As Passed by the House 1
122nd General Assembly 4
Regular Session Am. Sub. S. B. No. 45 5
1997-1998 6
SENATORS CUPP-GILLMOR-SUHADOLNIK-NEIN-LATTA-WHITE-B. JOHNSON- 8
DRAKE-RAY-SCHAFRATH-GAETH-DIX-FINAN-GARDNER-HORN- 9
REPRESENTATIVES THOMPSON-HODGES-WILLIAMS-CORBIN-WACHTMANN- 10
HOOD-SCHURING-CATES-MEAD-COUGHLIN-HARRIS-BUCHY-TIBERI- 11
VAN VYVEN-CALLENDER-BRADING-STAPLETON-PERZ-MYERS-HOTTINGER 12
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A B I L L
To amend sections 2913.48, 4121.121, 4121.32, 16
4121.34, 4121.35, 4121.36, 4121.38, 4121.44, 17
4121.47, 4121.61, 4121.67, 4123.01, 4123.032, 18
4123.033, 4123.07, 4123.25, 4123.27, 4123.28, 19
4123.34, 4123.343, 4123.35, 4123.352, 4123.411, 20
4123.412, 4123.413, 4123.414, 4123.416, 4123.419,
4123.511, 4123.512, 4123.52, 4123.54, 4123.541, 21
4123.55, 4123.56, 4123.57, 4123.58, 4123.59, 22
4123.60, 4123.61, 4123.62, 4123.64, 4123.65, 23
4123.651, 4123.66, 4123.68, 4123.70, 4123.80,
4123.82, 4123.84, 4123.85, 4123.90, 4123.93, 24
4127.03, 4127.06, and 4141.31 and to enact 25
sections 4121.444, 4121.445, 4123.061, 4123.15,
and 4123.531 of the Revised Code to make various 27
changes in the structure, payment, and
determination of benefits, to reduce the number 28
of weeks an employee can receive nonworking wage 30
loss, to permit an employer to have an employee
excepted from the Workers' Compensation Laws for 32
religious reasons, to change the duration of the
continuing jurisdiction of the Industrial 33
Commission generally to five years with specified 34
exceptions for certain occupational diseases or
prosthetic device cases, to require hearing 35
2
officers to report suspected fraudulent activity, 36
to limit recovery for aggravation of a 37
preexisting condition, to change the definition
of occupational disease, to permit certain 38
nonattorneys to represent parties in hearings 39
before the Industrial Commission, to create the
presumption concerning alcohol or a controlled 41
substance as the cause of an employee's injury,
to except buildings and land used for 42
agricultural production from safety rules that
apply to workshops and factories, to provide 44
criminal penalties for employers who
intentionally misclassify their employees for 45
workers' compensation purposes, to prohibit
kickbacks from health care providers under the 46
Workers' Compensation Law, to prohibit health
care providers from receiving payments for false 47
claims under the Workers' Compensation Law, to 48
provide that records kept by the Division of 49
Safety and Hygiene are confidential, to specify 50
that records produced by an attorney in
connection with a workers' compensation claim are 51
the property of the claimant, and to make other
changes in the Workers' Compensation Law. 52
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO: 54
Section 1. That sections 2913.48, 4121.121, 4121.32, 56
4121.34, 4121.35, 4121.36, 4121.38, 4121.44, 4121.47, 4121.61, 58
4121.67, 4123.01, 4123.032, 4123.033, 4123.07, 4123.25, 4123.27, 59
4123.28, 4123.34, 4123.343, 4123.35, 4123.352, 4123.411, 60
4123.412, 4123.413, 4123.414, 4123.416, 4123.419, 4123.511, 61
4123.512, 4123.52, 4123.54, 4123.541, 4123.55, 4123.56, 4123.57, 62
4123.58, 4123.59, 4123.60, 4123.61, 4123.62, 4123.64, 4123.65, 63
4123.651, 4123.66, 4123.68, 4123.70, 4123.80, 4123.82, 4123.84, 64
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4123.85, 4123.90, 4123.93, 4127.03, 4127.06, and 4141.31 be 65
amended and sections 4121.444, 4121.445, 4123.061, 4123.15, and 66
4123.531 of the Revised Code be enacted to read as follows: 67
Sec. 2913.48. (A) No person, with purpose to defraud or 76
knowing that the person is facilitating a fraud, shall do any of 77
the following: 78
(1) Receive workers' compensation benefits to which the 80
person is not entitled; 81
(2) Make or present or cause to be made or presented a 83
false or misleading statement with the purpose to secure payment 84
for goods or services rendered under Chapter 4121., 4123., 4127., 85
or 4131. of the Revised Code or to secure workers' compensation 86
benefits; 87
(3) Alter, falsify, destroy, conceal, or remove any record 89
or document that is necessary to fully establish the validity of 90
any claim filed with, or necessary to establish the nature and 91
validity of all goods and services for which reimbursement or 92
payment was received or is requested from, the bureau of workers' 93
compensation, or a self-insuring employer under Chapter 4121., 94
4123., 4127., or 4131. of the Revised Code; 95
(4) Enter into an agreement or conspiracy to defraud the 97
bureau or a self-insuring employer by making or presenting or 98
causing to be made or presented a false claim for workers' 99
compensation benefits; 100
(5) MAKE OR PRESENT OR CAUSE TO BE MADE OR PRESENTED A 102
FALSE OR MISLEADING STATEMENT OR OTHER MISREPRESENTATION 103
CONCERNING MANUAL CODES, CLASSIFICATION OF EMPLOYEES, PAYROLL, OR 104
NUMBER OF PERSONNEL, WHEN INFORMATION OF THAT NATURE IS NECESSARY 105
TO DETERMINE THE ACTUAL WORKERS' COMPENSATION PREMIUM OR 106
ASSESSMENT OWED TO THE BUREAU BY AN EMPLOYER; 107
(6) SOLICIT, OFFER, OR RECEIVE ANY REMUNERATION IN CASH OR 109
IN KIND, INCLUDING, BUT NOT LIMITED TO, A KICKBACK OR REBATE, IN 110
CONNECTION WITH A REFERRAL FOR THE FURNISHING OF GOODS OR 111
SERVICES FOR WHICH REIMBURSEMENT MAY BE MADE PURSUANT TO CHAPTER 112
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4121., 4123., 4127., OR 4131. OF THE REVISED CODE. DIVISION 113
(A)(6) OF THIS SECTION DOES NOT APPLY TO ANY CONTRACT TO PROVIDE 114
SERVICES UNDER THE BUREAU'S HEALTH CARE PARTNERSHIP PROGRAM OR A 115
QUALIFIED HEALTH PLAN ENTERED INTO BETWEEN A MANAGED CARE 116
ORGANIZATION AND AN ORGANIZATION FORMED PURSUANT TO DIVISION 117
(A)(4) OF SECTION 4123.29 OF THE REVISED CODE. 118
(7) ALTER, FORGE, OR CREATE A WORKERS' COMPENSATION 120
CERTIFICATE TO FALSELY SHOW CURRENT OR CORRECT WORKERS' 122
COMPENSATION COVERAGE;
(8) FAIL TO SECURE OR MAINTAIN WORKERS' COMPENSATION 124
COVERAGE AS REQUIRED BY CHAPTER 4123. OF THE REVISED CODE. 125
(B) Whoever violates this section is guilty of workers' 127
compensation fraud. Except as otherwise provided in this 129
division, a violation of this section is a misdemeanor of the 130
first degree. If the value of the PREMIUMS AND ASSESSMENTS 132
UNPAID PURSUANT TO ACTIONS DESCRIBED IN DIVISION (A)(5), (7), OR 133
(8) OF THIS SECTION, OR OF goods, services, property, or money 136
stolen is five hundred dollars or more and is less than five 137
thousand dollars, a violation of this section is a felony of the 138
fifth degree. If the value of the PREMIUMS AND ASSESSMENTS 140
UNPAID PURSUANT TO ACTIONS DESCRIBED IN DIVISION (A)(5), (7), OR 141
(8) OF THIS SECTION, OR OF goods, services, property, or money 143
stolen is five thousand dollars or more and is less than one 144
hundred thousand dollars, a violation of this section is a felony 145
of the fourth degree. If the value of the PREMIUMS AND 147
ASSESSMENTS UNPAID PURSUANT TO ACTIONS DESCRIBED IN DIVISION 148
(A)(5), (7), OR (8) OF THIS SECTION, OR OF goods, services, 150
property, or money stolen is one hundred thousand dollars or 151
more, a violation of this section is a felony of the third
degree. 152
(C) Upon application of the governmental body that 154
conducted the investigation and prosecution of a violation of 155
this section, the court shall order the person who is convicted 156
of the violation to pay the governmental body its costs of 157
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investigating and prosecuting the case. These costs are in 158
addition to any other costs or penalty provided in the Revised 159
Code or any other section of law. 160
(D) The remedies and penalties provided in this section 162
are not exclusive remedies and penalties and do not preclude the 163
use of any other criminal or civil remedy or penalty for any act 164
that is in violation of this section. 165
(E) As used in this section: 167
(1) "False" means wholly or partially untrue or deceptive. 169
(2) "Goods" includes, but is not limited to, medical 171
supplies, appliances, rehabilitative equipment, and any other 172
apparatus or furnishing provided or used in the care, treatment, 173
or rehabilitation of a claimant for workers' compensation 174
benefits. 175
(3) "Services" includes, but is not limited to, any 177
service provided by any health care provider to a claimant for 178
workers' compensation benefits AND ANY AND ALL SERVICES PROVIDED 179
BY THE BUREAU AS PART OF WORKERS' COMPENSATION INSURANCE 181
COVERAGE.
(4) "Claim" means any attempt to cause the bureau, an 183
independent third party with whom the administrator or an 184
employer contracts under section 4121.44 of the Revised Code, or 185
a self-insuring employer to make payment or reimbursement for 186
workers' compensation benefits. 187
(5) "Employment" means participating in any trade, 189
occupation, business, service, or profession for substantial 190
gainful remuneration. 191
(6) "Employer," "employee," and "self-insuring employer" 193
have the same meanings as in section 4123.01 of the Revised Code. 194
(7) "Remuneration" includes, but is not limited to, wages, 196
commissions, rebates, and any other reward or consideration. 197
(8) "Statement" includes, but is not limited to, any oral, 199
written, electronic, electronic impulse, or magnetic 200
communication notice, letter, memorandum, receipt for payment, 201
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invoice, account, financial statement, OR bill for services; a 203
diagnosis, prognosis, prescription, hospital, medical, or dental
chart or other record; and a computer generated document. 204
(9) "Records" means any medical, professional, financial, 206
or business record relating to the treatment or care of any 207
person, to goods or services provided to any person, or to rates 208
paid for goods or services provided to any person, or any record 209
that the administrator of workers' compensation requires pursuant 210
to rule. 211
(10) "Workers' compensation benefits" means any 213
compensation or benefits payable under Chapter 4121., 4123., 214
4127., or 4131. of the Revised Code. 215
Sec. 4121.121. (A) There is hereby created the bureau of 224
workers' compensation, which shall be administered by the 225
administrator of workers' compensation. A person appointed to 226
the position of administrator shall possess significant 227
management experience in effectively managing an organization or 228
organizations of substantial size and complexity. Before
September 1, 1998, the governor shall appoint the administrator 230
as provided in section 121.03 of the Revised Code, and the 232
administrator shall serve at the pleasure of the governor. The 233
governor shall fix the administrator's salary on the basis of the 235
administrator's experience and the administrator's
responsibilities and duties under this chapter and Chapter 237
CHAPTERS 4123., 4127., and 4131. of the Revised Code. The 238
governor shall not appoint to the position of administator any 239
person who has, or whose spouse has, given a contribution to the 240
campaign committee of the governor in an amount greater than one 241
thousand dollars during the two-year period immediately preceding 242
the date of the appointment of the administrator. After August 243
31, 1998, the workers' compensation oversight commission shall 244
appoint the administrator as provided in division (F)(9) of 245
section 4121.12 of the Revised Code, and the administrator shall 246
serve at the pleasure of the oversight commission. The oversight 248
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commission shall fix the administrator's salary on the basis of 249
the administrator's experience and the administrator's 250
responsibilities and duties under this chapter and Chapters 251
4123., 4127., and 4131. of the Revised Code. 252
The administrator shall hold no other public office and 254
shall devote full time to the duties of administrator. Before 256
entering upon the duties of the office, the administrator shall 257
take an oath of office as required by sections 3.22 and 3.23 of 258
the Revised Code, and shall file in the office of the secretary 259
of state, a bond signed by the administrator and by surety 260
approved by the governor, for the sum of fifty thousand dollars 262
payable to the state, conditioned upon the faithful performance 263
of the administrator's duties.
(B) The administrator is responsible for the management of 266
the bureau of workers' compensation and for the discharge of all 267
administrative duties imposed upon the administrator in this 268
chapter and Chapters 4123., 4127., and 4131. of the Revised Code, 270
and in the discharge thereof shall do all of the following: 271
(1) Establish the overall administrative policy of the 274
bureau for the purposes of this chapter and Chapters 4123.,
4127., and 4131. of the Revised Code, and perform all acts and 275
exercise all authorities and powers, discretionary and otherwise 277
that are required of or vested in the bureau or any of its 278
employees in this chapter and Chapters 4123., 4127., and 4131. of 279
the Revised Code, except the acts and the exercise of authority 280
and power that is required of and vested in the oversight 281
commission or the industrial commission pursuant to those 282
chapters. The treasurer of state shall honor all warrants signed 283
by the administrator, or by one or more of the administrator's 284
employees, authorized by the administrator in writing, or bearing 286
the facsimile signature of the administrator or such employee 287
under sections 4123.42 and 4123.44 of the Revised Code. 288
(2) Employ, direct, and supervise all employees required 290
in connection with the performance of the duties assigned to the 291
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bureau by this chapter and Chapters 4123., 4127., and 4131. of 292
the Revised Code, and may establish job classification plans and 293
compensation for all employees of the bureau provided that this 294
grant of authority shall not be construed as affecting any 295
employee for whom the state employment relations board has 296
established an appropriate bargaining unit under section 4117.06 297
of the Revised Code. All positions of employment in the bureau 298
are in the classified civil service except those employees the 299
administrator may appoint to serve at the administrator's 300
pleasure in the unclassified civil service pursuant to section 301
124.11 of the Revised Code. The administrator shall fix the 302
salaries of employees the administrator appoints to serve at the 304
administrator's pleasure, including the chief operating officer, 305
staff physicians, and other senior management personnel of the
bureau. 306
(3) Reorganize the work of the bureau, its sections, 308
departments, and offices to the extent necessary to achieve the 309
most efficient performance of its functions and to that end may 310
establish, change, or abolish positions and assign and reassign 311
duties and responsibilities of every employee of the bureau. All 312
persons employed by the commission in positions that, after 314
November 3, 1989, are supervised and directed by the 315
administrator under this section are transferred to the bureau in 316
their respective classifications but subject to reassignment and 317
reclassification of position and compensation as the 318
administrator determines to be in the interest of efficient 319
administration. The civil service status of any person employed 320
by the commission is not affected by this section. Personnel 321
employed by the bureau or the commission who are subject to 322
Chapter 4117. of the Revised Code shall retain all of their 323
rights and benefits conferred pursuant to that chapter as it 324
presently exists or is hereafter amended and nothing in this 325
chapter or Chapter 4123. of the Revised Code shall be construed 326
as eliminating or interfering with Chapter 4117. of the Revised 327
9
Code or the rights and benefits conferred under that chapter to 328
public employees or to any bargaining unit. 329
(4) Provide offices, equipment, supplies, and other 331
facilities for the bureau. The administrator also shall provide 333
suitable office space in the service offices for the district 334
hearing officers, the staff hearing officers, and commission 335
employees as requested by the commission.
(5) Prepare and submit to the oversight commission 338
information the administrator considers pertinent or the 339
oversight commission requires, together with the administrator's 342
recommendations, in the form of administrative rules, for the 343
advice and consent of the oversight commission, for 344
classifications of occupations or industries, for premium rates 345
and contributions, for the amount to be credited to the surplus 346
fund, for rules and systems of rating, rate revisions, and merit 347
rating. The administrator shall obtain, prepare, and submit any 348
other information the oversight commission requires for the 350
prompt and efficient discharge of its duties. 352
(6) Keep the accounts required by division (A) of section 354
4123.34 of the Revised Code and all other accounts and records 355
necessary to the collection, administration, and distribution of 356
the workers' compensation funds and shall obtain the statistical 357
and other information required by section 4123.19 of the Revised 358
Code. 359
(7) Exercise the investment powers vested in the 361
administrator by section 4123.44 of the Revised Code in 362
accordance with the investment objectives, policies, and criteria 364
established by the oversight commission pursuant to section 365
4121.12 of the Revised Code. The administrator shall not engage 366
in any prohibited investment activity specified by the oversight 367
commission pursuant to division (F)(6) of section 4121.12 of the 368
Revised Code. All business shall be transacted, all funds 369
invested, all warrants for money drawn and payments made, and all 370
cash and securities and other property held, in the name of the 371
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bureau, or in the name of its nominee, provided that nominees are
authorized by the administrator solely for the purpose of 373
facilitating the transfer of securities, and restricted to the 374
administrator and designated employees. 375
(8) Make contracts for and supervise the construction of 378
any project or improvement or the construction or repair of 379
buildings under the control of the bureau. 380
(9) Purchase supplies, materials, equipment, and services; 382
make contracts for, operate, and superintend the telephone, other 383
telecommunication, and computer services for the use of the 384
bureau; and make contracts in connection with office 385
reproduction, forms management, printing, and other services. 386
(10) Separately from the budget the industrial commission 389
submits, prepare and submit to the director of budget and 390
management a budget for each biennium. The budget submitted 391
shall include estimates of the costs and necessary expenditures 392
of the bureau in the discharge of any duty imposed by law as well 393
as the costs of furnishing office space to the district hearing 394
officers, staff hearing officers, and commission employees under 395
division (D) of this section. 396
(11) As promptly as possible in the course of efficient 398
administration, decentralize and relocate such of the personnel 399
and activities of the bureau as is appropriate to the end that 400
the receipt, investigation, determination, and payment of claims 401
may be undertaken at or near the place of injury or the residence 402
of the claimant and for that purpose establish regional offices, 403
in such places as the administrator considers proper, capable of 405
discharging as many of the functions of the bureau as is 406
practicable so as to promote prompt and efficient administration 407
in the processing of claims. All active and inactive lost-time 408
claims files shall be held at the service office responsible for 409
the claim. A claimant, at the claimant's request, shall be 410
provided with information by telephone as to the location of the 412
file pertaining to claim. The administrator shall ensure that 413
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all service office employees report directly to the director for 414
their service office.
(12) Provide a written binder on new coverage where the 416
administrator considers it to be in the best interest of the 417
risk. The administrator, or any other person authorized by the 418
administrator, shall grant the binder upon submission of a 420
request for coverage by the employer. A binder is effective for 421
a period of thirty days from date of issuance and is 422
nonrenewable. Payroll reports and premium charges shall coincide 423
with the effective date of the binder. 424
(13) Set standards for the reasonable and maximum handling 426
time of claims payment functions, ensure, by rules, the impartial 427
and prompt treatment of all claims and employer risk accounts, 428
and establish a secure, accurate method of time stamping all 429
incoming mail and documents hand delivered to bureau employees. 430
(14) Ensure that all employees of the bureau follow the 432
orders and rules of the commission as such orders and rules 433
relate to the commission's overall adjudicatory policy-making and 434
management duties under this chapter and Chapters 4123., 4127., 435
and 4131. of the Revised Code. 436
(15) Manage and operate a data processing system with a 438
common data base for the use of both the bureau and the 439
commission and, in consultation with the commission, using 440
electronic data processing equipment, shall develop a claims 441
tracking system that is sufficient to monitor the status of a 442
claim at any time and that lists appeals that have been filed and 443
orders or determinations that have been issued pursuant to 444
section 4123.511 or 4123.512 of the Revised Code, including the 445
dates of such filings and issuances. 446
(16) Establish and maintain a medical section within the 448
bureau. The medical section shall do all of the following: 449
(a) Assist the administrator in establishing standard 451
medical fees, approving medical procedures, and determining 452
eligibility and reasonableness of the compensation payments for 453
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medical, hospital, and nursing services, and in establishing 454
guidelines for payment policies which recognize usual, customary, 455
and reasonable methods of payment for covered services; 456
(b) Provide a resource to respond to questions from claims 458
examiners for employees of the bureau; 459
(c) Audit fee bill payments; 461
(d) Implement a program to utilize, to the maximum extent 463
possible, electronic data processing equipment for storage of 464
information to facilitate authorizations of compensation payments 465
for medical, hospital, drug, and nursing services; 466
(e) Perform other duties assigned to it by the 468
administrator. 469
(17) Appoint, as the administrator determines necessary, 471
panels to review and advise the administrator on disputes arising 473
over a determination that a health care service or supply 474
provided to a claimant is not covered under this chapter or 475
Chapter 4123. of the Revised Code or is medically unnecessary. 476
If an individual health care provider is involved in the dispute, 477
the panel shall consist of individuals licensed pursuant to the 478
same section of the Revised Code as such health care provider. 479
(18) Pursuant to section 4123.65 of the Revised Code, 481
approve applications for the final settlement of claims for 482
compensation or benefits under this chapter and Chapters 4123., 483
4127., and 4131. of the Revised Code as the administrator 484
determines appropriate, except in regard to the applications of 486
self-insuring employers and their employees; 487
(19) Comply with section 3517.13 of the Revised Code, and 489
except in regard to contracts entered into pursuant to the 492
authority contained in section 4121.44 of the Revised Code,
comply with the competitive bidding procedures set forth in the 494
Revised Code for all contracts into which the administrator 495
enters provided that those contracts fall within the type of 496
contracts and dollar amounts specified in the Revised Code for 497
competitive bidding and further provided that those contracts are 498
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not otherwise specifically exempt from the competitive bidding 499
procedures contained in the Revised Code. 500
(20) Adopt, with the advice and consent of the oversight 502
commission, rules for the operation of the bureau. NO RULE 503
ADOPTED BY THE ADMINISTRATOR SHALL BE CONSTRUED AS BARRING THE 504
PARTICIPATION OF A PERSON WHO IS NOT ADMITTED TO THE PRACTICE OF 505
LAW AS A REPRESENTATIVE OF A PARTY FOR THE PURPOSES OF ANY MATTER 506
ARISING UNDER THIS CHAPTER AND CHAPTERS 4123., 4127., AND 4131. 507
OF THE REVISED CODE, PROVIDED THAT THE REPRESENTATIVE OF THE
PARTY COMPLIES WITH RULES OF THE ADMINISTRATOR. 508
(21) Prepare and submit to the oversight commission 510
information the administrator considers pertinent or the 511
oversight commission requires, together with the administrator's 512
recommendations, in the form of administrative rules, for the 513
advice and consent of the oversight commission, for the health 514
partnership program and the qualified health plan system, as
provided in sections 4121.44, 4121.441, and 4121.442 of the 515
Revised Code.
