the first level, DHO hearing and the claim is rejected as not having been timely appealed. They then hire GHS before the next level-SHO hearing. An appeal is filed and that hearing officer is persuaded that the Waiver of Appeal gives them jurisdiction to hear the claim as if it was filed timely. The Staff Hearing Officer allowed the claim and temporary total compensation was awarded.
The Employer then appealed that decision to the Industrial Commission. Two Staff Hearing Officers reviewed the claim and refused to hear the appeal. Thus, the claim is still allowed, compensation continues to be paid.
The Employer then filed a Request for Reconsideration of that decision which was granted. A hearing was held in Columbus, Ohio and ultimately, they ruled that the Waiver of Appeal form that was filed was not timely. Therefore, the original order of the BWC would stand, thus the claim was dis-allowed.
As the injured worker had continued to receive compensation this created an overpayment in an amount over $24,000.00. GHS has now filed an appeal of the decision into Common Pleas Court.
A small mistake had huge consequences.
The sooner an injured worker retains an attorney is usually the better approach.
Every case is different and often there are legal issues of which the injured worker is not aware. Usually, it is not a simple matter of filling out a form and having your medical bills paid and compensation awarded. Delaying representation often causes additional hurdles that would not have existed had an attorney been involved at the outset.
There were several other issues in the aforementioned case that the average injured worker wouldn’t have the required legal knowledge to assess: 1.) Are paid break injuries compensable? 2.) Does the employer have a duty to provide a safe break area? 3.) Is there a premise liability or personal injury case as well as a workers’ compensation case? 4.) What effect will a pre-existing injury have? 5.) What if an employer originally advised a BWC rep they were going to certify/allow the claim? 6.) Do I have to accept the employer’s offer of light duty work? 7.) Do I have recourse if my employer terminates me? 8.) Do I have to keep seeing the doctor the employer sent me to? These and many other questions can result in confusion for the injured worker.
Any attorney who is going to represent you in a BWC claim can do a better job coming in at the start of a claim and avoiding mistakes, rather than coming in later to clean up the mistakes of self-representation.