1. Hearing Preparation:
Where “Know” Is Not A
Negative Word

2. Know The Issue

3. 1. KNOW THE ISSUE
A. Claim/Condition Allowance
(1) Initial Claim Allowance
can mean ER does not think acc happened
or if accident happened it did not cause any
injury
or accident did not cause the specific injuries
being requested
(2) Additional Allowance
Almost always involves medical causation and
requires medical support

4. 1. KNOW THE ISSUE
B. Payment of Benefits
primarily involves whether claimant is eligible for
payment
or
correct calculation of payment, FWW and/or AWW
C Authorization for Medical Treatment
Starts with a C-9 authorization for treatment (there
can be multiple C-9s in various stages of
authorization/denial, so make sure you have the
correct one)
State fund v. Self Insured and how to get the
treatment to hearing including appeals
Always requires greater support from treatment
requesting doctor

5. 1. KNOW THE ISSUE
D. Any combination of A, B, and/or C
Initial allowance—payment of benefits may be
included if supported
Additional allowance—B and C may be involved if
both C84 and C9 are part of motion.
E. Procedural Issues
see “Know The Procedure”
So when you are preparing for an upcoming hearing—start with what
is the exact issue involved. Tip: Check the hearing notice since it
should give you notice of the issue.

6. Know The Evidence

7. 2. KNOW THE EVIDENCE
A. Now that I know the issue, what do I need to
prove?

8. 2. KNOW THE EVIDENCE
B. Allowance of claim
(1) Accident
accident report—very important
have to be able to explain delay
statements from witnesses
not just those that actually saw what happened
“He told me he had just hurt his back” on DOA
review 1st history given to health care provider
(2) Repetitive trauma
careful review of mechanism of injury
Take a moment to talk about it
Need to be able to answer the question: Why now?

9. 2. KNOW THE EVIDENCE
B. Allowance of claim
(3) Occupational disease
review what the requirements are:
basically that the work creates a unique
hazard
claimant has a greater risk of exposure
develop your facts around these requirements
(4) Keep in mind that you still need medical causation
what doctor says that the injuries were caused by
the accident

10. 1. KNOW THE EVIDENCE
C. Additional allowance
(1) Who is supporting the additional condition, i.e.
which health care provider says that the additional
condition was caused by acc.
(2) Where does the evidence come from?
On a C-9
Separate causation statement from doctor
C30 form carefully tailored to the issue

11. 1. KNOW THE EVIDENCE
D. Payment of benefits
(1) Temporary Total
(a) Correct C-84 filled out by treating doctor with
correct allowed conditions and current up to
time of hearing
(b) Medical evidence that claimant was being actively
treated during disability period of waiting for
surgery to be approved
(2) Wage Loss
(a) too many requirements to cover here
(b) one tip that you should know—under the OAC, an
employee does not have to apply to Ohio Job and Family
Services if he returns to same employer at a job paying
less money and seeks a wage loss.

12. 1. KNOW THE EVIDENCE
D. Payment of benefits
(3) Permanent Partial
(a) If you are going to hearing on this, you must have
medical evidence to support the appeal
(b) Make sure all helpful records are imaged before filing
C92 and are provided to claimant’s examining
doctor
(c) Place the impairment reports side by side and see if
you can see the differences between the two—
usually it’s a matter of degree of severity found
and/or quality and thoroughness of examination

13. 1. KNOW THE EVIDENCE
E. Authorization for Treatment
(1) If State Fund—review the ADR packet paying particular
attention to the physician’s review of the treatment.
(2) If there is time, obtain response from treatment seeking doctor
to physician’s review
(3) If the treatment has provided relief to the claimant before and
more treatment is being requested, have claimant testify
about the positive results of the treatment.

14. Know The Procedure

15. 1. KNOW THE PROCEDURE
A. File your R2 as soon as possible
B. State fund or Self Insured
C Avoid being ambushed
D. Avoid ambushing the other side
E. Understand time limits and keep track of due dates

16. Know What The Employer Is Going
to Argue

17. 4. KNOW WHAT THE EMPLOYER IS GOING TO
ARGUE
A. Once you know the issue and the evidence you need, consider
the employer’s position.
B. Construct the employer’s argument in your mind and review
the claim file for evidence that will support that
argument
C. To the extent that a medical issue is involved, review the
employer’s IME carefully to understand how the
employer is going to argue
D. Once you have identified the employer’s arguments as best
you can, comb through the evidence that will refute or
dilute each argument and be prepared to point
out that evidence to the IC hearing officer
Tip: Look up the employer’s doctor online at the Ohio State Medical
Association web site and determine if the doctor actually has expertise for
the injury that you are in hearing about.

18. Know What To Do Next

19. 5. KNOW WHAT TO DO NEXT
A. If you win—
(1) Understand appeals
(2) Additional Allowance/Medical treatment
(3) Payment of benefits
B. If you lose—
(1) Understand appeal time
(2) Review order for reasoning and, where possible, obtain
evidence that will refute reasoning at next hearing
(3) When in doubt, appeal
(4) Appeal up through appeal to IC commission every time

20. 5. KNOW WHAT TO DO NEXT
C. When to refer
(1) On every allowance issue that is lost
(2) If you do not understand reasoning of IC order
(3) If order seems based on legal case or cases
(4) If you can’t think of a way to refute IC reasoning
(5) If you are not sure what to do next

21. So What Do We Need To Know To
Prepare For A Hearing?
• 1. Know The Issue
• 2. Know The Evidence
• 3. Know The Procedure
• 4. Know What The Employer Will
Argue
• 5. Know What To Do Next