(C) The administrator, with the advice and consent of the 517
senate, shall appoint a chief operating officer who has 519
significant experience in the field of workers' compensation 520
insurance or other similar insurance industry experience if the
administrator does not possess such experience. The chief 521
operating officer shall not commence the chief operating 522
officer's duties until after the senate consents to the chief 523
operating officer's appointment. The chief operating officer 524
shall serve in the unclassified civil service of the state. 525
Sec. 4121.32. (A) The rules covering operating procedure 533
and criteria for decision-making that the administrator of 534
workers' compensation and the industrial commission are required 535
to adopt pursuant to section 4121.31 of the Revised Code shall be 536
supplemented with operating manuals setting forth the procedural 537
steps in detail for performing each of the assigned tasks of each 538
section of the bureau of workers' compensation and commission. 539
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The administrator and commission jointly shall adopt such 540
manuals. No employee may deviate from manual procedures without 541
authorization of the section chief. 542
(B) Manuals shall set forth the procedure for the 544
assignment and transfer of claims within sections and be designed 545
to provide performance objectives and may require employees to 546
record sufficient data to reasonably measure the efficiency of 547
functions in all sections. The bureau's division of research and 548
statistics shall perform periodic cost-effectiveness analyses 549
which shall be made available to the general assembly, the 550
governor, and to the public during normal working hours. 551
(C) The bureau and commission jointly shall develop, 553
adopt, and use a policy manual setting forth the guidelines and 554
bases for decision-making for any decision which is the 555
responsibility of the bureau, district hearing officers, staff 556
hearing officers, or the commission. Guidelines shall be set 557
forth in the policy manual by the bureau and commission to the 558
extent of their respective jurisdictions for deciding at least 559
the following specific matters: 560
(1) Reasonable ambulance services; 562
(2) Relationship of drugs to injury; 564
(3) Awarding lump-sum advances for creditors; 566
(4) Awarding lump-sum advances for attorney's fees; 568
(5) Placing a claimant, INCLUDING A CLAIMANT WHOSE 570
EMPLOYER IS A SELF-INSURING EMPLOYER, into rehabilitation; 571
(6) Transferring costs of a claim from employer costs to 573
the statutory surplus fund pursuant to section 4123.343 of the 574
Revised Code; 575
(7) Utilization of physician specialist reports; 577
(8) Determining the percentage of permanent partial 579
disability, temporary IMPAIRMENT IN ACCORDANCE WITH THE MOST 580
RECENT EDITION OF THE AMERICAN MEDICAL ASSOCIATION'S GUIDES TO 581
THE EVALUATION OF PERMANENT IMPAIRMENT; 582
(9) DETERMINING THE PERCENTAGE OF TEMPORARY partial 584
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disability, temporary total disability, violations of specific 587
safety requirements, an award under division (B) of section 588
4123.57 of the Revised Code, and permanent total disability 589
IMPAIRMENT.
(D) The bureau shall establish, adopt, and implement 591
policy guidelines and bases for decisions involving reimbursement 592
issues including, but not limited to, the adjustment of invoices, 593
the reduction of payments for future services when an internal 594
audit concludes that a health care provider was overpaid or
improperly paid for past services, reimbursement fees, or other 595
adjustments to payments. These policy guidelines and bases for 596
decisions, and any changes to the guidelines and bases, shall be 597
set forth in a reimbursement manual and provider bulletins. 598
Neither the policy guidelines nor the bases set forth in 600
the reimbursement manual or provider bulletins referred to in 601
this division is a rule as defined in section 119.01 of the 602
Revised Code.
(E) With respect to any determination of disability OR 604
IMPAIRMENT under Chapter 4123. of the Revised Code, when the 606
physician makes a determination based upon statements or 607
information furnished by the claimant or upon subjective 608
evidence, he THE PHYSICIAN shall clearly indicate this fact in 610
his THE PHYSICIAN'S report.
(F) The administrator shall publish the manuals and make 612
copies of all manuals available to interested parties at cost. 613
Sec. 4121.34. (A) The industrial commission shall appoint 622
a sufficient number of district hearing officers for the purpose 623
of hearing the matters listed in division (B) of this section. 624
District hearing officers are in the classified civil service of 625
the state, are full-time employees of the commission, and shall 626
be persons admitted to the practice of law in this state. 628
District hearing officers shall not engage in any other activity
that interferes with their full-time employment by the commission 629
during normal working hours. 630
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(B) District hearing officers shall have original 632
jurisdiction on all of the following matters: 633
(1) Determinations under section 4123.57 of the Revised 635
Code; 636
(2) All appeals from a decision of the administrator of 638
workers' compensation under division (B) of section 4123.511 of 639
the Revised Code; 640
(3) All other contested claims matters under this chapter 642
and Chapters 4123., 4127., and 4131. of the Revised Code, except 643
those matters over which staff hearing officers have original 644
jurisdiction. 645
(C) The administrator of workers' compensation shall make 647
available to each district hearing officer the facilities and 648
assistance of bureau employees and furnish all information 649
necessary to the performance of the district hearing officer's 650
duties. 651
(D) A DISTRICT HEARING OFFICER SHALL REPORT TO THE 653
INSPECTION DIVISION OF THE BUREAU OF WORKERS' COMPENSATION 654
SUSPECTED FRAUDULENT ACTIVITY PERTAINING TO THE OPERATION OF THE 655
WORKERS' COMPENSATION SYSTEM AND ITS SEVERAL INSURANCE FUNDS AS 656
EVIDENCED DURING ANY HEARING IN WHICH THE HEARING OFFICER IS 657
PRESENT OR AS EVIDENCED BY ANY MATERIAL SUBMITTED FOR USE IN A
HEARING. A DISTRICT HEARING OFFICER SHALL BE HELD HARMLESS FOR 658
SUBMITTING A REPORT UNDER THIS DIVISION. THE INSPECTION DIVISION 659
SHALL MAINTAIN IN CONFIDENCE THE IDENTITY OF ANY HEARING OFFICER 660
WHO SUBMITS A REPORT UNDER THIS DIVISION. 661
Sec. 4121.35. (A) The industrial commission shall appoint 670
staff hearing officers to consider and decide all matters 671
specified in division (B) of this section. All staff hearing 672
officers are full-time employees of the commission and shall be 673
admitted to the practice of law in this state. Staff hearing 674
officers shall not engage in any other activity that interferes 676
with their full-time employment by the commission during normal 677
working hours.
17
(B) Except as provided in division (D) of this section, 679
staff hearing officers have original jurisdiction to hear and 680
decide the following matters: 681
(1) Applications for permanent, total disability 683
IMPAIRMENT awards pursuant to section 4123.58 of the Revised 685
Code;
(2) Appeals from an order of a district hearing officer 687
issued under division (C) of section 4123.511 of the Revised 688
Code; 689
(3) Applications for additional awards for violation of a 691
specific safety rule of the administrator of workers' 692
compensation pursuant to Section 35 of Article II of the Ohio 693
Constitution; 694
(4) Applications for reconsideration pursuant to division 696
(A) of section 4123.57 of the Revised Code. Decisions of the 697
staff hearing officers on reconsideration pursuant to division 698
(A) of section 4123.57 of the Revised Code are final. 699
(5) Reviews of settlement agreements pursuant to section 701
4123.65 of the Revised Code. Decisions of the staff hearing 702
officer under that section are final and not appealable to the 703
commission or to court under section 4123.511 or 4123.512 of the 704
Revised Code. 705
(C) The decision of a staff hearing officer under division 707
(D) of section 4123.511 of the Revised Code is the decision of 708
the commission for the purposes of section 4123.512 of the 709
Revised Code unless the commission hears an appeal under division 710
(E) of section 4123.511 of the Revised Code. 711
(D) Staff hearing officers shall hold hearings on all 713
matters referred to them for hearing. Hearing procedures shall 714
conform to the rules the commission adopts pursuant to section 715
4121.36 of the Revised Code. 716
(E) A STAFF HEARING OFFICER SHALL REPORT TO THE INSPECTION 719
DIVISION OF THE BUREAU OF WORKERS' COMPENSATION SUSPECTED 720
FRAUDULENT ACTIVITY PERTAINING TO THE OPERATION OF THE WORKERS'
18
COMPENSATION SYSTEM AND ITS SEVERAL INSURANCE FUNDS AS EVIDENCED 721
DURING ANY HEARING IN WHICH THE HEARING OFFICER IS PRESENT OR AS 722
EVIDENCED BY ANY MATERIAL SUBMITTED FOR USE IN A HEARING. A 723
STAFF HEARING OFFICER SHALL BE HELD HARMLESS FOR SUBMITTING A 724
REPORT UNDER THIS DIVISION. THE INSPECTION DIVISION SHALL 725
MAINTAIN IN CONFIDENCE THE IDENTITY OF ANY HEARING OFFICER WHO
SUBMITS A REPORT UNDER THIS DIVISION. 726
Sec. 4121.36. (A) The industrial commission shall adopt 735
rules as to the conduct of all hearings before the commission and 736
its staff and district hearing officers and the rendering of a 737
decision and shall focus such rules on managing, directing, and 738
otherwise ensuring a fair, equitable, and uniform hearing 739
process. These rules shall provide for at least the following 740
steps and procedures: 741
(1) Adequate notice to all parties and their 743
representatives to ensure that no hearing is conducted unless all 744
parties have the opportunity to be present and to present 745
evidence and arguments in support of their positions or in 746
rebuttal to the evidence or arguments of other parties; 747
(2) A public hearing; 749
(3) Written decisions; 751
(4) Impartial assignment of staff and district hearing 753
officers and assignment of appeals from a decision of the 754
administrator of workers' compensation to a district hearing 755
officer located at the commission service office that is the 756
closest in geographic proximity to the claimant's residence; 758
(5) Publication of a docket; 760
(6) The securing of the attendance or testimony of 762
witnesses; 763
(7) Prehearing rules, including rules relative to 765
discovery, the taking of depositions, and exchange of information 766
relevant to a claim prior to the conduct of a hearing; 767
(8) The issuance of orders by the district or staff 769
hearing officer who renders the decision. 770
19
NOTHING IN DIVISION (A) OF THIS SECTION SHALL BE CONSTRUED 773
AS BARRING THE PARTICIPATION OF A PERSON WHO IS NOT ADMITTED TO 774
THE PRACTICE OF LAW AS A REPRESENTATIVE OF A PARTY FOR THE 775
PURPOSES OF ANY MATTER ARISING UNDER THIS CHAPTER AND CHAPTERS 776
4123., 4127., AND 4131. OF THE REVISED CODE, PROVIDED THAT THE 779
REPRESENTATIVE OF THE PARTY COMPLIES WITH RULES OF THE 780
COMMISSION. NO PERSON OTHER THAN AN ATTORNEY WHO IS ADMITTED TO 781
THE PRACTICE OF LAW MAY RENDER ADVICE OR SERVICES IN THE 782
PREPARATION OR PRESENTATION OF A CLAIM ARISING UNDER THIS CHAPTER 784
OR CHAPTER 4123., 4127., OR 4131. OF THE REVISED CODE IF A FEE 786
FOR THE ADVICE OR SERVICES IS TO BE RECEIVED FROM OR CHARGED 787
AGAINST THE PERSON HAVING THE CLAIM. 788
(B) Every decision by a staff or district hearing officer 790
or the commission shall be in writing and contain all of the 791
following elements: 792
(1) A concise statement of the order or award; 794
(2) A notation as to notice provided and as to appearance 796
of parties; 797
(3) Signatures of each commissioner COMMISSION MEMBER or 799
appropriate hearing officer on the original copy of the decision 800
only, verifying the commissioner's or hearing officer's vote; 802
(4) Description of the part of the body and nature of the 804
disability recognized in the claim. 805
(C) The commission shall adopt rules that require the 807
regular rotation of district hearing officers with respect to the 808
types of matters under consideration and that ensure that no 809
district or staff hearing officer or the commission hears a claim 810
unless all interested and affected parties have the opportunity 811
to be present and to present evidence and arguments in support of 812
their positions or in rebuttal to the evidence or arguments of 813
other parties. 814
(D) All matters which, at the request of one of the 816
parties or on the initiative of the administrator and any 817
commissioner COMMISSION MEMBER, are to be expedited, shall 818
20
require at least forty-eight hours' notice, a public hearing, and 820
a statement in any order of the circumstances that justified such 821
expeditious hearings. 822
(E) All meetings of the commission and district and staff 824
hearing officers shall be public with adequate notice, including 825
if necessary, to the claimant, the employer, their 826
representatives, and the administrator. Confidentiality of 827
medical evidence presented at a hearing does not constitute a 828
sufficient ground to relieve the requirement of a public hearing, 829
but the presentation of privileged or confidential evidence shall 830
not create any greater right of public inspection of evidence 831
than presently exists. 832
(F) The commission shall compile all of its original 834
memorandums, orders, and decisions in a journal and make the 835
journal available to the public with sufficient indexing to allow 836
orderly review of documents. The journal shall indicate the vote 837
of each commissioner COMMISSION MEMBER. 838
(G)(1) All original orders, rules, and memoranda, and 840
decisions of the commission shall contain the signatures of two 842
of the three commissioners COMMISSION MEMBERS and state whether 843
adopted at a meeting of the commission or by circulation to 845
individual commissioners COMMISSION MEMBERS. Any facsimile or 847
secretarial signature, initials of commissioners COMMISSION 848
MEMBERS, and delegated employees, and any printed record of the 849
"yes" and "no" vote of a commission member or of a hearing 850
officer on such original is invalid. 852
(2) Written copies of final decisions of district or staff 854
hearing officers or the commission that are mailed to the 855
administrator, employee, employer, and their respective 856
representatives need not contain the signatures of the hearing 857
officer or commission members if the hearing officer or 858
commission members have complied with divisions (B)(3) and (G)(1) 859
of this section.
(H) The commission shall do both of the following: 861
21
(1) Appoint an individual as a hearing officer trainer who 863
is in the unclassified civil service of the state and who serves 864
at the pleasure of the commission. The trainer shall be an 865
attorney registered to practice law in this state and have 866
experience in training or education, and the ability to furnish 867
the necessary training for district and staff hearing officers. 868
The hearing officer trainer shall develop and periodically 870
update a training manual and such other training materials and 871
courses as will adequately prepare district and staff hearing 872
officers for their duties under this chapter and Chapter 4123. of 873
the Revised Code. All district and staff hearing officers shall 874
undergo the training courses developed by the hearing officer 875
trainer, the cost of which the commission shall pay. The 876
commission shall make the hearing officer manual and all 877
revisions thereto available to the public at cost. 878
The commission shall have the final right of approval over 880
all training manuals, courses, and other materials the hearing 881
officer trainer develops and updates. 882
(2) Appoint a hearing administrator, who shall be in the 884
classified civil service of the state, for each bureau service 885
office, and sufficient support personnel for each hearing 886
administrator, which support personnel shall be under the direct 887
supervision of the hearing administrator. The hearing 888
administrator shall do all of the following: 889
(a) Assist the commission in ensuring that district 891
hearing officers comply with the time limitations for the holding 892
of hearings and issuance of orders under section 4123.511 of the 893
Revised Code. For that purpose, each hearing administrator shall 894
prepare a monthly report identifying the status of all claims in 895
its office and identifying specifically the claims which have not 896
been decided within the time limits set forth in section 4123.511 897
of the Revised Code. The commission shall submit an annual 898
report of all such reports to the standing committees of the 899
house of representatives and of the state to which matters 900
22
concerning workers' compensation are normally referred. 901
(b) Provide information to requesting parties or their 903
representatives on the status of their claim; 904
(c) Issue compliance letters, upon a finding of good cause 906
and without a formal hearing in all of the following areas: 907
(i) Divisions (B) and (C) of section 4123.651 of the 909
Revised Code; 910
(ii) Requests for the taking of depositions of bureau and 912
commission physicians; 913
(iii) The issuance of subpoenas; 915
(iv) The granting or denying of requests for continuances; 917
(v) Matters involving section 4123.522 of the Revised 919
Code; 920
(vi) Requests for conducting telephone pre-hearing 922
conferences; 923
(vii) Any other matter that will cause a free exchange of 925
information prior to the formal hearing. 926
(d) Ensure that claim files are reviewed by the district 928
hearing officer prior to the hearing to ensure that there is 929
sufficient information to proceed to a hearing; 930
(e) Ensure that for occupational disease claims under 932
section 4123.68 of the Revised Code that require a medical 933
examination the medical examination is conducted prior to the 934
hearing; 935
(f) Take the necessary steps to prepare a claim to proceed 937
to a hearing where the parties agree and advise the hearing 938
administrator that the claim is not ready for a hearing. 940
(I) The commission shall permit any person direct access 942
to information contained in electronic data processing equipment 943
regarding the status of a claim in the hearing process. The 944
information shall indicate the number of days that the claim has 945
been in process, the number of days the claim has been in its 946
current location, and the number of days in the current point of 947
the process within that location. 948
23
(J)(1) The industrial commission may establish an 950
alternative dispute resolution process for workers' compensation 951
claims that are within the commission's jurisdiction under 953
Chapters 4121., 4123., 4127., and 4131. of the Revised Code when 955
the commission determines that such a process is necessary. 956
Notwithstanding sections 4121.34 and 4121.35 of the Revised Code, 957
the commission may enter into personal service contracts with 958
individuals who are qualified because of their education and 959
experience to act as facilitators in the commission's alternative 960
dispute resolution process.
(2) The parties' use of the alternative dispute resolution 962
process is voluntary, and requires the agreement of all necessary 963
parties. The use of the alternative dispute resolution process 965
does not alter the rights or obligations of the parties, nor does 967
it delay the timelines set forth in section 4123.511 of the 968
Revised Code. 969
(3) The commission shall prepare monthly reports and 971
submit those reports to the governor, the president of the 972
senate, and the speaker of the house of representatives 973
describing all of the following:
(a) The names of each facilitator employed under a 975
personal service contract; 976
(b) The hourly amount of money and the total amount of 979
money paid to each facilitator;
(c) The number of disputed issues resolved during that 982
month by each facilitator;
(d) The number of decisions of each facilitator that were 985
appealed by a party;
(e) A certification by the commission that the alternative 988
dispute resolution process did not delay any hearing timelines as
set forth in section 4123.511 of the Revised Code for any 990
disputed issue.
(4) The commission may adopt rules in accordance with 992
Chapter 119. of the Revised Code for the administration of any 995
24
alternative dispute resolution process that the commission 996
establishes.
Sec. 4121.38. (A) The industrial commission shall DO ALL 1,005
OF THE FOLLOWING: 1,006
(1) Implement a program of impairment evaluation training 1,008
for its staff physicians; 1,009
(2) Issue a manual of commission policy as to impairment 1,011
evaluation so as to increase consistency of medical reports, 1,012
INCLUDING, BUT NOT LIMITED TO, A POLICY REQUIRING THE USE OF THE 1,013
MOST RECENT EDITION OF THE AMERICAN MEDICAL ASSOCIATION'S GUIDES 1,014
TO THE EVALUATION OF PERMANENT IMPAIRMENT FOR THE EVALUATION OF 1,015
PERMANENT PARTIAL IMPAIRMENT CLAIMS. This manual shall be 1,017
available to the public at cost but shall be provided free to all 1,018
physicians who treat claimants or to whom claimants are referred 1,019
for evaluation. The commission shall take steps to ensure that 1,020
the manual receives the widest possible distribution to 1,021
physicians.
(3) Develop a method of peer review of medical reports 1,023
prepared by the commission referral doctors; 1,024
(4) Issue a policy manual as to the basis upon which 1,026
referrals to other than commission specialists will be made; 1,027
(5) Designate two hearing examiners and two medical staff 1,029
members who shall be specially trained in medical-legal analysis. 1,030
The specialists shall write evaluations of medical-legal problems 1,031
upon assignment by other hearing examiners or the commission. The 1,033
director of administrative services upon commission advice shall 1,034
assign such employees to a salary schedule commensurate with 1,035
expertise required of them.
(6) Require that prior to any examination, a physician to 1,037
whom a claimant is referred for examination receives all 1,038
necessary medical information in the claim file about the 1,039
claimant and a complete statement as to the purpose of the 1,040
examination. 1,041
(B) The commission may establish a medical section within 1,043
25
the commission to perform the duties assigned to the commission 1,044
under this section. 1,045
Sec. 4121.44. (A) The administrator of workers' 1,054
compensation shall oversee the implementation of the Ohio 1,055
workers' compensation qualified health plan system as established 1,056
under section 4121.442 of the Revised Code. 1,057
(B) The administrator shall direct the implementation of 1,060
the health partnership program administered by the bureau as set 1,061
forth in section 4121.441 of the Revised Code. To implement the 1,062
health partnership program, the bureau:
(1) Shall certify one or more external vendors to provide 1,064
medical management and cost containment services in the health 1,065
partnership program for a period of two years beginning on the 1,067
date of certification, consistent with the standards established 1,068
under this section; AND
(2) May recertify external vendors for an additional 1,071
period of two years upon the expiration of the certification set 1,072
forth in division (B)(1) of this section; and 1,073
(3) May integrate the certified vendors with bureau staff 1,076
and existing bureau services for purposes of operation and
training to allow the bureau to assume operation of the health 1,077
partnership program at the conclusion of the certification 1,079
periods set forth in division (B)(1) or (2) of this section. 1,080
(C) Any vendor selected shall demonstrate all of the 1,082
following: 1,083
(1) Arrangements and reimbursement agreements with a 1,085
substantial number of the medical, professional and pharmacy 1,086
providers currently being utilized by claimants. 1,087
(2) Ability to accept a common format of medical bill data 1,089
in an electronic fashion from any provider who wishes to submit 1,090
medical bill data in that form. 1,091
(3) A computer system able to handle the volume of medical 1,093
bills and willingness to customize that system to the bureau's 1,095
needs and to be operated by the vendor's staff, bureau staff, or 1,096
26
some combination of both staffs.
(4) A prescription drug system where pharmacies on a 1,098
statewide basis have access to the eligibility and pricing, at a 1,099
discounted rate, of all prescription drugs. 1,100
(5) A tracking system to record all telephone calls from 1,102
claimants and providers regarding the status of submitted medical 1,104
bills so as to be able to track each inquiry.
(6) Data processing capacity to absorb all of the bureau's 1,106
medical bill processing or at least that part of the processing 1,107
which the bureau arranges to delegate. 1,108
(7) Capacity to store, retrieve, array, simulate, and 1,110
model in a relational mode all of the detailed medical bill data 1,111
so that analysis can be performed in a variety of ways and so 1,112
that the bureau and its governing authority can make informed 1,113
decisions. 1,114
(8) Wide variety of software programs which translate 1,116
medical terminology into standard codes, and which reveal if a 1,117
provider is manipulating the procedures codes, commonly called 1,119
"unbundling."
(9) Necessary professional staff to conduct, at a minimum, 1,121
authorizations for treatment, medical necessity, utilization 1,122
review, concurrent review, post-utilization review, and have the 1,123
attendant computer system which supports such activity and 1,124
measures the outcomes and the savings. 1,125
(10) Management experience and flexibility to be able to 1,127
react quickly to the needs of the bureau in the case of required 1,128
change in federal or state requirements. 1,129
(D) The administrator may limit freedom of choice of 1,133
health care provider or supplier by requiring, beginning with the 1,134
period set forth in division (B)(1) or (2) of this section, that 1,135
claimants shall pay an appropriate out-of-plan co-pay for 1,137
selecting a medical provider not within the health partnership 1,138
program as provided for in this section.
(E) The administrator, six months prior to the expiration 1,141
27
of the bureau's certification or recertification of the vendor or 1,142
vendors as set forth in division (B)(1) or (2) of this section, 1,144
may certify and provide evidence to the governor, the speaker of 1,145
the house of representatives, and the president of the senate 1,146
that the existing bureau staff is able to match or exceed the 1,147
performance and outcomes of the external vendor or vendors and 1,148
that the bureau should be permitted to internally administer the 1,149
health partnership program upon the expiration of the 1,150
certification or recertification as set forth in division (B)(1) 1,151
or (2) of this section.
(F) The administrator shall establish and operate a bureau 1,153
of workers' compensation health care data program. The 1,155
administrator may contract with the Ohio health care data center 1,156
for such purposes. The administrator shall develop reporting 1,157
requirements from all employees, employers and medical providers, 1,158
medical vendors, and plans that participate in the workers' 1,159
compensation system. The administrator shall do all of the 1,160
following:
(1) Utilize the collected data to measure and perform 1,162
comparison analyses of costs, quality, appropriateness of medical 1,163
care, and effectiveness of medical care delivered by all 1,165
components of the workers' compensation system.
(2) Compile data to support activities of the selected 1,167
vendor or vendors and to measure the outcomes and savings of the 1,168
health partnership program. 1,169
(3) Publish and report compiled data to the governor, the 1,171
speaker of the house of representatives, and the president of the 1,172
senate on the first day of each January and July, the measures of 1,174
outcomes and savings of the health partnership program and the 1,175
qualified health plan system. The administrator shall protect 1,176
the confidentiality of all proprietary pricing data. 1,177
(G)(F) Any rehabilitation facility the bureau operates is 1,179
eligible for inclusion in the Ohio workers' compensation 1,180
qualified health plan system or the health partnership program 1,181
28
under the same terms as other providers within health care plans 1,182
or the program. 1,183
(H)(G) In areas outside the state or within the state 1,185
where no qualified health plan or an inadequate number of 1,186
providers within the health partnership program exist, the 1,187
administrator shall permit employees to use a nonplan or 1,188
nonprogram health care provider and shall pay the provider for 1,189
the services or supplies provided to or on behalf of an employee 1,190
for an injury or occupational disease that is compensable under 1,191
this chapter or Chapter 4123., 4127., or 4131. of the Revised 1,192
Code on a fee schedule the administrator adopts. 1,193
(I)(H) No certified health care provider shall charge, 1,195
assess, or otherwise attempt to collect from an employee, 1,196
employer, a managed care organization, or the bureau any amount 1,197
for covered services or supplies that is in excess of the allowed 1,198
amount paid by a managed care organization, the bureau, or a 1,199
qualified health plan. 1,200
(J)(I) The administrator shall permit any employer or 1,202
group of employers who agree to abide by the rules adopted under 1,203
this section and sections 4121.441 and 4121.442 of the Revised 1,204
Code to provide services or supplies to or on behalf of an 1,205
employee for an injury or occupational disease that is 1,206
compensable under this chapter or Chapter 4123., 4127., or 4131. 1,207
of the Revised Code through qualified health plans of the Ohio 1,208
workers' compensation qualified health plan system pursuant to 1,209
section 4121.442 of the Revised Code or through the health 1,210
partnership program pursuant to section 4121.441 of the Revised 1,211
Code. No amount paid under the qualified health plan system 1,212
pursuant to section 4121.442 of the Revised Code by an employer 1,213
who is a state fund employer shall be charged to the employer's 1,214
experience or otherwise be used in merit-rating or determining 1,215
the risk of that employer for the purpose of the payment of 1,216
premiums under this chapter, and if the employer is a 1,217
self-insuring employer, the employer shall not include that 1,218
29
amount in the paid compensation the employer reports under 1,219
section 4123.35 of the Revised Code.
Sec. 4121.444. (A) NO HEALTH CARE PROVIDER, MANAGED CARE 1,221
ORGANIZATION, OR OWNER OF A HEALTH CARE PROVIDER OR MANAGED CARE 1,222
ORGANIZATION SHALL OBTAIN OR ATTEMPT TO OBTAIN PAYMENTS BY 1,223
DECEPTION UNDER CHAPTER 4121., 4123., 4127., OR 4131. OF THE 1,224
REVISED CODE TO WHICH THE HEALTH CARE PROVIDER, MANAGED CARE 1,225
ORGANIZATION, OR OWNER IS NOT ENTITLED UNDER RULES OF THE BUREAU 1,226
OF WORKERS' COMPENSATION ADOPTED PURSUANT TO SECTIONS 4121.441 1,227
AND 4121.442 OF THE REVISED CODE. 1,228
(B) ANY HEALTH CARE PROVIDER, MANAGED CARE ORGANIZATION, 1,230
OR OWNER THAT VIOLATES DIVISION (A) OF THIS SECTION IS LIABLE, IN 1,232
ADDITION TO ANY OTHER PENALTIES PROVIDED BY LAW, FOR ALL OF THE
FOLLOWING PENALTIES: 1,233
(1) PAYMENT OF INTEREST ON THE AMOUNT OF THE EXCESS 1,235
PAYMENTS AT THE MAXIMUM INTEREST RATE ALLOWABLE FOR REAL ESTATE 1,236
MORTGAGES UNDER SECTION 1343.01 OF THE REVISED CODE. THE 1,237
INTEREST SHALL BE CALCULATED FROM THE DATE THE PAYMENT WAS MADE 1,238
TO THE OWNER, HEALTH CARE PROVIDER, OR MANAGED CARE ORGANIZATION 1,240
THROUGH THE DATE UPON WHICH REPAYMENT IS MADE TO THE BUREAU OR
THE SELF-INSURING EMPLOYER. 1,242
(2) PAYMENT OF AN AMOUNT EQUAL TO THREE TIMES THE AMOUNT 1,244
OF ANY EXCESS PAYMENTS; 1,245
(3) UPON PROOF OF A SPECIFIC INTENT OF THE HEALTH CARE 1,248
PROVIDER, MANAGED CARE ORGANIZATION, OR OWNER TO DEFRAUD, PAYMENT 1,250
OF A SUM OF NOT LESS THAN FIVE THOUSAND DOLLARS AND NOT MORE THAN 1,252
TEN THOUSAND DOLLARS FOR EACH ACT OF DECEPTION;
(4) ALL REASONABLE AND NECESSARY EXPENSES THAT THE COURT 1,254
DETERMINES HAVE BEEN INCURRED BY THE BUREAU OR THE SELF-INSURING 1,255
EMPLOYER IN THE ENFORCEMENT OF THIS SECTION. 1,257
ALL MONEYS COLLECTED BY THE BUREAU PURSUANT TO THIS SECTION 1,259
SHALL BE DEPOSITED INTO THE STATE INSURANCE FUND CREATED IN 1,260
SECTION 4123.30 OF THE REVISED CODE. ALL MONEYS COLLECTED BY A 1,262
SELF-INSURING EMPLOYER PURSUANT TO THIS SECTION SHALL BE AWARDED 1,263
30
TO THE SELF-INSURING EMPLOYER. 1,264
(C)(1) IN ADDITION TO THE MONETARY PENALTIES PROVIDED IN 1,267
DIVISION (B) OF THIS SECTION AND EXCEPT AS PROVIDED IN DIVISION 1,268
(C)(3) OF THIS SECTION, THE ADMINISTRATOR MAY TERMINATE, FOR A 1,269
PERIOD NOT TO EXCEED FIVE YEARS FROM THE DATE OF CONVICTION, PLEA 1,270
OF GUILTY, OR JUDGMENT ENTRY, ANY AGREEMENT BETWEEN THE BUREAU 1,271
AND A HEALTH CARE PROVIDER OR MANAGED CARE ORGANIZATION OR ITS 1,272
OWNER AND CEASE REIMBURSEMENT TO THAT PROVIDER, ORGANIZATION, OR 1,273
OWNER FOR SERVICES RENDERED IF ANY OF THE FOLLOWING APPLY: 1,274
(a) THE HEALTH CARE PROVIDER, MANAGED CARE ORGANIZATION, 1,277
OR ITS OWNER, OR AN OFFICER, AUTHORIZED AGENT, ASSOCIATE,
MANAGER, OR EMPLOYEE OF A PROVIDER OR ORGANIZATION IS CONVICTED 1,278
OF OR PLEADS GUILTY TO A VIOLATION OF SECTIONS 2913.48 OR 2923.31 1,280
TO 2923.36 OF THE REVISED CODE.
(b) THERE EXISTS AN ENTRY OF JUDGMENT AGAINST THE HEALTH 1,283
CARE PROVIDER, MANAGED CARE ORGANIZATION, OR ITS OWNER, OR AN
OFFICER, AUTHORIZED AGENT, ASSOCIATE, MANAGER, OR EMPLOYEE OF A 1,284
PROVIDER OR ORGANIZATION AND PROOF OF THE SPECIFIC INTENT OF THE 1,286
HEALTH CARE PROVIDER, MANAGED CARE ORGANIZATION, OR OWNER TO
DEFRAUD, IN A CIVIL ACTION BROUGHT PURSUANT TO THIS SECTION. 1,287
(c) THERE EXISTS AN ENTRY OF JUDGMENT AGAINST THE HEALTH 1,289
CARE PROVIDER, MANAGED CARE ORGANIZATION, OR ITS OWNER, OR AN 1,290
OFFICER, AUTHORIZED AGENT, ASSOCIATE, MANAGER, OR EMPLOYEE OF A 1,291
PROVIDER OR ORGANIZATION IN A CIVIL ACTION BROUGHT PURSUANT TO 1,293
SECTIONS 2923.31 TO 2923.36 OF THE REVISED CODE. 1,294
(2) NO HEALTH CARE PROVIDER OR MANAGED CARE ORGANIZATION 1,296
THAT HAS HAD ITS AGREEMENT WITH AND REIMBURSEMENT FROM THE BUREAU 1,297
TERMINATED BY THE ADMINISTRATOR PURSUANT TO DIVISION (C)(1) OF 1,298
THIS SECTION, OR AN OWNER, OFFICER, AUTHORIZED AGENT, ASSOCIATE, 1,300
MANAGER, OR EMPLOYEE OF THAT HEALTH CARE PROVIDER OR MANAGED CARE 1,301
ORGANIZATION SHALL DO ANY OF THE FOLLOWING:
(a) DIRECTLY PROVIDE SERVICES TO ANY OTHER BUREAU PROVIDER 1,304
OR HAVE AN OWNERSHIP INTEREST IN A PROVIDER OF SERVICES THAT
FURNISHES SERVICES TO ANY OTHER BUREAU PROVIDER; 1,306
31
(b) ARRANGE FOR, RENDER, OR ORDER SERVICES FOR CLAIMANTS 1,309
DURING THE PERIOD THAT THE AGREEMENT OF THE HEALTH CARE PROVIDER,
MANAGED CARE ORGANIZATION, OR ITS OWNER IS TERMINATED AS 1,310
DESCRIBED IN DIVISION (C)(1) OF THIS SECTION; 1,311
(c) RECEIVE REIMBURSEMENT IN THE FORM OF DIRECT PAYMENTS 1,314
FROM THE BUREAU OR INDIRECT PAYMENTS OF BUREAU FUNDS IN THE FORM
OF SALARIES, SHARED FEES, CONTRACTS, KICKBACKS, OR REBATES FROM 1,315
OR THROUGH ANY PARTICIPATING PROVIDER. 1,316
(3) THE ADMINISTRATOR SHALL NOT TERMINATE THE AGREEMENT OR 1,318
REIMBURSEMENT IF THE HEALTH CARE PROVIDER, MANAGED CARE 1,319
ORGANIZATION, OR OWNER DEMONSTRATES THAT THE PROVIDER, 1,320
ORGANIZATION, OR OWNER DID NOT DIRECTLY OR INDIRECTLY SANCTION 1,321
THE ACTION OF THE AUTHORIZED AGENT, ASSOCIATE, MANAGER, OR
EMPLOYEE THAT RESULTED IN THE CONVICTION, PLEA OF GUILTY, OR 1,323
ENTRY OF JUDGMENT AS DESCRIBED IN DIVISION (C)(1) OF THIS 1,324
SECTION.
(4) NOTHING IN DIVISION (C) OF THIS SECTION PROHIBITS AN 1,327
OWNER, OFFICER, AUTHORIZED AGENT, ASSOCIATE, MANAGER, OR EMPLOYEE 1,328
OF A HEALTH CARE PROVIDER OR MANAGED CARE ORGANIZATION FROM
ENTERING INTO AN AGREEMENT WITH THE BUREAU IF THE PROVIDER, 1,329
ORGANIZATION, OWNER, OFFICER, AUTHORIZED AGENT, ASSOCIATE, 1,330
MANAGER, OR EMPLOYEE DEMONSTRATES ABSENCE OF KNOWLEDGE OF THE 1,332
ACTION OF THE HEALTH CARE PROVIDER OR MANAGED CARE ORGANIZATION 1,333
WITH WHICH THAT INDIVIDUAL OR ORGANIZATION WAS FORMERLY
ASSOCIATED THAT RESULTED IN A CONVICTION, PLEA OF GUILTY, OR 1,335
ENTRY OF JUDGMENT AS DESCRIBED IN DIVISION (C)(1) OF THIS 1,336
SECTION.
(D) THE ATTORNEY GENERAL MAY BRING AN ACTION ON BEHALF OF 1,339
THE STATE AND A SELF-INSURING EMPLOYER MAY BRING AN ACTION ON ITS 1,340
OWN BEHALF TO ENFORCE THIS SECTION IN ANY COURT OF COMPETENT
JURISDICTION. THE ATTORNEY GENERAL MAY SETTLE OR COMPROMISE ANY 1,341
ACTION BROUGHT UNDER THIS SECTION WITH THE APPROVAL OF THE 1,343
ADMINISTRATOR.
NOTWITHSTANDING ANY OTHER LAW PROVIDING A SHORTER PERIOD OF 1,345
32
LIMITATIONS, THE ATTORNEY GENERAL OR A SELF-INSURING EMPLOYER MAY 1,346
BRING AN ACTION TO ENFORCE THIS SECTION AT ANY TIME WITHIN SIX 1,347
YEARS AFTER THE CONDUCT IN VIOLATION OF THIS SECTION TERMINATES. 1,348
(E) THE AVAILABILITY OF REMEDIES UNDER THIS SECTION AND 1,351
SECTIONS 2913.48 AND 2923.31 TO 2923.36 OF THE REVISED CODE FOR 1,352
RECOVERING BENEFITS PAID ON BEHALF OF CLAIMANTS FOR MEDICAL
ASSISTANCE DOES NOT LIMIT THE AUTHORITY OF THE BUREAU OR A 1,353
SELF-INSURING EMPLOYER TO RECOVER EXCESS PAYMENTS MADE TO AN 1,354
OWNER, HEALTH CARE PROVIDER, OR MANAGED CARE ORGANIZATION UNDER 1,356
STATE AND FEDERAL LAW.
(F) AS USED IN THIS SECTION: 1,358
(1) "DECEPTION" MEANS ACTING WITH ACTUAL KNOWLEDGE OF, IN 1,360
DELIBERATE IGNORANCE OF, OR RECKLESS DISREGARD OF THE TRUTH OR 1,361
FALSITY OF, ANY REPRESENTATION OR INFORMATION IN ORDER TO DECEIVE 1,362
ANOTHER OR CAUSE ANOTHER TO BE DECEIVED BY MEANS OF ANY OF THE 1,363
FOLLOWING:
(a) A FALSE OR MISLEADING REPRESENTATION; 1,365
(b) THE WITHHOLDING OF INFORMATION; 1,367
(c) THE PREVENTING OF ANOTHER FROM ACQUIRING INFORMATION; 1,370
(d) ANY OTHER CONDUCT, ACT, OR OMISSION THAT CREATES, 1,373
CONFIRMS, OR PERPETUATES A FALSE IMPRESSION AS TO A FACT, THE
LAW, THE VALUE OF SOMETHING, OR A PERSON'S STATE OF MIND. 1,375
EXCEPT AS PROVIDED IN DIVISION (B)(3) OF THIS SECTION, FOR 1,379
PURPOSES OF THIS SECTION PROOF OF SPECIFIC INTENT TO DEFRAUD IS 1,380
NOT REQUIRED IN ORDER TO SHOW THAT AN OWNER, HEALTH CARE 1,381
PROVIDER, OR MANAGED CARE ORGANIZATION IS ENGAGING IN OR HAS 1,382
ENGAGED IN DECEPTION.
(2) "OWNER" MEANS ANY PERSON HAVING AT LEAST A FIVE PER 1,384
CENT OWNERSHIP INTEREST IN A HEALTH CARE PROVIDER OR MANAGED CARE 1,385
ORGANIZATION.
Sec. 4121.445. EACH HEALTH CARE PROVIDER AND MANAGED CARE 1,387
ORGANIZATION SHALL MAKE AT LEAST ONE COPY OF AN EMPLOYEE'S 1,388
MEDICAL RECORDS AND THE REPORT OF THE EMPLOYEE'S TREATING OR 1,389
CONSULTING PHYSICIAN AVAILABLE TO THE EMPLOYEE OR THE EMPLOYEE'S 1,390
33
REPRESENTATIVE UPON REQUEST AT A CHARGE NOT TO EXCEED FIFTEEN
CENTS PER PRINTED PAGE. 1,391
Sec. 4121.47. (A) No employer shall violate a specific 1,400
safety rule adopted by the administrator of workers' compensation 1,401
pursuant to section 4121.13 of the Revised Code or an act of the 1,403
general assembly to protect the lives, health, and safety of 1,404
employees pursuant to Section 35 of Article II, Ohio 1,405
Constitution. Chapter 4167. of the Revised Code and rules and 1,406
standards adopted thereunder UNDER THAT CHAPTER are not the rules 1,407
or enactment referred to in this division and shall not be 1,408
considered as such for purposes of this section. FOR PURPOSES OF 1,409
THIS SECTION, A SPECIFIC SAFETY RULE OF THE ADMINISTRATOR THAT 1,411
REFERS TO OR IS INTERPRETED AS APPLYING TO WORKSHOPS AND
FACTORIES SHALL NOT APPLY TO BUILDINGS OR STRUCTURES USED FOR 1,412
AGRICULTURAL PRODUCTION, OR TO ANY OF THE FIXTURES, MACHINERY, 1,413
EQUIPMENT, TOOLS, OR DEVICES UTILIZED IN THOSE BUILDINGS OR 1,414
STRUCTURES.
AS USED IN THIS DIVISION, "AGRICULTURAL PRODUCTION" MEANS 1,416
OPERATIONS UPON FARM PREMISES, INCLUDING THE PLANTING, 1,418
CULTIVATING, PRODUCING, GROWING, HARVESTING, DRYING, AND STORING
OF AGRICULTURAL OR HORTICULTURAL COMMODITIES AND PREPARATION FOR 1,419
MARKET OF THOSE COMMODITIES ON FARM PREMISES, THE RAISING OF 1,420
LIVESTOCK, FOR FOOD PRODUCTS, OR RACING PURPOSES, AND POULTRY ON 1,421
FARM PREMISES, AND ANY WORK PERFORMED INCIDENT TO OR IN 1,422
CONNECTION WITH THOSE FARM OPERATIONS. "AGRICULTURAL PRODUCTION" 1,423
DOES NOT INCLUDE THE COMMERCIAL PROCESSING, PACKING, DRYING, 1,424
STORING, OR CANNING OF THOSE COMMODITIES FOR MARKET, OR
COMMERCIAL TIMBER HARVESTING BY AN INDEPENDENT CONTRACTOR. 1,425
(B) If a staff hearing officer, in the course of his THE 1,427
HEARING OFFICER'S determination of a claim for an additional 1,428
award under Section 35 of Article II, Ohio Constitution, finds 1,429
the employer guilty of violating division (A) of this section, he 1,430
shall THE HEARING OFFICER, in addition to any award paid to the 1,431
claimant, SHALL issue an order to the employer to correct the 1,433
34
violation within the period of time he fixes FIXED BY THE HEARING 1,434
OFFICER. For any violation occurring within twenty-four months 1,435
of the last violation, the staff hearing officer shall assess 1,436
against the employer a civil penalty in an amount he THE HEARING 1,437
OFFICER determines up to a maximum of fifty thousand dollars for 1,439
each violation. In fixing the exact penalty, the staff hearing 1,440
officer shall base his THE decision upon the size of the employer 1,442
as measured by the number of employees, assets, and earnings of 1,443
the employer.
(C) An employer dissatisfied with the imposition of a 1,445
civil penalty pursuant to division (B) of this section may appeal 1,446
the staff hearing officer's decision, if the commission refuses 1,447
to hear the appeal under division (E) of section 4123.511 of the 1,448
Revised Code, or a decision of the commission, if the commission 1,449
hears the appeal under that division, to a court of common pleas 1,450
pursuant to the Rules of Civil Procedure. An appeal operates to 1,451
stay the payment of the fine pending the appeal. 1,452
(D) The administrator shall deposit all penalties 1,454
collected pursuant to this section in the occupational safety 1,455
loan program fund established pursuant to section 4121.48 of the 1,456
Revised Code. 1,457
(E) INVESTIGATIVE REPORTS OF VIOLATIONS OF SPECIFIC SAFETY 1,459
RULES SHALL BE AVAILABLE TO THE EMPLOYER THAT IS THE SUBJECT OF 1,460
AN INVESTIGATION AND A CLAIMANT THAT IS INJURED BECAUSE OF AN 1,461
ALLEGED VIOLATION THAT IS THE SUBJECT OF THAT INVESTIGATION. 1,462
Sec. 4121.61. (A) The administrator of workers' 1,471
compensation, with the advice and consent of the workers' 1,473
compensation oversight commission, shall adopt rules, INCLUDING 1,474
RULES DESCRIBED IN DIVISION (B) OF THIS SECTION, take measures, 1,475
and make expenditures as it THE ADMINISTRATOR deems necessary to 1,476
aid claimants who have sustained compensable injuries or incurred 1,477
compensable occupational diseases pursuant to Chapter 4123., 1,478
4127., or 4131. of the Revised Code to return to work or to 1,479
assist in lessening or removing any resulting handicap.
35
(B) THE ADMINISTRATOR SHALL ADOPT RULES UNDER THIS SECTION 1,481
ESTABLISHING CRITERIA GOVERNING DETERMINATIONS REGARDING THE 1,482
PROVISION OF REHABILITATION SERVICES, COUNSELING, OR TRAINING TO 1,483
EMPLOYEES OF BOTH STATE FUND AND SELF-INSURING EMPLOYERS. THE 1,484
INDUSTRIAL COMMISSION SHALL ESTABLISH RULES REGARDING A HEARING 1,485
PROCEDURE TO GOVERN DISPUTES BETWEEN A CLAIMANT AND A 1,486
SELF-INSURING EMPLOYER REGARDING THE PROVISION OF REHABILITATION 1,487
SERVICES, COUNSELING, OR TRAINING.
Sec. 4121.67. The administrator of workers' compensation, 1,495
with the advice and consent of the workers' compensation 1,497
oversight commission, shall adopt rules: 1,498
(A) For the encouragement of reemployment of claimants who 1,500
have successfully completed prescribed rehabilitation programs by 1,501
payment from the surplus fund established by section 4123.34 of 1,502
the Revised Code to employers who employ or reemploy the 1,503
claimants. The period or periods of payments shall not exceed 1,504
six months in the aggregate, unless the administrator or his THE 1,505
ADMINISTRATOR'S designee determines that the claimant will be 1,506
benefited by an extension of payments. 1,507
(B) Requiring payment, in the same manner as living 1,509
maintenance payments are made pursuant to section 4121.63 of the 1,510
Revised Code, to the claimant who completes a rehabilitation 1,511
training program and returns to employment, but who suffers a 1,512
wage loss compared to the wage the claimant was receiving at the 1,513
time of injury. Payments per week shall be sixty-six and 1,514
two-thirds per cent of the difference, if any, between the 1,515
claimant's weekly wage at the time of injury and the weekly wage 1,516
received while employed, up to a maximum payment per week equal 1,517
to the statewide average weekly wage. The payments may continue 1,518
for up to a maximum of two hundred weeks but shall be reduced by 1,519
the corresponding number of weeks in which the claimant receives 1,520
payments pursuant to division (B)(C) of section 4123.56 of the 1,521
Revised Code. 1,522
(C) PROVIDING INCENTIVES FOR EMPLOYERS TO REEMPLOY THEIR 1,524
36
EMPLOYEES WHO HAVE SUCCESSFULLY COMPLETED PRESCRIBED 1,525
REHABILITATION PROGRAMS. THESE INCENTIVES MAY INCLUDE, BUT ARE 1,526
NOT LIMITED TO, ALTERNATIVE RATING PLANS AND PREMIUM REDUCTION 1,527
PLANS.
Sec. 4123.01. As used in this chapter: 1,536
(A)(1) "Employee" means: 1,538
(a) Every person in the service of the state, or of any 1,540
county, municipal corporation, township, or school district 1,541
therein, including regular members of lawfully constituted police 1,542
and fire departments of municipal corporations and townships, 1,543
whether paid or volunteer, and wherever serving within the state 1,544
or on temporary assignment outside thereof, and executive 1,545
officers of boards of education, under any appointment or 1,546
contract of hire, express or implied, oral or written, including 1,547
any elected official of the state, or of any county, municipal 1,548
corporation, or township, or members of boards of education; 1,549
(b) Every person in the service of any person, firm, or 1,551
private corporation, including any public service corporation, 1,552
that (i) employs one or more persons regularly in the same 1,553
business or in or about the same establishment under any contract 1,554
of hire, express or implied, oral or written, including aliens 1,555
and minors, household workers who earn one hundred sixty dollars 1,556
or more in cash in any calendar quarter from a single household 1,557
and casual workers who earn one hundred sixty dollars or more in 1,558
cash in any calendar quarter from a single employer, or (ii) is 1,559
bound by any such contract of hire or by any other written 1,560
contract, to pay into the state insurance fund the premiums 1,561
provided by this chapter. 1,562
(c) Every person who performs labor or provides services 1,565
pursuant to a construction contract, as defined in section 1,566
4123.79 of the Revised Code, if at least ten of the following
criteria apply:
(i) The person is required to comply with instructions 1,569
from the other contracting party regarding the manner or method 1,570
37
of performing services;
(ii) The person is required by the other contracting party 1,573
to have particular training;
(iii) The person's services are integrated into the 1,576
regular functioning of the other contracting party; 1,577
(iv) The person is required to perform the work 1,579
personally;
(v) The person is hired, supervised, or paid by the other 1,581
contracting party;
(vi) A continuing relationship exists between the person 1,584
and the other contracting party that contemplates continuing or 1,585
recurring work even if the work is not full time; 1,586
(vii) The person's hours of work are established by the 1,589
other contracting party;
(viii) The person is required to devote full time to the 1,592
business of the other contracting party;
(ix) The person is required to perform the work on the 1,595
premises of the other contracting party;
(x) The person is required to follow the order of work set 1,598
by the other contracting party;
(xi) The person is required to make oral or written 1,601
reports of progress to the other contracting party; 1,602
(xii) The person is paid for services on a regular basis 1,605
such as hourly, weekly, or monthly;
(xiii) The person's expenses are paid for by the other 1,607
contracting party;
(xiv) The person's tools and materials are furnished by 1,610
the other contracting party;
(xv) The person is provided with the facilities used to 1,612
perform services;
(xvi) The person does not realize a profit or suffer a 1,615
loss as a result of the services provided;
(xvii) The person is not performing services for a number 1,618
of employers at the same time;
38
(xviii) The person does not make the same services 1,620
available to the general public; 1,621
(xix) The other contracting party has a right to discharge 1,624
the person;
(xx) The person has the right to end the relationship with 1,627
the other contracting party without incurring liability pursuant 1,628
to an employment contract or agreement. 1,629
Every person in the service of any independent contractor 1,631
or subcontractor who has failed to pay into the state insurance 1,632
fund the amount of premium determined and fixed by the 1,633
administrator of workers' compensation for the person's 1,634
employment or occupation or if a self-insuring employer has 1,635
failed to pay compensation and benefits directly to the 1,636
employer's injured and to the dependents of the employer's killed 1,637
employees as required by section 4123.35 of the Revised Code, 1,639
shall be considered as the employee of the person who has entered 1,640
into a contract, whether written or verbal, with such independent 1,641
contractor unless such employees or their legal representatives 1,642
or beneficiaries elect, after injury or death, to regard such 1,643
independent contractor as the employer.
(2) "Employee" does not mean: 1,645
(a) A duly ordained, commissioned, or licensed minister or 1,647
assistant or associate minister of a church in the exercise of 1,648
ministry; or 1,649
(b) Any officer of a family farm corporation; OR 1,651
(c) AN INDIVIDUAL WHO SIGNS THE WAIVER AND AFFIDAVIT 1,653
PROVIDED FOR IN SECTION 4123.15 OF THE REVISED CODE, PROVIDED 1,654
THAT THE ADMINISTRATOR HAS GRANTED A WAIVER AND EXCEPTION TO THE 1,655
INDIVIDUAL'S EMPLOYER UNDER THAT SECTION.
Any employer may elect to include as an "employee" within 1,657
this chapter, any person excluded from the definition of 1,658
"employee" pursuant to division (A)(2) of this section. If an 1,659
employer is a partnership, sole proprietorship, or family farm 1,660
corporation, such employer may elect to include as an "employee" 1,661
39
within this chapter, any member of such partnership, the owner of 1,662
the sole proprietorship, or the officers of the family farm 1,663
corporation. In the event of an election, the employer shall 1,664
serve upon the bureau of workers' compensation written notice 1,665
naming the persons to be covered, include such employee's 1,666
remuneration for premium purposes in all future payroll reports, 1,667
and no person excluded from the definition of "employee" pursuant 1,668
to division (A)(2) of this section, proprietor, or partner shall 1,669
be deemed an employee within this division until the employer has 1,670
served such notice. 1,671
For informational purposes only, the bureau shall prescribe 1,673
such language as it considers appropriate, on such of its forms 1,674
as it considers appropriate, to advise employers of their right 1,675
to elect to include as an "employee" within this chapter a sole 1,676
proprietor, any member of a partnership, the officers of a family 1,677
farm corporation, or a person excluded from the definition of 1,678
"employee" under division (A)(2)(a) of this section, that they 1,679
should check any health and disability insurance policy, or other 1,680
form of health and disability plan or contract, presently 1,681
covering them, or the purchase of which they may be considering, 1,682
to determine whether such policy, plan, or contract excludes 1,683
benefits for illness or injury that they might have elected to 1,684
have covered by workers' compensation. 1,685
(B) "Employer" means: 1,687
(1) The state, including state hospitals, each county, 1,689
municipal corporation, township, school district, and hospital 1,690
owned by a political subdivision or subdivisions other than the 1,691
state; 1,692
(2) Every person, firm, and private corporation, including 1,694
any public service corporation, that (a) has in service one or 1,695
more employees regularly in the same business or in or about the 1,696
same establishment under any contract of hire, express or 1,697
implied, oral or written, or (b) is bound by any such contract of 1,698
hire or by any other written contract, to pay into the insurance 1,699
40
fund the premiums provided by this chapter. 1,700
All such employers are subject to this chapter. Any member 1,702
of a firm or association, who regularly performs manual labor in 1,703
or about a mine, factory, or other establishment, including a 1,704
household establishment, shall be considered an employee in 1,705
determining whether such person, firm, or private corporation, or 1,706
public service corporation, has in its service, one or more 1,707
employees and the employer shall report the income derived from 1,708
such labor to the bureau as part of the payroll of such employer, 1,709
and such member shall thereupon be entitled to all the benefits 1,710
of an employee. 1,711
(C) "Injury" includes any injury, whether caused by 1,713
external accidental means or accidental in character and result, 1,714
received in the course of, and arising out of, the injured 1,715
employee's employment. "Injury" does not include: 1,716
(1) Psychiatric conditions except where the conditions 1,718
have arisen from an injury or occupational disease; 1,719
(2) Injury, IMPAIRMENT, or disability caused primarily by 1,722
the natural deterioration of tissue, an organ, or part of the 1,723
body;
(3) Injury, IMPAIRMENT, or disability incurred in 1,725
voluntary participation in an employer-sponsored recreation or 1,727
fitness activity if the employee signs a waiver of the employee's 1,728
right to compensation or benefits under this chapter prior to 1,729
engaging in the recreation or fitness activity; 1,730
(4) A CONDITION, IMPAIRMENT, OR DISEASE PROCESS THAT 1,734
PRE-EXISTED AN INJURY UNLESS THAT PRE-EXISTING CONDITION OR
IMPAIRMENT IS SUBSTANTIALLY WORSENED OR THAT DISEASE PROCESS IS 1,735
SUBSTANTIALLY ACCELERATED BY AN INJURY AS DOCUMENTED BY OBJECTIVE 1,736
CLINICAL FINDINGS AND TEST RESULTS, AND SUBJECTIVE COMPLAINTS 1,737
WITHOUT THESE FINDINGS AND RESULTS ARE INSUFFICIENT TO ESTABLISH 1,738
A COMPENSABLE INJURY AS DESCRIBED IN DIVISION (C)(4) OF THIS 1,740
SECTION;
(5) INJURY, IMPAIRMENT, OR DISABILITY RESULTING FROM 1,742
41
CUMULATIVE OR REPETITIVE TRAUMA. 1,743
(D) "Child" includes a posthumous child and a child 1,745
legally adopted prior to the injury. 1,746
(E) "Family farm corporation" means a corporation founded 1,748
for the purpose of farming agricultural land in which the 1,749
majority of the voting stock is held by and the majority of the 1,750
stockholders are persons or the spouse of persons related to each 1,751
other within the fourth degree of kinship, according to the rules 1,752
of the civil law, and at least one of the related persons is 1,753
residing on or actively operating the farm, and none of whose 1,754
stockholders are a corporation. A family farm corporation does 1,755
not cease to qualify under this division where, by reason of any 1,756
devise, bequest, or the operation of the laws of descent or 1,757
distribution, the ownership of shares of voting stock is 1,758
transferred to another person, as long as that person is within 1,759
the degree of kinship stipulated in this division. 1,760
(F) "Occupational disease" means a disease contracted in 1,762
the course of employment, which by its causes and the 1,763
characteristics of its manifestation or the condition of the 1,764
employment results in a hazard which distinguishes the employment 1,765
in character from employment generally, and the employment 1,766
creates a risk of contracting the disease in greater degree and 1,767
in a different manner from the public in general, INCLUDING A 1,768
DISEASE OR CONDITION THAT RESULTS FROM A CUMULATIVE OR REPETITIVE 1,770
TRAUMA, THAT IS CONTRACTED IN THE COURSE OF EMPLOYMENT, THAT 1,772
RESULTS IN DAMAGE OR HARM TO THE PHYSICAL STRUCTURE OF THE BODY, 1,773
AND THAT IS DUE TO CAUSES AND CONDITIONS THAT ARE CHARACTERISTIC 1,774
OF OR PECULIAR TO A PARTICULAR INDUSTRIAL PROCESS, TRADE, OR 1,775
OCCUPATION. "OCCUPATIONAL DISEASE" DOES NOT INCLUDE ANY OF THE 1,776
FOLLOWING:
(1) A DISEASE OR CONDITION TO WHICH THE GENERAL PUBLIC IS 1,778
EXPOSED OUTSIDE OF EMPLOYMENT ABSENT A SHOWING, BY A 1,779
PREPONDERANCE OF THE EVIDENCE, THAT THE DISEASE OR CONDITION IS 1,781
CHARACTERISTIC OF OR PECULIAR TO A PARTICULAR INDUSTRIAL PROCESS, 1,783
42
TRADE, OR OCCUPATION;
(2) A DISEASE OR CONDITION THAT WOULD HAVE ARISEN WITHOUT 1,785
THE OCCUPATIONAL EXPOSURE; 1,786
(3) A DISEASE OR CONDITION THAT RESULTS FROM AGGRAVATION 1,788
OF A PRE-EXISTING DISEASE, CONDITION, OR DISEASE PROCESS; 1,789
(4) A DISEASE OR CONDITION CAUSED PRIMARILY BY THE NATURAL 1,791
DETERIORATION OF THE TISSUE, ORGANS, OR OTHER PARTS OF THE BODY; 1,792
(5) PSYCHIATRIC CONDITIONS, EXCEPT WHERE THE CONDITIONS 1,794
HAVE ARISEN FROM AN OCCUPATIONAL DISEASE. 1,796
(G) "Self-insuring employer" means any of the following 1,798
categories of employers if granted the privilege of paying 1,799
compensation and benefits directly under section 4123.35 of the 1,800
Revised Code: 1,801
(1) Any employer mentioned in division (B)(2) of this 1,803
section; 1,804
(2) A board of county hospital trustees; 1,806
(3) A publicly owned utility. 1,808
Sec. 4123.032. Every emergency management worker shall, 1,817
with respect to the performance of his THE WORKER'S duties as 1,819
such AN emergency management worker, SHALL be in the employment 1,822
of the state or political subdivision for purposes of sections
4123.01 to 4123.94 of the Revised Code, and every emergency 1,823
management worker or, in case of death, his THE EMERGENCY 1,824
MANAGEMENT WORKER'S dependents shall be entitled to the benefits 1,825
payable on account of total disability OR IMPAIRMENT, loss of 1,826
member, or death as accorded by such sections to employees 1,828
covered by its THEIR provisions. No payment for such disability 1,830
OR IMPAIRMENT, loss of member, or death shall be made unless a 1,831
claim is filed within one year of the date of the accidental 1,832
injury causing the total disability OR IMPAIRMENT, loss of 1,833
member, or death. If an injury claim is filed within the said 1,835
THAT one-year period and the claimant subsequently dies, his THE 1,837
EMERGENCY MANAGEMENT WORKER'S dependents shall file any death 1,839
claim based on such injury within six months after the death or
43
be forever barred. 1,840
Sec. 4123.033. Any emergency management worker who suffers 1,849
an accidental injury while performing emergency management 1,850
duties, as defined herein, shall be compensated for any total 1,852
disability, IMPAIRMENT, or loss of member and his THE WORKER'S 1,853
dependents shall be compensated for any death resulting from such 1,854
an injury on the same basis as provided for workers, employees, 1,855
and their dependents under sections 4123.01 to 4123.94 of the 1,856
Revised Code. 1,857
This section shall not apply in the case of any person who 1,859
is otherwise entitled, under sections 4123.01 to 4123.94 of the 1,860
Revised Code, to receive workers' compensation benefits for such 1,861
accidental injury or death. 1,862
Sec. 4123.061. ANY RECORDS, FILES, PLEADINGS, OR DOCUMENTS 1,865
GENERATED BY A CLAIMANT'S ATTORNEY WITH RESPECT TO A CLIENT IN A 1,866
WORKERS' COMPENSATION CLAIM ARE THE PROPERTY OF THAT CLIENT. 1,867
UPON THE CLIENT'S REQUEST, THE ATTORNEY SHALL CONVEY TO THE 1,868
CLIENT COPIES OF ALL RECORDS, FILES, PLEADINGS, AND DOCUMENTS 1,869
RELATING TO THE CLIENT'S WORKERS' COMPENSATION CLAIM NO LATER 1,870
THAN FIFTEEN DAYS AFTER THE CLIENT'S REQUEST.
Sec. 4123.07. The administrator of the bureau of workers' 1,879
compensation shall prepare and furnish blank forms of application 1,880
for benefits or compensation from the state insurance fund, 1,881
reports of injury, disability, IMPAIRMENT, or occupational 1,883
disease, notices to employers and employees, proofs of injury, 1,884
disease, disability, IMPAIRMENT, or death, proofs of medical 1,886
attendance and hospital and nursing care, and proofs of 1,887
employment and wage earnings, and other necessary blanks, and 1,888
shall provide in his THE ADMINISTRATOR'S rules for their 1,889
preparation and distribution so that they may be readily
available and so prepared that the furnishing of information 1,890
required of any person with respect to any aspect of a claim 1,891
shall not be delayed by a requirement that information with 1,892
respect to another aspect of such claim shall be furnished on the 1,893
44
form by the same or another person. Insured employers shall keep 1,894
on hand a sufficient supply of such blanks. 1,895
Sec. 4123.15. (A) AN EMPLOYER WHO IS A MEMBER OF A 1,897
RECOGNIZED RELIGIOUS SECT OR DIVISION OF A RECOGNIZED RELIGIOUS 1,898
SECT AND WHO IS AN ADHERENT OF ESTABLISHED TENETS OR TEACHINGS OF 1,900
THAT SECT OR DIVISION BY REASON OF WHICH THE EMPLOYER IS
CONSCIENTIOUSLY OPPOSED TO ACCEPTANCE OF THE BENEFITS OF ANY 1,901
PUBLIC OR PRIVATE INSURANCE THAT MAKES PAYMENTS IN THE EVENT OF 1,902
DEATH, DISABILITY, IMPAIRMENT, OLD AGE, OR RETIREMENT OR MAKES 1,904
PAYMENTS TOWARD THE COST OF, OR PROVIDES SERVICES FOR, MEDICAL 1,905
BILLS, INCLUDING THE BENEFITS OF ANY INSURANCE SYSTEM ESTABLISHED
BY THE "SOCIAL SECURITY ACT," 42 U.S.C.A. 301, ET SEQ., MAY APPLY 1,907
TO THE ADMINISTRATOR OF WORKERS' COMPENSATION TO BE EXCEPTED FROM 1,908
PAYMENT OF PREMIUMS AND OTHER CHARGES ASSESSED UNDER THIS CHAPTER 1,909
AND CHAPTER 4121. OF THE REVISED CODE WITH RESPECT TO, OR IF THE 1,911
EMPLOYER IS A SELF-INSURING EMPLOYER, FROM PAYMENT OF DIRECT 1,912
COMPENSATION AND BENEFITS TO AND ASSESSMENTS REQUIRED BY THIS 1,913
CHAPTER AND CHAPTER 4121. OF THE REVISED CODE ON ACCOUNT OF, AN 1,914
INDIVIDUAL WHO MEETS THE REQUIREMENTS OF THIS SECTION. THE 1,915
APPLICATION SHALL BE ON FORMS PROVIDED BY THE BUREAU OF WORKERS' 1,916
COMPENSATION, WHICH FORMS MAY BE THOSE USED BY OR SIMILAR TO 1,917
THOSE USED BY THE INTERNAL REVENUE SERVICE FOR THE PURPOSE OF 1,918
GRANTING AN EXEMPTION FROM THE PAYMENT OF SOCIAL SECURITY TAXES 1,919
UNDER 26 U.S.C.A. 1402(g) OF THE INTERNAL REVENUE CODE, AND SHALL 1,921
INCLUDE A WRITTEN WAIVER, SIGNED BY THE INDIVIDUAL TO BE 1,922
EXCEPTED, OF ALL THE BENEFITS AND COMPENSATION PROVIDED FOR IN 1,923
THIS CHAPTER AND CHAPTER 4121. OF THE REVISED CODE. 1,925
THE APPLICATION ALSO SHALL INCLUDE AFFIDAVITS SIGNED BY THE 1,928
EMPLOYER AND THAT INDIVIDUAL THAT THE EMPLOYER AND THE INDIVIDUAL 1,929
ARE MEMBERS OF A RECOGNIZED RELIGIOUS SECT OR DIVISION OF A 1,930
RECOGNIZED RELIGIOUS SECT AND ARE ADHERENTS OF ESTABLISHED TENETS 1,932
OR TEACHINGS OF THAT SECT OR DIVISION BY REASON OF WHICH THE 1,933
EMPLOYER AND THE INDIVIDUAL ARE CONSCIENTIOUSLY OPPOSED TO
ACCEPTANCE OF THE BENEFITS OF ANY PUBLIC OR PRIVATE INSURANCE 1,935
45
THAT MAKES PAYMENTS IN THE EVENT OF DEATH, DISABILITY, 1,936
IMPAIRMENT, OLD AGE, OR RETIREMENT OR MAKES PAYMENTS TOWARD THE 1,937
COST OF, OR PROVIDES SERVICES FOR, MEDICAL BILLS, INCLUDING THE 1,938
BENEFITS OF ANY INSURANCE SYSTEM ESTABLISHED BY THE "SOCIAL 1,940
SECURITY ACT," 42 U.S.C.A. 301, ET SEQ. IF THE INDIVIDUAL IS A 1,942
MINOR, THE GUARDIAN OF THE MINOR SHALL COMPLETE THE WAIVER AND 1,943
AFFIDAVIT REQUIRED BY THIS DIVISION.
(B) THE ADMINISTRATOR SHALL GRANT THE WAIVER AND EXCEPTION 1,946
TO THE EMPLOYER FOR A PARTICULAR INDIVIDUAL IF THE ADMINISTRATOR
FINDS THAT THE EMPLOYER AND THE INDIVIDUAL ARE MEMBERS OF A SECT 1,947
OR DIVISION HAVING THE ESTABLISHED TENETS OR TEACHINGS DESCRIBED 1,948
IN DIVISION (A) OF THIS SECTION, THAT IT IS THE PRACTICE, AND HAS 1,949
BEEN FOR A SUBSTANTIAL NUMBER OF YEARS, FOR MEMBERS OF THAT SECT 1,950
OR DIVISION OF THAT SECT TO MAKE PROVISION FOR THEIR DEPENDENT 1,951
MEMBERS WHICH IN THE ADMINISTRATOR'S JUDGMENT IS REASONABLE IN 1,952
VIEW OF THEIR GENERAL LEVEL OF HIRING, AND THAT THAT SECT OR 1,953
DIVISION OF THAT SECT HAS BEEN IN EXISTENCE AT ALL TIMES SINCE 1,954
DECEMBER 31, 1950. 1,955
(C) A WAIVER AND EXCEPTION UNDER DIVISION (B) OF THIS 1,958
SECTION IS EFFECTIVE ON THE DATE THE ADMINISTRATOR GRANTS THE 1,959
WAIVER AND EXCEPTION. AN EMPLOYER WHO COMPLIES WITH THIS CHAPTER 1,960
AND THE EMPLOYER'S EMPLOYEES, WITH RESPECT TO AN INDIVIDUAL FOR 1,961
WHOM THE ADMINISTRATOR GRANTS THE WAIVER AND EXCEPTION, ARE 1,962
ENTITLED, AS TO THAT INDIVIDUAL AND AS TO ALL INJURIES AND 1,963
OCCUPATIONAL DISEASES OF THAT INDIVIDUAL THAT OCCURRED PRIOR TO 1,964
THE EFFECTIVE DATE OF THE WAIVER AND EXCEPTION, TO THE 1,965
PROTECTIONS OF SECTIONS 4123.74 AND 4123.741 OF THE REVISED CODE. 1,966
ON AND AFTER THE EFFECTIVE DATE OF THE WAIVER AND EXCEPTION, THE 1,967
EMPLOYER IS NOT LIABLE FOR THE PAYMENT OF ANY PREMIUMS OR OTHER 1,968
CHARGES ASSESSED UNDER THIS CHAPTER OR CHAPTER 4121. OF THE 1,969
REVISED CODE, OR IF THE INDIVIDUAL IS A SELF-INSURING EMPLOYER, 1,970
THE EMPLOYER IS NOT LIABLE FOR THE PAYMENT OF ANY COMPENSATION OR 1,971
BENEFITS DIRECTLY OR OTHER CHARGES ASSESSED UNDER THIS CHAPTER OR 1,972
CHAPTER 4121. OF THE REVISED CODE, IN REGARD TO THAT INDIVIDUAL, 1,974
46
IS CONSIDERED A COMPLYING EMPLOYER UNDER THOSE CHAPTERS, AND THE 1,975
EMPLOYER AND THE EMPLOYER'S EMPLOYEES ARE ENTITLED TO THE 1,976
PROTECTIONS OF SECTIONS 4123.74 AND 4123.741 OF THE REVISED CODE, 1,977
AS TO THAT INDIVIDUAL, AND AS TO INJURIES AND OCCUPATIONAL 1,978
DISEASES OF THAT INDIVIDUAL THAT OCCUR ON AND AFTER THE EFFECTIVE 1,979
DATE OF THE WAIVER AND EXCEPTION. 1,980
(D) A WAIVER AND EXCEPTION GRANTED IN REGARD TO A SPECIFIC 1,983
INDIVIDUAL IS VALID FOR ALL FUTURE YEARS UNLESS THE ADMINISTRATOR 1,984
DETERMINES THAT THE EMPLOYER, INDIVIDUAL, OR SECT OR DIVISION
CEASES TO MEET THE REQUIREMENTS OF THIS SECTION. IF THE 1,985
ADMINISTRATOR MAKES THIS DETERMINATION, THE EMPLOYER IS LIABLE 1,986
FOR THE PAYMENT OF PREMIUMS AND OTHER CHARGES ASSESSED UNDER THIS 1,987
CHAPTER AND CHAPTER 4121. OF THE REVISED CODE, OR IF THE 1,989
INDIVIDUAL IS A SELF-INSURING EMPLOYER, THE EMPLOYER IS LIABLE 1,990
FOR THE PAYMENT OF COMPENSATION AND BENEFITS DIRECTLY AND OTHER 1,991
CHARGES ASSESSED UNDER THOSE CHAPTERS, IN REGARD TO THAT 1,992
INDIVIDUAL FOR ALL INJURIES AND OCCUPATIONAL DISEASES OF THAT 1,993
INDIVIDUAL THAT OCCUR ON AND AFTER THE DATE OF THE 1,994
ADMINISTRATOR'S DETERMINATION AND THE INDIVIDUAL IS ENTITLED TO 1,995
ALL OF THE BENEFITS AND COMPENSATION PROVIDED IN THOSE CHAPTERS 1,996
FOR AN INJURY OR OCCUPATIONAL DISEASE THAT OCCURS ON OR AFTER THE 1,997
DATE OF THE ADMINISTRATOR'S DETERMINATION.
Sec. 4123.25. (A) No employer shall KNOWINGLY 2,006
misrepresent to the bureau of workers' compensation the amount OR 2,007
CLASSIFICATION of payroll upon which the premium under this 2,009
chapter is based. Whoever violates this division shall be liable 2,010
to the state in FOR UP TO ten times the amount of the difference 2,012
in BETWEEN THE premium paid and the amount the employer should 2,013
have paid. THE ADMINISTRATOR OF WORKERS' COMPENSATION, WITH THE 2,014
ADVICE AND CONSENT OF THE WORKERS' COMPENSATION OVERSIGHT 2,015
COMMISSION, SHALL ADOPT RULES IN ACCORDANCE WITH CHAPTER 119. OF 2,016
THE REVISED CODE FOR THE ASSESSMENT OF A FINE OR PENALTY AGAINST 2,017
AN EMPLOYER FOR A VIOLATION OF THIS DIVISION. The liability to 2,018
the state under this division shall MAY be enforced in a civil 2,019
47
action in the name of the state, and all sums collected under 2,020
this division shall be paid into the state insurance fund. 2,021
(B) No self-insuring employer shall misrepresent the 2,023
amount of paid compensation paid by such employer for purposes of 2,024
the assessments provided under this chapter and Chapter 4121. of 2,025
the Revised Code as required by section 4123.35 of the Revised 2,026
Code. Whoever violates this division is liable to the state in 2,027
an amount assessed by the self-insuring employers evaluation 2,028
board ADMINISTRATOR pursuant to division (C)(B) of section 2,030
4123.352 of the Revised Code or UP TO ten times the amount of the 2,031
difference between the assessment paid and the amount of the 2,032
assessment that should have been paid along with any other 2,033
penalty as determined by the board. The liability to the state 2,034
under this division may be enforced in a civil action in the name 2,035
of the state and all sums collected under this division shall be 2,036
paid into the self-insurance assessment fund created pursuant to 2,037
division (J) of section 4123.35 of the Revised Code. 2,038
Sec. 4123.27. Information contained in the annual 2,046
statement provided for in section 4123.26 of the Revised Code, 2,047
and such other information as may be furnished to the bureau of 2,048
workers' compensation by employers in pursuance of that section, 2,049
is OR AS THE BUREAU DEVELOPS OR CREATES, AND RECORDS KEPT BY THE 2,051
DIVISION OF SAFETY AND HYGIENE PERTAINING TO WORKPLACE INJURIES 2,052
AND ILLNESSES OR OCCUPATIONAL SAFETY AND HEALTH CONDITIONS IN 2,053
SPECIFIC WORKPLACES, INCLUDING, BUT NOT LIMITED TO, INDUSTRIAL 2,054
HYGIENE REPORTS, ERGONOMIC SURVEY REPORTS, TEAM APPROACH REPORTS, 2,055
SAFETY CONSULTANT REPORTS, ACCIDENT INVESTIGATION REPORTS, LOSS 2,056
CONTROL ANALYSIS REPORTS, AND ILLNESS AND INJURY DATA PERTAINING 2,057
TO SPECIFIC WORKPLACES, ARE for the exclusive use and information 2,058
of the bureau in the discharge of its official duties, and shall 2,059
not be open to the public nor be used in any court in any action 2,060
or proceeding pending therein unless the bureau is a party to the 2,061
action or proceeding; but the information contained in the 2,062
statement may be tabulated and published by the bureau in 2,063
48
statistical form for the use and information of other state 2,064
departments and the public. No person in the employ of the 2,065
bureau, except those who are authorized by the administrator of 2,066
workers' compensation, shall divulge any information secured by 2,067
him THE PERSON while in the employ of the bureau in respect to 2,068
the transactions, property, claim files, records, or papers of 2,071
the bureau or in respect to the business or mechanical, chemical, 2,073
or other industrial process of any company, firm, corporation, 2,074
person, association, partnership, or public utility to any person 2,075
other than the administrator or to the superior of such employee
of the bureau. 2,076
Notwithstanding the restrictions imposed by this section, 2,078
the governor, select or standing committees of the general 2,079
assembly, the auditor of state, the attorney general, or their 2,080
designees, pursuant to the authority granted in this chapter and 2,081
Chapter 4121. of the Revised Code, may examine any records, claim 2,082
files, or papers in possession of the industrial commission or 2,083
the bureau. They also are bound by the privilege that attaches 2,084
to these papers. 2,085
The administrator shall report to the director of human 2,087
services or to the county director of human services the name, 2,088
address, and social security number or other identification 2,089
number of any person receiving workers' compensation whose name 2,090
or social security number or other identification number is the 2,091
same as that of a person required by a court or child support 2,092
enforcement agency to provide support payments to a recipient of 2,093
public assistance, and whose name is submitted to the 2,094
administrator by the director under section 5101.36 of the 2,095
Revised Code. The administrator also shall inform the director 2,096
of the amount of workers' compensation paid to the person during 2,097
such period as the director specifies. 2,098
Within fourteen days after receiving from the director of 2,100
human services a list of the names and social security numbers of 2,101
recipients of public assistance pursuant to section 5101.181 of 2,102
49
the Revised Code, the administrator shall inform the auditor of 2,103
state of the name, current or most recent address, and social 2,104
security number of each person receiving workers' compensation 2,105
pursuant to this chapter whose name and social security number 2,106
are the same as that of a person whose name or social security 2,107
number was submitted by the director. The administrator also 2,109
shall inform the auditor of state of the amount of workers'
compensation paid to the person during such period as the 2,110
director specifies. 2,111
The bureau and its employees, except for purposes of 2,113
furnishing the auditor of state with information required by this 2,114
section, shall preserve the confidentiality of recipients of 2,115
public assistance in compliance with division (A) of section 2,116
5101.181 of the Revised Code. 2,117
For the purposes of this section, "public assistance" means 2,119
medical assistance provided through the medical assistance 2,120
program established under section 5111.01 of the Revised Code, 2,121
aid to dependent children provided under Chapter 5107. of the 2,122
Revised Code, or disability assistance provided under Chapter 2,123
5115. of the Revised Code. 2,124
Sec. 4123.28. Every employer in this state shall keep a 2,133
record of all injuries and occupational diseases, fatal or 2,134
otherwise, received or contracted by his THE EMPLOYER'S employees 2,136
in the course of their employment and resulting in seven days or 2,137
more of total disability OR IMPAIRMENT. Within a week after 2,138
acquiring knowledge of an injury or death therefrom, and in the 2,140
event of occupational disease or death therefrom, within one week 2,141
after acquiring knowledge of or diagnosis of or death from an 2,142
occupational disease or of a report to the employer of the 2,143
occupational disease or death, a report thereof shall be made in 2,144
writing to the bureau of workers' compensation upon blanks to be 2,145
procured from the bureau for that purpose. The report shall 2,146
state the name and nature of the business of the employer, the 2,147
location of his THE EMPLOYER'S establishment or place of work, 2,149
50
the name, address, nature and duration of occupation of the 2,150
injured, disabled, IMPAIRED, or deceased employee and the time, 2,152
the nature, and the cause of injury, occupational disease, or 2,153
death, and such other information as is required by the bureau. 2,154
The employer shall give a copy of each report to the 2,156
employee it concerns or his THE EMPLOYEE'S surviving dependents. 2,158
No employer shall refuse or neglect to make any report 2,160
required by this section. 2,161
Each day that an employer fails to file a report required 2,163
by this section constitutes an additional day within the time 2,164
period given to a claimant by the applicable statute of 2,165
limitations for the filing of a claim based on the injury or 2,166
occupational disease, provided that a failure to file a report 2,167
shall not extend the applicable statute of limitations for more 2,168
than two additional years. 2,169
Sec. 4123.34. The administrator of workers' compensation, 2,178
in the exercise of the powers and discretion conferred upon him 2,179
THE ADMINISTRATOR in section 4123.29 of the Revised Code, shall 2,180
fix and maintain, with the advice and consent of the workers' 2,183
compensation oversight commission, for each class of occupation 2,185
or industry, the lowest possible rates of premium consistent with 2,186
the maintenance of a solvent state insurance fund and the 2,187
creation and maintenance of a reasonable surplus, after the 2,188
payment of legitimate claims for injury, occupational disease, 2,189
and death that he THE ADMINISTRATOR authorizes to be paid from 2,190
the state insurance fund for the benefit of injured, diseased, 2,191
and the dependents of killed employees. In establishing rates, 2,192
the administrator shall take into account the necessity of 2,193
ensuring sufficient money is set aside in the premium payment 2,194
security fund to cover any defaults in premium obligations. The 2,195
administrator shall observe all of the following requirements in 2,196
fixing the rates of premium for the risks of occupations or 2,197
industries:
(A) He THE ADMINISTRATOR shall keep an accurate account of 2,199
51
the money paid in premiums by each of the several classes of 2,201
occupations or industries, and the losses on account of injuries, 2,202
occupational disease, and death of employees thereof, and also 2,203
keep an account of the money received from each individual 2,204
employer and the amount of losses incurred against the state 2,205
insurance fund on account of injuries, occupational disease, and 2,206
death of the employees of the employer. 2,207
(B) Ten per cent of the money paid into the state 2,209
insurance fund shall be set aside for the creation of a surplus 2,210
until the surplus amounts to the sum of one hundred thousand 2,211
dollars, after which time, whenever necessary in the judgment of 2,212
the administrator to guarantee a solvent state insurance fund, a 2,213
sum not exceeding five per cent of all the money paid into the 2,214
state insurance fund shall be credited to the surplus fund. A 2,215
revision of basic rates shall be made annually on the first day 2,216
of July. 2,217
Notwithstanding any provision of the law to the contrary, 2,219
one hundred eighty days after the effective date on which 2,220
self-insuring employers first may elect under division (D) of 2,221
section 4121.66 of the Revised Code to directly pay for 2,222
rehabilitation expenses, the administrator shall calculate the 2,223
deficit, if any, in the portion of surplus fund that is used for 2,224
reimbursement to self-insuring employers for all expenses other 2,225
than handicapped reimbursement under section 4123.343 of the 2,226
Revised Code. Without regard to whether a self-insuring employer 2,227
makes the election under division (D) of section 4121.66 of the 2,228
Revised Code, the administrator shall assess all self-insuring 2,229
employers the amount he THE ADMINISTRATOR determines necessary to 2,231
reduce the deficit over a period not to exceed five years from 2,232
the effective date of this amendment OCTOBER 20, 1993. After the 2,234
initial assessment, the administrator, from time to time, may 2,235
determine whether the surplus fund has such a deficit and may 2,237
assess all self-insuring employers who participated in the 2,238
portion of the surplus fund during the accrual of the deficit and 2,239
52
who during that time period have not made the election under 2,240
division (D) of section 4121.66 of the Revised Code the amount he 2,241
THE ADMINISTRATOR determines necessary to reduce the deficit. 2,242
Revisions of basic rates shall be in accordance with the 2,244
oldest four of the last five calendar years of the combined 2,245
accident and occupational disease experience of the administrator 2,246
in the administration of this chapter, as shown by the accounts 2,247
kept as provided in this section, EXCLUDING THE EXPERIENCE OF 2,248
EMPLOYERS THAT ARE NO LONGER ACTIVE IF THE ADMINISTRATOR 2,249
DETERMINES THAT THE INCLUSION OF THOSE EMPLOYERS WOULD HAVE A 2,250
SIGNIFICANT NEGATIVE IMPACT ON THE REMAINDER OF THE EMPLOYERS IN 2,251
A PARTICULAR MANUAL CLASSIFICATION; and the administrator shall 2,252
adopt rules, with the advice and consent of the oversight 2,254
commission, governing rate revisions, the object of which shall 2,255
be to make an equitable distribution of losses among the several 2,256
classes of occupation or industry, which rules shall be general 2,257
in their application.
(C) The administrator may apply that form of rating system 2,259
which he THE ADMINISTRATOR finds is best calculated to merit rate 2,261
or individually rate the risk more equitably, predicated upon the
basis of its individual industrial accident and occupational 2,262
disease experience, and may encourage and stimulate accident 2,263
prevention. The administrator shall develop fixed and equitable 2,264
rules controlling the rating system, which rules shall conserve 2,265
to each risk the basic principles of workers' compensation 2,266
insurance.
(D) The administrator, from the money paid into the state 2,268
insurance fund, shall set aside into an account of the state 2,269
insurance fund titled a premium payment security fund sufficient 2,270
money to pay for any premiums due from an employer and 2,271
uncollected that are in excess of the employer's premium security 2,274
deposit.
The fund shall be in the custody of the treasurer of state. 2,276
All investment earnings of the fund shall be deposited in the 2,277
53
fund. Disbursements from the fund shall be made by the bureau of 2,278
workers' compensation upon order of the administrator to the 2,279
state insurance fund. The use of the moneys held by the premium 2,280
payment security fund is restricted to reimbursement to the state 2,281
insurance fund of premiums due and uncollected in excess of an 2,282
employer's premium security deposit. The moneys constituting the 2,283
premium payment security fund shall be maintained without regard 2,284
to or reliance upon any other fund. This section does not 2,285
prevent the deposit or investment of the premium payment security 2,286
fund with any other fund created by this chapter, but the premium 2,287
payment security fund is separate and distinct for every other 2,288
purpose and a strict accounting thereof shall be maintained. 2,289
(E) The administrator may grant discounts on premium rates 2,291
for employers who meet either of the following requirements: 2,292
(1) Have not incurred a compensable injury for one year or 2,294
more and who maintain an employee safety committee or similar 2,295
organization or make periodic safety inspections of the 2,296
workplace. 2,297
(2) Successfully complete a loss prevention program 2,299
prescribed by the superintendent of the division of safety and 2,300
hygiene and conducted by the division or by any other person 2,301
approved by the superintendent. 2,302
(F)(1) In determining the premium rates for the 2,304
construction industry the administrator shall calculate the 2,305
employers' premiums based upon the actual remuneration 2,306
construction industry employees receive from construction 2,307
industry employers, provided that the amount of remuneration the 2,308
administrator uses in calculating the premiums shall not exceed 2,309
an average weekly wage equal to one hundred fifty per cent of the 2,310
statewide average weekly wage as defined in division (C) of 2,312
section 4123.62 of the Revised Code. 2,313
(2) Division (F)(1) of this section shall not be construed 2,315
as affecting the manner in which benefits to a claimant are 2,316
awarded under this chapter. 2,317
54
(3) As used in division (F) of this section, "construction 2,319
industry" includes any activity performed in connection with the 2,320
erection, alteration, repair, replacement, renovation, 2,321
installation, or demolition of any building, structure, highway, 2,322
or bridge. 2,323
Sec. 4123.343. This section shall be construed liberally 2,332
to the end that employers shall be encouraged to employ and 2,333
retain in their employment handicapped employees as defined in 2,334
this section. 2,335
(A) As used in this section, "handicapped employee" means 2,337
an employee who is afflicted with or subject to any physical or 2,338
mental impairment, or both, whether congenital or due to an 2,339
injury or disease of such character that the impairment 2,340
constitutes a handicap in obtaining employment or would 2,341
constitute a handicap in obtaining reemployment if the employee 2,342
should become unemployed and whose handicap is due to any of the 2,343
following diseases or conditions: 2,344
(1) Epilepsy; 2,346
(2) Diabetes; 2,348
(3) Cardiac disease; 2,350
(4) Arthritis; 2,352
(5) Amputated foot, leg, arm, or hand; 2,354
(6) Loss of sight of one or both eyes or a partial loss of 2,356
uncorrected vision of more than seventy-five per cent 2,357
bilaterally; 2,358
(7) Residual disability OR IMPAIRMENT from poliomyelitis; 2,360
(8) Cerebral palsy; 2,362
(9) Multiple sclerosis; 2,364
(10) Parkinson's disease; 2,366
(11) Cerebral vascular accident; 2,368
(12) Tuberculosis; 2,370
(13) Silicosis; 2,372
(14) Psycho-neurotic disability OR IMPAIRMENT following 2,374
treatment in a recognized medical or mental institution; 2,375
55
(15) Hemophilia; 2,377
(16) Chronic osteomyelitis; 2,379
(17) Ankylosis of joints; 2,381
(18) Hyper insulinism; 2,383
(19) Muscular dystrophies; 2,385
(20) Arterio-sclerosis; 2,387
(21) Thrombo-phlebitis; 2,389
(22) Varicose veins; 2,391
(23) Cardiovascular, pulmonary, or respiratory diseases of 2,393
a fire fighter or police officer employed by a municipal 2,394
corporation or township as a regular member of a lawfully 2,395
constituted police department or fire department; 2,396
(24) Coal miners' pneumoconiosis, commonly referred to as 2,398
"black lung disease"; 2,399
(25) Disability OR IMPAIRMENT with respect to which an 2,401
individual has completed a rehabilitation program conducted 2,402
pursuant to sections 4121.61 to 4121.69 of the Revised Code. 2,403
(B) Under the circumstances set forth in this section all 2,405
or such portion as the administrator determines of the 2,406
compensation and benefits paid in any claim arising hereafter 2,407
shall be charged to and paid from the statutory surplus fund 2,408
created under section 4123.34 of the Revised Code and only the 2,409
portion remaining shall be merit-rated or otherwise treated as 2,410
part of the accident or occupational disease experience of the 2,411
employer. If the employer is a self-insuring employer, the 2,412
proportion of such costs whether charged to the statutory surplus 2,413
fund in whole or in part shall be by way of direct payment to 2,414
such employee or his THE EMPLOYEE'S dependents or by way of 2,415
reimbursement to the self-insuring employer as the circumstances 2,417
indicate. The provisions of this section apply only in cases of 2,418
death, TEMPORARY total disability, whether temporary or permanent 2,420
TOTAL IMPAIRMENT, and all disabilities IMPAIRMENTS compensated 2,422
under division (B) of section 4123.57 of the Revised Code. The 2,423
administrator shall adopt rules specifying the grounds upon which 2,424
56
charges to the statutory surplus fund are to be made. The rules 2,425
shall prohibit as a grounds any agreement between employer and 2,426
claimant as to the merits of a claim and the amount of the 2,427
charge.
(C) Any employer who advises the bureau of workers' 2,429
compensation prior to the occurrence of an injury or occupational 2,430
disease that it has in its employ a handicapped employee is 2,431
entitled, in the event the person is injured, to a determination 2,432
under this section. Any employer who fails to notify the bureau 2,433
but applies for a determination under this section is entitled to 2,434
a determination if the bureau finds that there was good cause for 2,435
the failure to give notice of the employment of the handicapped 2,436
employee. The bureau annually shall require employers to file an 2,437
inventory of current handicapped employees. 2,438
An employer shall file an application for a determination 2,440
with the bureau or commission in the same manner as other claims. 2,441
An application only may be made in cases where IN WHICH a 2,442
handicapped employee or his THE HANDICAPPED EMPLOYEE'S dependents 2,444
claim or is ARE receiving an award of compensation as a result of 2,445
an injury OCCURRING or AN occupational disease occurring or 2,447
contracted FIRST DIAGNOSED BY A LICENSED PHYSICIAN on or after 2,448
the date on which division (A) of this section first included the 2,450
handicap of such employee.
(D) The circumstances under and the manner in which an 2,452
apportionment under this section shall be made are AS FOLLOWS: 2,453
(1) Whenever a handicapped employee is injured, IMPAIRED, 2,456
or disabled or dies as the result of an injury or occupational 2,457
disease sustained in the course of and arising out of his THE 2,458
EMPLOYEE'S employment in this state and the administrator awards 2,460
compensation therefor and when it appears to the satisfaction of 2,461
the administrator that the injury or occupational disease or the 2,462
death resulting therefrom would not have occurred but for the 2,463
pre-existing physical or mental impairment of the handicapped 2,464
employee, all compensation and benefits payable on account of the 2,465
57
disability, IMPAIRMENT, or death shall be paid from the surplus 2,467
fund.
(2) Whenever a handicapped employee is injured, IMPAIRED, 2,470
or disabled or dies as a result of an injury or occupational 2,471
disease and the administrator finds that the injury or 2,472
occupational disease would have been sustained or suffered 2,473
without regard to the employee's pre-existing impairment but that 2,474
the resulting IMPAIRMENT, disability, or death was caused at 2,476
least in part through aggravation of the employee's pre-existing 2,477
disability IMPAIRMENT, the administrator shall determine in a 2,479
manner that is equitable and, reasonable, and based upon medical 2,481
evidence the amount of disability, IMPAIRMENT, or proportion of 2,482
the cost of the death award that is attributable to the 2,483
employee's pre-existing disability IMPAIRMENT and the amount 2,484
found shall be charged to the statutory surplus fund. 2,486
(E) The benefits and provisions of this section apply only 2,488
to employers who have complied with this chapter either through 2,489
insurance with the state fund or as a self-insuring employer. 2,490
(F) No employer shall in any year SHALL receive credit 2,492
under this section in an amount greater than the premium he THE 2,493
EMPLOYER paid if a state fund employer or greater than his THE 2,495
EMPLOYER'S assessments if a self-insuring employer. 2,497
(G) Self-insuring employers may, for all claims made after 2,499
January 1, 1987, for compensation and benefits under this 2,500
section, MAY pay the compensation and benefits directly to the 2,501
employee or the employee's dependents. If such an employer 2,502
chooses to pay compensation and benefits directly, he THE 2,503
EMPLOYER shall receive no money or credit from the surplus fund 2,505
for the payment under this section, nor shall he THE EMPLOYER be 2,506
required to pay any amounts into the surplus fund that otherwise 2,508
would be assessed for handicapped reimbursements for claims made 2,509
after January 1, 1987. Where IF a self-insuring employer elects 2,510
to pay for compensation and benefits pursuant to this section, he 2,512
THE EMPLOYER shall assume responsibility for compensation and 2,514
58
benefits arising out of claims made prior to January 1, 1987, and 2,515
shall not be required to pay any amounts into the surplus fund 2,516
and may not receive any money or credit from that fund on account 2,517
of this section. The election made under this division is 2,518
irrevocable.
(H) An order issued by the administrator pursuant to this 2,520
section is appealable under section 4123.511 of the Revised Code 2,521
but is not appealable to court under section 4123.512 of the 2,522
Revised Code. 2,523
Sec. 4123.35. (A) Except as provided in this section, 2,532
every employer mentioned in division (B)(2) of section 4123.01 of 2,533
the Revised Code, and every publicly owned utility shall pay 2,534
semiannually in the months of January and July into the state 2,536
insurance fund the amount of annual premium the administrator of 2,537
workers' compensation fixes for the employment or occupation of 2,538
the employer, the amount of which premium to be paid by each 2,539
employer to be determined by the classifications, rules, and 2,540
rates made and published by the administrator. The employer
shall pay semiannually a further sum of money into the state 2,541
insurance fund as may be ascertained to be due from the employer 2,544
by applying the rules of the administrator, and a receipt or 2,545
certificate certifying that payment has been made shall be mailed 2,547
immediately to the employer by the bureau of workers'
compensation. The receipt or certificate is prima facie evidence 2,548
of the payment of the premium. 2,549
The bureau of workers' compensation shall verify with the 2,551
secretary of state the existence of all corporations and 2,552
organizations making application for workers' compensation 2,553
coverage and shall require every such application to include the 2,554
employer's federal identification number. 2,555
An employer as defined in division (B)(2) of section 2,557
4123.01 of the Revised Code who has contracted with a 2,558
subcontractor is liable for the unpaid premium due from any 2,559
subcontractor with respect to that part of the payroll of the 2,560
59
subcontractor that is for work performed pursuant to the contract 2,562
with the employer.
Division (A) of section 4123.35 of the Revised Code 2,564
providing for the payment of premiums semiannually does not apply 2,565
to any employer who was a subscriber to the state insurance fund 2,566
prior to January 1, 1914, or who may first become a subscriber to 2,567
the fund in any month other than January or July. Instead, the 2,568
semiannual premiums shall be paid by those employers from time to 2,569
time upon the expiration of the respective periods for which 2,570
payments into the fund have been made by them.
The administrator shall adopt rules to permit employers to 2,572
make periodic payments of the semiannual premium due under this 2,573
division. The rules shall include provisions for the assessment 2,574
of interest charges, where appropriate, and for the assessment of 2,575
penalties when an employer fails to make timely premium payments. 2,577
An employer who timely pays the amounts due under this division 2,578
is entitled to all of the benefits and protections of this 2,579
chapter. Upon receipt of payment, the bureau immediately shall 2,580
mail a receipt or certificate to the employer certifying that
payment has been made, which receipt is prima-facie evidence of 2,582
payment. Workers' compensation coverage under this chapter 2,583
continues uninterrupted upon timely receipt of payment under this 2,584
division.
Every employer mentioned in division (B)(1) of section 2,586
4123.01 of the Revised Code, except boards of county hospital 2,587
trustees that are self-insuring employers under this section, 2,588
shall comply with sections 4123.38 to 4123.41, and 4123.48 of the 2,590
Revised Code in regard to the contribution of moneys to the 2,591
public insurance fund. 2,592
(B) Provided, that employers mentioned in division (B)(2) 2,594
of section 4123.01 of the Revised Code, boards of county hospital 2,595
trustees, and publicly owned utilities who will abide by the 2,596
rules of the administrator and who may be of sufficient financial 2,597
ability to render certain the payment of compensation to injured 2,598
60
employees or the dependents of killed employees, and the 2,599
furnishing of medical, surgical, nursing, and hospital attention 2,600
and services and medicines, and funeral expenses, equal to or 2,601
greater than is provided for in sections 4123.52, 4123.55 to 2,602
4123.62, and 4123.64 to 4123.67 of the Revised Code, and who do 2,603
not desire to insure the payment thereof or indemnify themselves 2,604
against loss sustained by the direct payment thereof, upon a 2,605
finding of such facts by the administrator, may be granted the 2,606
privilege to pay individually compensation, and furnish medical, 2,608
surgical, nursing, and hospital services and attention and 2,609
funeral expenses directly to injured employees or the dependents 2,610
of killed employees, thereby being granted status as a 2,612
self-insuring employer. The administrator may charge employers, 2,613
boards of county hospital trustees, or publicly owned utilities 2,614
who apply for the status as a self-insuring employer a reasonable 2,615
application fee to cover the bureau's costs in connection with 2,616
processing and making a determination with respect to an 2,617
application. All employers granted such status shall demonstrate 2,618
sufficient financial and administrative ability to assure that 2,619
all obligations under this section are promptly met. The 2,620
administrator shall deny the privilege where the employer is 2,621
unable to demonstrate the employer's ability to promptly meet all 2,622
the obligations imposed on the employer by this section. The 2,623
administrator shall consider, but is not limited to, the 2,625
following factors, where applicable, in determining the
employer's ability to meet all of the obligations imposed on the 2,626
employer by this section: 2,627
(1) The employer employs a minimum of five hundred 2,629
employees in this state; 2,630
(2) The employer has operated in this state for a minimum 2,632
of two years, provided that an employer who has purchased, 2,633
acquired, or otherwise succeeded to the operation of a business, 2,634
or any part thereof, situated in this state that has operated for 2,635
at least two years in this state, also shall qualify; 2,636
61
(3) Where the employer previously contributed to the state 2,638
insurance fund or is a successor employer as defined by bureau 2,639
rules, the amount of the buy-out, as defined by bureau rules; 2,640
(4) The sufficiency of the employer's assets located in 2,642
this state to insure the employer's solvency in paying 2,643
compensation directly; 2,644
(5) The financial records, documents, and data, certified 2,646
by a certified public accountant, necessary to provide the 2,647
employer's full financial disclosure. The records, documents, 2,648
and data include, but are not limited to, balance sheets and 2,649
profit and loss history for the current year and previous four 2,650
years. 2,651
(6) The employer's organizational plan for the 2,653
administration of the workers' compensation law; 2,654
(7) The employer's proposed plan to inform employees of 2,656
the change from a state fund insurer to a self-insuring employer, 2,657
the procedures the employer will follow as a self-insuring 2,658
employer, and the employees' rights to compensation and benefits; 2,659
and 2,660
(8) The employer has either an account in a financial 2,662
institution in this state, or if the employer maintains an 2,663
account with a financial institution outside this state, ensures 2,664
that workers' compensation checks are drawn from the same account 2,665
as payroll checks or the employer clearly indicates that payment 2,666
will be honored by a financial institution in this state. 2,667
The administrator may waive the requirements of divisions 2,669
(B)(1) and (2) of this section and the requirement of division 2,670
(B)(5) of this section that the financial records, documents, and 2,671
data be certified by a certified public accountant. The 2,672
administrator shall adopt rules establishing the criteria that an 2,673
employer shall meet in order for the administrator to waive the 2,674
requirement of division (B)(5) of this section. Such rules may 2,675
require additional security of that employer pursuant to division 2,676
(E) of section 4123.351 of the Revised Code. The administrator 2,677
62
shall not grant the status of self-insuring employer to any 2,678
public employer, other than publicly owned utilities and boards 2,679
of county hospital trustees. 2,680
(C) The administrator shall require a surety bond from all 2,682
self-insuring employers, issued pursuant to section 4123.351 of 2,683
the Revised Code, that is sufficient to compel, or secure to 2,684
injured employees, or to the dependents of employees killed, the 2,685
payment of compensation and expenses, which shall in no event be 2,686
less than that paid or furnished out of the state insurance fund 2,687
in similar cases to injured employees or to dependents of killed 2,688
employees whose employers contribute to the fund, except when an 2,689
employee of the employer, who has suffered the loss of a hand, 2,690
arm, foot, leg, or eye prior to the injury for which compensation 2,691
is to be paid, and thereafter suffers the loss of any other of 2,692
the members as the result of any injury sustained in the course 2,693
of and arising out of the employee's employment, the compensation 2,695
to be paid by the self-insuring employer is limited to the
disability OR IMPAIRMENT suffered in the subsequent injury, 2,696
additional compensation, if any, to be paid by the bureau out of 2,698
the surplus created by section 4123.34 of the Revised Code. 2,699
(D) In addition to the requirements of this section, the 2,701
administrator shall make and publish rules governing the manner 2,702
of making application and the nature and extent of the proof 2,703
required to justify a finding of fact by the administrator as to 2,704
granting the status of a self-insuring employer, which rules 2,705
shall be general in their application, one of which rules shall 2,706
provide that all self-insuring employers shall pay into the state 2,707
insurance fund such amounts as are required to be credited to the 2,708
surplus fund in division (B) of section 4123.34 of the Revised 2,709
Code. 2,710
Employers shall secure directly from the bureau central 2,712
offices application forms upon which the bureau shall stamp a 2,713
designating number. Prior to submission of an application, an 2,714
employer shall make available to the bureau, and the bureau shall 2,715
63
review, the information described in divisions (B)(1) to (8) of 2,716
this section. An employer shall file the completed application 2,717
forms with an application fee, which shall cover the costs of 2,718
processing the application, as established by the administrator, 2,719
by rule, with the bureau at least ninety days prior to the 2,720
effective date of the employer's new status as a self-insuring 2,721
employer. The application form is not deemed complete until all 2,722
the required information is attached thereto. The bureau shall 2,723
only accept applications that contain the required information. 2,724
(E) The bureau shall review completed applications within 2,726
a reasonable time. If the bureau determines to grant an employer 2,727
the status as a self-insuring employer, the bureau shall issue a 2,728
statement, containing its findings of fact, that is prepared by 2,729
the bureau and signed by the administrator. If the bureau 2,730
determines not to grant the status as a self-insuring employer, 2,731
the bureau shall notify the employer of the determination and 2,732
require the employer to continue to pay its full premium into the 2,733
state insurance fund. The administrator also shall adopt rules 2,734
establishing a minimum level of performance as a criterion for 2,735
granting and maintaining the status as a self-insuring employer 2,736
and fixing time limits beyond which failure of the self-insuring 2,737
employer to provide for the necessary medical examinations and 2,738
evaluations may not delay a decision on a claim. 2,739
(F) The administrator shall adopt rules setting forth 2,741
procedures for auditing the program of self-insuring employers. 2,742
The bureau shall conduct the audit upon a random basis or 2,743
whenever the bureau has grounds for believing that an employer is 2,744
not in full compliance with bureau rules or this chapter. 2,745
The administrator shall monitor the programs conducted by 2,747
self-insuring employers, to ensure compliance with bureau 2,748
requirements and for that purpose, shall develop and issue to 2,749
self-insuring employers standardized forms for use by the 2,750
employer in all aspects of the employers' direct compensation 2,751
program and for reporting of information to the bureau. 2,752
64
The bureau shall receive and transmit to the employer all 2,754
complaints concerning any self-insuring employer. In the case of 2,755
a complaint against a self-insuring employer, the administrator 2,756
shall handle the complaint through the self-insurance division of 2,757
the bureau. The bureau shall maintain a file by employer of all 2,758
complaints received that relate to the employer. The bureau 2,759
shall evaluate each complaint and take appropriate action. 2,760
The administrator shall adopt as a rule a prohibition 2,762
against any self-insuring employer from harassing, dismissing, or 2,763
otherwise disciplining any employee making a complaint, which 2,764
rule shall provide for a financial penalty to be levied by the 2,765
administrator payable by the offending employer. 2,766
(G) For the purpose of making determinations as to whether 2,768
to grant status as a self-insuring employer, the administrator 2,769
may subscribe to and pay for a credit reporting service that 2,770
offers financial and other business information about individual 2,771
employers. The costs in connection with the bureau's 2,772
subscription or individual reports from the service about an 2,773
applicant may be included in the application fee charged 2,774
employers under this section. 2,775
(H) The administrator, notwithstanding other provisions of 2,778
this chapter, may permit a self-insuring employer to resume 2,779
payment of premiums to the state insurance fund with appropriate 2,780
credit modifications to the employer's basic premium rate as such 2,781
rate is determined pursuant to section 4123.29 of the Revised 2,782
Code.
(I) On the first day of July of each year, the 2,784
administrator shall calculate separately each self-insuring 2,785
employer's assessments for the safety and hygiene fund, 2,786
administrative costs pursuant to section 4123.342 of the Revised 2,787
Code, and for the portion of the surplus fund under division (B) 2,788
of section 4123.34 of the Revised Code that is not used for 2,789
handicapped reimbursement, on the basis of the paid compensation 2,790
attributable to the individual self-insuring employer according 2,791
65
to the following calculation: 2,792
(1) The total assessment against all self-insuring 2,794
employers as a class for each fund and for the administrative 2,795
costs for the year that the assessment is being made, as 2,796
determined by the administrator, divided by the total amount of 2,797
paid compensation for the previous calendar year attributable to 2,798
all amenable self-insuring employers; 2,799
(2) Multiply the quotient in division (I)(1) of this 2,801
section by the total amount of paid compensation for the previous 2,802
calendar year that is attributable to the individual 2,803
self-insuring employer for whom the assessment is being 2,804
determined. Each self-insuring employer shall pay the assessment 2,805
that results from this calculation, unless the assessment 2,806
resulting from this calculation falls below a minimum assessment, 2,807
which minimum assessment the administrator shall determine on the 2,808
first day of July of each year with the advice and consent of the 2,809
workers' compensation oversight commission, in which event, the 2,810
self-insuring employer shall pay the minimum assessment. 2,811
In determining the total amount due for the total 2,813
assessment against all self-insuring employers as a class for 2,814
each fund and the administrative assessment, the administrator 2,815
shall reduce proportionately the total for each fund and 2,817
assessment by the amount of money in the self-insurance 2,818
assessment fund as of the date of the computation of the 2,819
assessment. 2,820
The administrator shall calculate the assessment for the 2,822
portion of the surplus fund under division (B) of section 4123.34 2,823
of the Revised Code that is used for handicapped reimbursement in 2,824
the same manner as set forth in divisions (I)(1) and (2) of this 2,825
section except that the administrator shall calculate the total 2,826
assessment for this portion of the surplus fund only on the basis 2,827
of those self-insuring employers that retain participation in the 2,828
handicapped reimbursement program and the individual 2,829
self-insuring employer's proportion of paid compensation shall be 2,830
66
calculated only for those self-insuring employers who retain 2,831
participation in the handicapped reimbursement program. The 2,832
administrator, as the administrator determines appropriate, may 2,834
determine the total assessment for the handicapped portion of the 2,835
surplus fund in accordance with sound actuarial principles. 2,836
The administrator shall calculate the assessment for the 2,838
portion of the surplus fund under division (B) of section 4123.34 2,839
of the Revised Code that under division (D) of section 4121.66 of 2,840
the Revised Code is used for rehabilitation costs in the same 2,841
manner as set forth in divisions (I)(1) and (2) of this section, 2,842
except that the administrator shall calculate the total 2,843
assessment for this portion of the surplus fund only on the basis 2,844
of those self-insuring employers who have not made the election 2,845
to make payments directly under division (D) of section 4121.66 2,846
of the Revised Code and an individual self-insuring employer's 2,847
proportion of paid compensation only for those self-insuring 2,848
employers who have not made that election. 2,849
An employer who no longer is a self-insuring employer in 2,851
this state or who no longer is operating in this state, shall 2,852
continue to pay assessments for administrative costs and for the 2,853
portion of the surplus fund under division (B) of section 4123.34 2,854
of the Revised Code that is not used for handicapped 2,855
reimbursement, based upon paid compensation attributable to 2,856
claims that occurred while the employer was a self-insuring 2,857
employer within this state. 2,858
(J) There is hereby created in the state treasury the 2,860
self-insurance assessment fund. All investment earnings of the 2,861
fund shall be deposited in the fund. The administrator shall use 2,862
the money in the self-insurance assessment fund only for 2,863
administrative costs as specified in section 4123.341 of the 2,864
Revised Code. 2,865
(K) Every self-insuring employer shall certify, in 2,867
affidavit form subject to the penalty for perjury, to the bureau 2,868
the amount of the self-insuring employer's paid compensation for 2,869
67
the previous calendar year. In reporting paid compensation paid 2,870
for the previous year, a self-insuring employer shall exclude 2,871
from the total amount of paid compensation any reimbursement the 2,872
employer receives in the previous calendar year from the surplus 2,873
fund pursuant to section 4123.512 of the Revised Code for any 2,874
paid compensation. The self-insuring employer also shall exclude 2,875
from the paid compensation reported any amount recovered under 2,876
section 4123.93 of the Revised Code and any amount that is 2,877
determined not to have been payable to or on behalf of a claimant 2,878
in any final administrative or judicial proceeding. The 2,879
self-insuring employer shall exclude such amounts from the paid 2,880
compensation reported in the reporting period subsequent to the 2,881
date the determination is made. The administrator shall adopt 2,882
rules, in accordance with Chapter 119. of the Revised Code, 2,883
establishing the date by which self-insuring employers must 2,884
submit such information and the amount of the assessments 2,885
provided for in division (I) of this section for employers who 2,886
have been granted self-insuring status within the last calendar 2,887
year. 2,888
The administrator shall include any assessment that remains 2,890
unpaid for previous assessment periods in the calculation and 2,891
collection of any assessments due under this division or division 2,892
(I) of this section. 2,893
(L) As used in this section, "paid compensation" means all 2,895
amounts paid by a self-insuring employer for living maintenance 2,896
benefits, all amounts for compensation paid pursuant to sections 2,897
4121.63, 4121.67, 4123.56, 4123.57, 4123.58, 4123.59, 4123.60, 2,898
and 4123.64 of the Revised Code, all amounts paid as wages in 2,899
lieu of such compensation, all amounts paid in lieu of such 2,900
compensation under a nonoccupational accident and sickness 2,901
program fully funded by the self-insuring employer, and all 2,902
amounts paid by a self-insuring employer for a violation of a 2,903
specific safety standard pursuant to Section 35 of Article II, 2,904
Ohio Constitution and section 4121.47 of the Revised Code. 2,905
68
(M) Should any section of this chapter or Chapter 4121. of 2,907
the Revised Code providing for self-insuring employers' 2,908
assessments based upon compensation paid be declared 2,909
unconstitutional by a final decision of any court, then that 2,910
section of the Revised Code declared unconstitutional shall 2,911
revert back to the section in existence prior to November 3, 2,912
1989, providing for assessments based upon payroll. 2,913
(N) The administrator may grant a self-insuring employer 2,915
the privilege to self-insure a construction project entered into 2,916
by the self-insuring employer that is scheduled for completion 2,917
within six years after the date the project begins, and the total 2,918
cost of which is estimated to exceed one hundred million dollars. 2,920
The administrator may waive such cost and time criteria and grant 2,921
a self-insuring employer the privilege to self-insure a
construction project regardless of the time needed to complete 2,922
the construction project and provided that the cost of the 2,923
construction project is estimated to exceed fifty million 2,924
dollars. A self-insuring employer who desires to self-insure a 2,926
construction project shall submit to the administrator an
application listing the dates the construction project is 2,927
scheduled to begin and end, the estimated cost of the 2,929
construction project, the contractors and subcontractors whose
employees are to be self-insured by the self-insuring employer, 2,930
the provisions of a safety program that is specifically designed 2,931
for the construction project, and a statement as to whether a 2,932
collective bargaining agreement governing the rights, duties, and 2,933
obligations of each of the parties to the agreement with respect 2,934
to the construction project exists between the self-insuring 2,935
employer and a labor organization. 2,936
A self-insuring employer may apply to self-insure the 2,938
employees of either of the following: 2,939
(1) All contractors and subcontractors who perform labor 2,941
or work or provide materials for the construction project; 2,942
(2) All contractors and, at the administrator's 2,944
69
discretion, a substantial number of all the subcontractors who 2,945
perform labor or work or provide materials for the construction 2,946
project.
Upon approval of the application, the administrator shall 2,948
mail a certificate granting the privilege to self-insure the 2,949
construction project to the self-insuring employer. The 2,950
certificate shall contain the name of the self-insuring employer 2,951
and the name, address, and telephone number of the self-insuring 2,952
employer's representatives who are responsible for administering
workers' compensation claims for the construction project. The 2,953
self-insuring employer shall post the certificate in a 2,954
conspicuous place at the site of the construction project. 2,955
The administrator shall maintain a record of the 2,957
contractors and subcontractors whose employees are covered under 2,958
the certificate issued to the self-insured employer. A 2,959
self-insuring employer immediately shall notify the administrator 2,960
when any contractor or subcontractor is added or eliminated from 2,961
inclusion under the certificate.
Upon approval of the application, the self-insuring 2,963
employer is responsible for the administration and payment of all 2,964
claims under this chapter and Chapter 4121. of the Revised Code 2,965
for the employees of the contractor and subcontractors covered 2,966
under the certificate who receive injuries or are killed in the 2,967
course of and arising out of employment on the construction 2,969
project, or who contract an occupational disease in the course of 2,970
employment on the construction project. For purposes of this
chapter and Chapter 4121. of the Revised Code, a claim that is 2,972
administered and paid in accordance with this division is
considered a claim against the self-insuring employer listed in 2,973
the certificate. A contractor or subcontractor included under 2,974
the certificate shall report to the self-insuring employer listed 2,975
in the certificate, all claims that arise under this chapter and 2,976
Chapter 4121. of the Revised Code in connection with the 2,978
construction project for which the certificate is issued. 2,979
70
A self-insuring employer who complies with this division is 2,981
entitled to the protections provided under this chapter and 2,982
Chapter 4121. of the Revised Code with respect to the employees 2,984
of the contractors and subcontractors covered under a certificate 2,985
issued under this division for death or injuries that arise out 2,986
of, or death, injuries, or occupational diseases that arise in
the course of, those employees' employment on that construction 2,988
project, as if the employees were employees of the self-insuring 2,989
employer, provided that the self-insuring employer also complies 2,990
with this section. No employee of the contractors and
subcontractors covered under a certificate issued under this 2,991
division shall be considered the employee of the self-insuring 2,992
employer listed in that certificate for any purposes other than 2,993
this chapter and Chapter 4121. of the Revised Code. Nothing in 2,994
this division gives a self-insuring employer authority to control 2,995
the means, manner, or method of employment of the employees of 2,996
the contractors and subcontractors covered under a certificate 2,997
issued under this division. 2,998
The contractors and subcontractors included under a 3,000
certificate issued under this division are entitled to the 3,001
protections provided under this chapter and Chapter 4121. of the 3,002
Revised Code with respect to the contractor's or subcontractor's 3,003
employees who are employed on the construction project which is 3,004
the subject of the certificate, for death or injuries that arise 3,005
out of, or death, injuries, or occupational diseases that arise 3,006
in the course of, those employees' employment on that 3,007
construction project.
The contractors and subcontractors included under a 3,009
certificate issued under this division shall identify in their 3,010
payroll records the employees who are considered the employees of 3,011
the self-insuring employer listed in that certificate for 3,012
purposes of this chapter and Chapter 4121. of the Revised Code, 3,014
and the amount that those employees earned for employment on the 3,015
construction project that is the subject of that certificate. 3,016
71
Notwithstanding any provision to the contrary under this chapter
and Chapter 4121. of the Revised Code, the administrator shall 3,019
exclude the payroll that is reported for employees who are 3,020
considered the employees of the self-insuring employer listed in
that certificate, and that the employees earned for employment on 3,021
the construction project that is the subject of that certificate, 3,022
when determining those contractors' or subcontractors' premiums 3,023
or assessments required under this chapter and Chapter 4121. of 3,024
the Revised Code. A self-insuring employer issued a certificate 3,025
under this division shall include in the amount of paid 3,026
compensation it reports pursuant to division (K) of this section, 3,027
the amount of paid compensation the self-insuring employer paid 3,028
pursuant to this division for the previous calendar year. 3,029
Nothing in this division shall be construed as altering the 3,031
rights of employees under this chapter and Chapter 4121. of the 3,032
Revised Code as those rights existed prior to the effective date 3,034
of this amendment SEPTEMBER 17, 1996. Nothing in this division 3,035
shall be construed as altering the rights devolved under sections 3,036
2305.31 and 4123.82 of the Revised Code as those rights existed 3,038
prior to the effective date of this amendment SEPTEMBER 17, 1996. 3,039
As used in this division, "privilege to self-insure a 3,041
construction project" means privilege to pay individually 3,042
compensation, and to furnish medical, surgical, nursing, and 3,043
hospital services and attention and funeral expenses directly to 3,044
injured employees or the dependents of killed employees. 3,045
(O) A self-insuring employer whose application is granted 3,047
under division (N) of this section shall designate a safety 3,048
professional to be responsible for the administration and 3,049
enforcement of the safety program that is specifically designed 3,050
for the construction project that is the subject of the 3,051
application.
A self-insuring employer whose application is granted under 3,053
division (N) of this section shall employ an ombudsperson for the 3,054
construction project that is the subject of the application. The 3,055
72
ombudsperson shall have experience in workers' compensation or 3,056
the construction industry, or both. The ombudsperson shall 3,057
perform all of the following duties:
(1) Communicate with and provide information to employees 3,059
who are injured in the course of, or whose injury arises out of 3,060
employment on the construction project, or who contract an 3,061
occupational disease in the course of employment on the 3,062
construction project;
(2) Investigate the status of a claim upon the request of 3,064
an employee to do so; 3,065
(3) Provide information to claimants, third party 3,067
administrators, employers, and other persons to assist those 3,068
persons in protecting their rights under this chapter and Chapter 3,069
4121. of the Revised Code. 3,070
A self-insuring employer whose application is granted under 3,072
division (N) of this section shall post the name of the safety 3,074
professional and the ombudsperson and instructions for contacting
the safety professional and the ombudsperson in a conspicuous 3,075
place at the site of the construction project. 3,076
(P) The administrator may consider all of the following 3,079
when deciding whether to grant a self-insuring employer the 3,080
privilege to self-insure a construction project as provided under 3,081
division (N) of this section: 3,082
(1) Whether the self-insuring employer has an 3,084
organizational plan for the administration of the workers' 3,085
compensation law; 3,086
(2) Whether the safety program that is specifically 3,088
designed for the construction project provides for the safety of 3,089
employees employed on the construction project, is applicable to 3,091
all contractors and subcontractors who perform labor or work or 3,092
provide materials for the construction project, and has a
component, a safety training program that complies with standards 3,093
adopted pursuant to the "Occupational Safety and Health Act of 3,094
1970," 84 Stat. 1590, 29 U.S.C.A. 651, and provides for 3,095
73
continuing management and employee involvement; 3,096
(3) Whether granting the privilege to self-insure the 3,098
construction project will reduce the costs of the construction 3,099
project; 3,100
(4) Whether the self-insuring employer has employed an 3,102
ombudsperson as required under division (O) of this section; 3,104
(5) Whether the self-insuring employer has sufficient 3,106
surety to secure the payment of claims for which the 3,107
self-insuring employer would be responsible pursuant to the 3,108
granting of the privilege to self-insure a construction project 3,109
under division (N) of this section. 3,111
Sec. 4123.352. (A) There is hereby created the 3,120
self-insuring employers evaluation board consisting of three 3,121
members. The member of the industrial commission representing 3,122
the public shall be a member of the self-insuring employers 3,123
evaluation board and shall serve, ex officio, as chairman 3,124
CHAIRPERSON. The governor shall appoint the remaining two 3,125
members with the advice and consent of the senate. One member 3,126
shall be a member of the Ohio self-insurance association and one 3,127
member shall be a representative of labor. Not more than two of 3,128
the three members of the board may be of the same political 3,129
party.
Of the two members originally appointed by the governor 3,131
pursuant to this section, one shall serve an initial term of two 3,132
years and one an initial term of four years. Thereafter, terms 3,133
of office of the two members are for four years, each term ending 3,134
on the same date as the original date of appointment. Any member 3,135
appointed to fill a vacancy occurring prior to the expiration of 3,136
the term for which his THE MEMBER'S predecessor was appointed 3,137
shall hold office for the remainder of such term. Any member 3,138
shall continue in office subsequent to the expiration date of his 3,139
THE MEMBER'S term until his A successor takes office, or until a 3,140
period of sixty days has elapsed, whichever occurs first. A 3,142
vacancy in an unexpired term shall be filled in the same manner 3,143
74
as the original appointment. The governor may remove any member 3,144
pursuant to section 3.05 of the Revised Code. 3,145
The board member who also is a member of the commission 3,147
shall receive no additional compensation but shall be reimbursed 3,148
for actual and necessary expenses in the performance of his THE 3,149
MEMBER'S duties AS A MEMBER OF THE BOARD. The two remaining 3,150
members of the board shall receive per diem compensation fixed 3,151
pursuant to division (J) of section 124.15 of the Revised Code 3,152
and actual and necessary expenses incurred in the performance of 3,153
their duties.
For administrative purposes, the board is a part of the 3,155
bureau of workers' compensation, and the bureau shall furnish the 3,156
board with necessary office space, staff, and supplies. The 3,157
board shall meet as required by the administrator of workers' 3,158
compensation. 3,159
(B) In addition to the grounds listed in section 4123.35 3,161
of the Revised Code pertaining to criteria for being granted the 3,162
status as a self-insuring employer, the grounds upon which the 3,163
administrator may ASSESS A FINE OR PENALTY AGAINST, OR revoke or 3,164
refuse to renew the SELF-INSURING status includes OF A 3,165
SELF-INSURING EMPLOYER INCLUDE failure to comply with any rules 3,166
or orders of the administrator or to pay contributions to the 3,168
self-insuring employers' guaranty fund established by section 3,169
4123.351 of the Revised Code, continued failure to file medical 3,170
reports bearing upon the injury of the claimant, and failure to 3,171
pay compensation or benefits in accordance with law in a timely 3,172
manner. A deficiency in any of the grounds listed in this 3,173
division is sufficient to justify the administrator's ASSESSMENT 3,174
OF A FINE OR PENALTY AGAINST A SELF-INSURING EMPLOYER, OR THE 3,175
revocation or refusal to renew the employer's status as a 3,176
self-insuring employer. THE ADMINISTRATOR, OR THE
ADMINISTRATOR'S DESIGNEE, SHALL HOLD A HEARING, AFTER NOTICE TO 3,177
THE SELF-INSURING EMPLOYER OF THE HEARING, BEFORE ASSESSING A 3,178
FINE OR PENALTY AGAINST A SELF-INSURING EMPLOYER OR REVOKING OR 3,179
75
REFUSING TO RENEW AN EMPLOYER'S STATUS AS A SELF-INSURING 3,180
EMPLOYER. The administrator need not ASSESS A FINE OR PENALTY 3,182
AGAINST A SELF-INSURING EMPLOYER, OR revoke or refuse to renew an 3,183
employer's status as a self-insuring employer if adequate 3,184
corrective action is taken by the employer pursuant to division 3,185
(C) of this section. THE ADMINISTRATOR, WITH THE ADVICE AND 3,186
CONSENT OF THE WORKERS' COMPENSATION OVERSIGHT COMMISSION, SHALL 3,187
ADOPT RULES IN ACCORDANCE WITH CHAPTER 119. OF THE REVISED CODE 3,190
FOR THE ASSESSMENT OF A FINE OR PENALTY UNDER THIS SECTION 3,191
AGAINST A SELF-INSURING EMPLOYER. ALL SUMS COLLECTED UNDER THIS 3,192
DIVISION SHALL BE PAID INTO THE SELF-INSURANCE ASSESSMENT FUND 3,193
CREATED PURSUANT TO DIVISION (J) OF SECTION 4123.35 OF THE 3,195
REVISED CODE. 3,196
(C) The administrator shall refer to the board all 3,198
complaints or allegations of misconduct against a self-insuring 3,199
employer or questions as to whether a self-insuring employer 3,200
continues to meet minimum standards. The board shall investigate 3,201
and may order the employer to take corrective action in 3,202
accordance with the schedule the board fixes. The board's 3,203
determination in this regard need not be made by formal hearing 3,204
but shall be issued in written form and contain the signature of 3,205
at least two board members. If the board determines, after A 3,207
SELF-INSURING EMPLOYER MAY APPEAL THE ADMINISTRATOR'S ASSESSMENT 3,208
OF A FINE OR PENALTY AGAINST A SELF-INSURING EMPLOYER, OR THE 3,209
REVOCATION OF OR REFUSAL TO RENEW THE SELF-INSURING STATUS OF A 3,210
SELF-INSURING EMPLOYER UNDER THIS SECTION, WITHIN THIRTY DAYS 3,211
AFTER RECEIPT OF NOTICE OF THE FINE, PENALTY, REVOCATION, OR 3,212
RENEWAL REFUSAL, TO THE SELF-INSURING EMPLOYERS EVALUATION BOARD. 3,213
THE FILING OF AN APPEAL SHALL STAY THE ADMINISTRATOR'S ORDER. 3,214
AFTER a hearing conducted pursuant to Chapter 119. of the Revised 3,215
Code and the rules of the bureau, that the employer has failed to 3,216
correct the deficiencies within the time fixed by the board or is 3,217
otherwise in violation of this chapter, the board shall recommend 3,219
to the administrator revocation of an employer's status as a
76
self-insuring employer or such other penalty which may include, 3,220
but is not limited to, probation, or a civil penalty not to 3,221
exceed ten thousand dollars for each failure. A board 3,222
recommendation to revoke an employer's status as a self-insuring 3,223
employer shall be by unanimous vote. A recommendation for any 3,224
other penalty shall be by majority vote. Where the board makes 3,225
recommendations to the administrator for disciplining a 3,226
self-insuring employer, the administrator promptly and fully 3,227
shall implement the recommendations AFFIRM OR VACATE THE 3,229
ASSESSMENT OF A FINE OR PENALTY AGAINST A SELF-INSURING EMPLOYER 3,230
BY MAJORITY VOTE OF THE BOARD. IF THE ADMINISTRATOR DECIDES TO 3,231
REVOKE OR REFUSE TO RENEW THE EMPLOYER'S STATUS AS A 3,232
SELF-INSURING EMPLOYER, THE BOARD'S DECISION TO AFFIRM THE 3,233
ADMINISTRATOR'S DECISION SHALL BE BY UNANIMOUS VOTE. 3,234
Sec. 4123.411. (A) For the purpose of carrying out 3,243
sections 4123.412 to 4123.418 of the Revised Code, the 3,244
administrator of workers' compensation, with the advice and 3,246
consent of the workers' compensation oversight commission, shall 3,247
levy an assessment against all employers at a rate, of at least 3,249
five but not to exceed ten cents per one hundred dollars of 3,250
payroll, such rate to be determined annually for each employer 3,251
group listed in divisions (A)(1) to (3) of this section, which 3,252
will produce an amount no greater than the amount the 3,253
administrator estimates to be necessary to carry out such 3,254
sections for the period for which the assessment is levied. In 3,255
the event the amount produced by the assessment is not sufficient 3,256
to carry out such sections the additional amount necessary shall 3,257
be provided from the income produced as a result of investments 3,258
made pursuant to section 4123.44 of the Revised Code. 3,259
Assessments shall be levied according to the following 3,261
schedule: 3,262
(1) Private fund employers, except self-insuring 3,264
employers--in January and July of each year upon gross payrolls 3,265
of the preceding six months; 3,266
77
(2) Counties and taxing district employers therein, except 3,268
county hospitals that are self-insuring employers--in January of 3,269
each year upon gross payrolls of the preceding twelve months; 3,270
(3) The state as an employer--in January, April, July, and 3,272
October of each year upon gross payrolls of the preceding three 3,273
months. 3,274
Amounts assessed in accordance with this section shall be 3,276
collected from each employer as prescribed in rules the 3,277
administrator adopts. 3,278
The moneys derived from the assessment provided for in this 3,280
section shall be credited to the disabled workers' relief fund 3,281
created by section 4123.412 of the Revised Code. The 3,282
administrator shall establish by rule classifications of 3,283
employers within divisions (A)(1) to (3) of this section and 3,284
shall determine rates for each class so as to fairly apportion 3,285
the costs of carrying out sections 4123.412 to 4123.418 of the 3,286
Revised Code. 3,287
(B) For all injuries and disabilities occurring on or 3,290
after January 1, 1987, AND FOR ALL INJURIES, IMPAIRMENTS, AND 3,291
DISABILITIES ARISING ON OR AFTER THE EFFECTIVE DATE OF THIS 3,292
AMENDMENT, the administrator, for the purposes of carrying out 3,294
sections 4123.412 to 4123.418 of the Revised Code, shall levy an 3,295
assessment against all employers at a rate per one hundred 3,296
dollars of payroll, such rate to be determined annually for each 3,297
classification of employer in each employer group listed in 3,298
divisions (A)(1) to (3) of this section, which will produce an
amount no greater than the amount the administrator estimates to 3,299
be necessary to carry out such sections for the period for which 3,300
the assessment is levied. 3,301
Amounts assessed in accordance with this division shall be 3,303
billed at the same time premiums are billed and credited to the 3,304
disabled workers' relief fund created by section 4123.412 of the 3,305
Revised Code. The administrator shall determine the rates for 3,306
each class in the same manner as he THE ADMINISTRATOR fixes the 3,307
78
rates for premiums pursuant to section 4123.29 of the Revised 3,309
Code.
(C) For a self-insuring employer, the bureau of workers' 3,311
compensation shall pay to employees who are participants 3,312
regardless of the date of injury, any amounts due to the 3,313
participants under section 4123.414 of the Revised Code and shall 3,314
bill the self-insuring employer, semiannually, for all amounts 3,315
paid to a participant. 3,316
Sec. 4123.412. For the relief of persons who are 3,325
permanently and totally disabled IMPAIRED as the result of injury 3,327
or disease sustained in the course of their employment and who 3,328
are receiving workers' compensation which is payable to them by 3,329
virtue of and under the laws of this state in amounts, the total 3,330
of which, when combined with disability benefits received 3,331
pursuant to the Social Security Act is less than three hundred 3,332
forty-two dollars per month adjusted annually as provided in 3,333
division (B) of section 4123.62 of the Revised Code, there is 3,334
hereby created a separate fund to be known as the disabled 3,335
workers' relief fund, which fund shall consist of the sums that 3,336
are from time to time appropriated by the general assembly and 3,337
made available to the order of the bureau of workers' 3,338
compensation to carry out the objects and purposes of sections 3,339
4123.412 to 4123.418 of the Revised Code. The fund shall be in 3,340
the custody of the treasurer of the state. Disbursements from 3,341
the fund shall be made by the bureau to those persons entitled to 3,342
participate therein and in amounts to each participant as is 3,343
provided in section 4123.414 of the Revised Code. All investment 3,344
earnings of the fund shall be credited to the fund. 3,345
Sec. 4123.413. To be eligible to participate in said THE 3,354
DISABLED WORKERS' RELIEF fund, a participant must be permanently 3,356
and totally disabled IMPAIRED and be receiving workers' 3,357
compensation payments, the total of which, when combined with 3,358
disability benefits received pursuant to The THE Social Security 3,359
Act is less than three hundred forty-two dollars per month 3,361
79
adjusted annually as provided in division (B) of section 4123.62 3,362
of the Revised Code.
Sec. 4123.414. Each person determined eligible, pursuant 3,371
to section 4123.413 of the Revised Code, to participate in the 3,372
disabled workers' relief fund is entitled to receive payments, 3,373
without application, from the fund of a monthly amount equal to 3,374
the lesser of the difference between three hundred forty-two 3,375
dollars, adjusted annually pursuant to division (B) of section 3,376
4123.62 of the Revised Code, and: 3,377
(1)(A) The amount he THE PERSON is receiving per month as 3,380
the disability monthly benefits award pursuant to The Social 3,382
Security Act; or
(2)(B) The amount he THE PERSON is receiving monthly under 3,385
the workers' compensation laws for permanent and total disability 3,387
IMPAIRMENT. In determining such difference, a participant shall 3,389
be considered as receiving the amount of such participant's 3,390
compensation which shall have been commuted under the provisions 3,391
of section 4123.64 of the Revised Code. Such payments shall be 3,392
made monthly during the period in which such participant is 3,393
permanently and totally disabled IMPAIRED. 3,394
Sec. 4123.416. The administrator of workers' compensation 3,403
shall promptly require of each employer who has elected to pay 3,404
compensation direct under the provisions of section 4123.35 of 3,405
the Revised Code SELF-INSURING EMPLOYER a verified list of the 3,406
names and addresses of all persons to whom the employer is paying 3,408
workers' compensation on account of permanent and total 3,409
disability IMPAIRMENT and the evidence respecting such persons as 3,411
the administrator reasonably deems necessary to determine the 3,412
eligibility of any such person to participate in the disabled 3,413
workers' relief fund. The superintendent of insurance shall 3,414
promptly require of each insurance company which is organized or 3,415
licensed to do business in this state and which has at any time 3,416
written workers' compensation insurance in this state a like 3,417
verified list and like evidence respecting persons to whom the 3,418
80
insurance companies are paying workers' compensation under the 3,419
Ohio workers' compensation laws and contracts of insurance in 3,420
respect thereof; and the superintendent of insurance shall 3,421
promptly transmit all such lists and evidence to the bureau of 3,422
workers' compensation. Any person claiming the right to 3,423
participate in the fund may file his AN application therefor with 3,424
the bureau and shall be accorded a hearing thereon. 3,425
Sec. 4123.419. The assessment rate established pursuant to 3,434
section 4123.411 of the Revised Code, subject to the limits set 3,435
forth in that section, shall be adequate to provide the amounts 3,436
estimated as necessary by the administrator of workers' 3,437
compensation to carry out the provisions of sections 4123.412 to 3,438
4123.418 of the Revised Code, and in addition to provide moneys 3,439
to reimburse the general revenue fund for moneys appropriated by 3,440
Section 2 of H.B. No. 1131 of the 103rd general assembly or by 3,441
the 104th and succeeding general assemblies for disabled OR 3,442
IMPAIRED workers' relief. When the additional moneys are 3,444
available in whole or part for the purpose of making the 3,445
reimbursement, the director of budget and management shall 3,446
certify the amount to the bureau of workers' compensation which 3,447
shall thereupon cause the moneys to be paid to the general 3,448
revenue fund from the disabled workers' relief fund except that 3,449
any amounts due because of the state's obligation as an employer 3,450
pursuant to section 4123.411 of the Revised Code and not paid to 3,451
the disabled workers' relief fund shall be deducted from any such 3,452
reimbursement.
Sec. 4123.511. (A) Within seven days after receipt of any 3,462
claim under this chapter, the bureau of workers' compensation
shall notify the claimant and the employer of the claimant of the 3,463
receipt of the claim and of the facts alleged therein. If the 3,464
bureau receives from a person other than the claimant written or 3,465
telecommunicated information indicating that an injury HAS 3,466
OCCURRED or AN occupational disease has occurred or been 3,467
contracted which THAT may be compensable under this chapter HAS 3,469
81
BEEN DIAGNOSED BY A LICENSED PHYSICIAN, the bureau shall notify 3,470
the employee and the employer of the information. If the 3,471
information is provided by any method of telecommunication, the 3,472
person providing the information shall provide written 3,473
verification of the information to the bureau according to 3,474
division (E) of section 4123.84 of the Revised Code. The receipt 3,475
of the information in writing, or if by a method of 3,476
telecommunications, the written verification, and the notice by 3,477
the bureau shall be considered an application for compensation 3,478
under section 4123.84 or 4123.85 of the Revised Code provided 3,479
that the conditions of division (E) of section 4123.84 of the 3,480
Revised Code apply to information provided by a method of 3,481
telecommunication. Upon receipt of a claim, the bureau shall 3,482
advise the claimant of the claim number assigned and the 3,483
claimant's right to representation in the processing of a claim 3,484
or to elect no representation. If the bureau determines that a 3,485
claim is determined to be a compensable lost time claim, the 3,486
bureau shall notify the claimant and the employer of the 3,487
availability of rehabilitation services. No bureau or industrial 3,488
commission employee shall directly or indirectly convey any 3,489
information in derogation of this right. This section shall in no 3,490
way abrogate the bureau's responsibility to aid and assist a 3,491
claimant in the filing of a claim and to advise the claimant of 3,492
the claimant's rights under the law.
The administrator of workers' compensation shall assign all 3,494
claims and investigations to the bureau service office from which 3,495
investigation and determination may be made most expeditiously. 3,496
The bureau shall investigate the facts concerning an injury 3,498
or occupational disease and ascertain such facts in whatever 3,499
manner is most appropriate and may obtain statements of the 3,500
employee, employer, attending physician, and witnesses in 3,501
whatever manner is most appropriate. 3,502
(B)(1) Except as provided in division (B)(2) of this 3,504
section, in claims other than those in which the employer is a 3,505
82
self-insuring employer, if the administrator determines under 3,506
division (A) of this section that a claimant is or is not 3,507
entitled to an award of compensation or benefits, the 3,508
administrator shall issue an order, no sooner than twenty-one 3,509
days but no later than twenty-eight days after the sending of the 3,511
notice under division (A) of this section, granting or denying 3,512
the payment of the compensation or benefits, or both as is 3,513
appropriate to the claimant. Notwithstanding the time limitation 3,514
specified in this division for the issuance of an order, if a 3,515
medical examination of the claimant is required by statute, the 3,516
administrator promptly shall schedule the claimant for that
examination and shall issue an order no later than twenty-eight 3,517
days after receipt of the report of the examination. The 3,518
administrator shall notify the claimant and the employer of the 3,520
claimant and their respective representatives in writing of the 3,521
nature of the order and the amounts of compensation and benefit 3,522
payments involved. The employer or claimant may appeal the order 3,523
pursuant to division (C) of this section within fourteen days 3,524
after the date of the receipt of the order. The employer and 3,525
claimant may waive, in writing, their rights to an appeal under 3,526
this division.
(2) Notwithstanding the time limitation specified in 3,528
division (B)(1) of this section for the issuance of an order, if 3,529
the employer certifies a claim for payment of compensation or 3,530
benefits, or both, to a claimant, and the administrator has 3,531
completed the investigation of the claim, the payment of benefits 3,533
or compensation, or both, as is appropriate, shall commence upon 3,534
the later of the date of the certification or completion of the 3,535
investigation and issuance of the order by the administrator, 3,536
provided that the administrator shall issue the order no later 3,537
than the time limitation specified in division (B)(1) of this 3,538
section. 3,539
(3) If an appeal is made under division (B)(1) or (2) of 3,541
this section, the administrator shall forward the claim file to 3,542
83
the appropriate district hearing officer within seven days of the 3,543
appeal. In contested claims other than state fund claims, the 3,544
administrator shall forward the claim within seven days of the 3,545
administrator's receipt of the claim to the commission, which 3,547
shall refer the claim to an appropriate district hearing officer 3,548
for a hearing in accordance with division (C) of this section. 3,549
(C) If an employer or claimant timely appeals the order of 3,551
the administrator issued under division (B) of this section or in 3,552
the case of other contested claims other than state fund claims, 3,553
the commission shall refer the claim to an appropriate district 3,554
hearing officer according to rules the commission adopts under 3,555
section 4121.36 of the Revised Code. The district hearing 3,556
officer shall notify the parties and their respective 3,557
representatives of the time and place of the hearing. 3,558
The district hearing officer shall hold a hearing on a 3,560
disputed issue or claim within forty-five days after the filing 3,562
of the appeal under this division and issue a decision within 3,563
seven days after holding the hearing. The district hearing 3,564
officer shall notify the parties and their respective
representatives in writing of the order. Any party may appeal an 3,566
order issued under this division pursuant to division (D) of this 3,567
section within fourteen days after receipt of the order under 3,568
this division. 3,569
(D) Upon the timely filing of an appeal of the order of 3,571
the district hearing officer issued under division (C) of this 3,572
section, the commission shall refer the claim file to an 3,573
appropriate staff hearing officer according to its rules adopted 3,574
under section 4121.36 of the Revised Code. The staff hearing 3,575
officer shall hold a hearing within forty-five days after the 3,576
filing of an appeal under this division and issue a decision 3,577
within seven days after holding the hearing under this division. 3,580
The staff hearing officer shall notify the parties and their 3,581
respective representatives in writing of his THE STAFF HEARING
OFFICER'S order. Any party may appeal an order issued under this 3,583
84
division pursuant to division (E) of this section within fourteen 3,584
days after receipt of the order under this division. 3,585
(E) Upon the filing of a timely appeal of the order of the 3,587
staff hearing officer issued under division (D) of this section, 3,588
the commission or a designated staff hearing officer, on behalf 3,589
of the commission, shall determine whether the commission will 3,591
hear the appeal. If the commission or the designated staff
hearing officer decides to hear the appeal, the commission or the 3,593
designated staff hearing officer shall notify the parties and 3,594
their respective representatives in writing of the time and place 3,595
of the hearing. The commission shall hold the hearing within 3,596
forty-five days after the filing of the notice of appeal and, 3,597
within seven days after the conclusion of the hearing, the 3,598
commission shall issue its order affirming, modifying, or 3,599
reversing the order issued under division (D) of this section. 3,600
The commission shall notify the parties and their respective 3,601
representatives in writing of the order. If the commission or 3,602
the designated staff hearing officer determines not to hear the 3,603
appeal, within fourteen days after the filing of the notice of 3,604
appeal, the commission or the designated staff hearing officer 3,605
shall issue an order to that effect and notify the parties and
their respective representatives in writing of that order. 3,606
Except as otherwise provided in this chapter and Chapters 3,608
4121., 4127., and 4131. of the Revised Code, any party may appeal 3,609
an order issued under this division to the court pursuant to 3,610
section 4123.512 of the Revised Code within sixty days after 3,611
receipt of the order, subject to the limitations contained in 3,612
that section. 3,613
(F) Every notice of an appeal from an order issued under 3,615
divisions (B), (C), (D), and (E) of this section shall state the 3,616
names of the claimant and employer, the number of the claim, the 3,617
date of the decision appealed from, and the fact that the 3,618
appellant appeals therefrom. 3,619
(G) All of the following apply to the proceedings under 3,621
85
divisions (C), (D), and (E) of this section: 3,622
(1) The parties shall proceed promptly and without 3,624
continuances except for good cause; 3,625
(2) The parties, in good faith, shall engage in the free 3,627
exchange of information relevant to the claim prior to the 3,628
conduct of a hearing according to the rules the commission adopts 3,629
under section 4121.36 of the Revised Code; 3,630
(3) The administrator is a party and may appear and 3,632
participate at all administrative proceedings on behalf of the 3,633
state insurance fund. However, in cases in which the employer is 3,634
represented, the administrator shall neither present arguments 3,635
nor introduce testimony that is cumulative to that presented or 3,636
introduced by the employer or the employer's representative. The 3,637
administrator may file an appeal under this section on behalf of
the state insurance fund; however, except in cases arising under 3,638
section 4123.343 of the Revised Code, the administrator only may 3,639
appeal questions of law or issues of fraud when the employer 3,640
appears in person or by representative.
(H) Except as provided in division (J) of this section, 3,642
payments of compensation to a claimant or on behalf of a claimant 3,643
as a result of any order issued under this chapter shall commence 3,644
upon the earlier of the following: 3,645
(1) Fourteen days after the date the administrator issues 3,647
an order under division (B) of this section, unless that order is 3,648
appealed; 3,649
(2) The date when the employer has waived the right to 3,651
appeal a decision issued under division (B) of this section; 3,652
(3) If no appeal of an order has been filed under this 3,654
section or to a court under section 4123.512 of the Revised Code, 3,655
the expiration of the time limitations for the filing of an 3,656
appeal of an order; 3,657
(4) The TWENTY-ONE DAYS AFTER THE date of receipt by the 3,659
employer of an order of a district hearing officer, a staff 3,660
hearing officer, or the industrial commission issued under 3,662
86
division (C), (D), or (E) of this section. 3,663
(I) No medical benefits payable under this chapter or 3,665
Chapter 4121., 4127., or 4131. of the Revised Code are payable 3,666
until the earlier of the following: 3,667
(1) The date of the issuance of the staff hearing 3,669
officer's order under division (D) of this section; 3,670
(2) The date of the final administrative or judicial 3,672
determination. 3,673
(J) Upon the final administrative or judicial 3,675
determination, if a claimant is found to have received 3,676
compensation to which the claimant was not entitled, the 3,678
claimant's employer, if a self-insuring employer, or the bureau, 3,679
shall withhold from any amount to which the claimant becomes 3,680
entitled pursuant to any claim, past, present, or future, under 3,681
Chapter 4121., 4123., 4127., or 4131. of the Revised Code, the 3,682
amount to which the claimant was not entitled pursuant to the 3,683
following criteria:
(1) No withholding for the first twelve weeks of temporary 3,685
total disability compensation pursuant to section 4123.56 of the 3,686
Revised Code shall be made; 3,687
(2) Forty per cent of all awards of compensation paid 3,689
pursuant to sections 4123.56 and 4123.57 of the Revised Code, 3,690
until the amount overpaid is refunded; 3,691
(3) Twenty-five per cent of any compensation paid pursuant 3,693
to section 4123.58 of the Revised Code until the amount overpaid 3,694
is refunded; 3,695
(4) If, pursuant to an appeal under section 4123.512 of 3,697
the Revised Code, the court of appeals or the supreme court 3,698
reverses the allowance of the claim, then no amount of any 3,699
compensation will be withheld. 3,700
(K) If a staff hearing officer or the commission fails to 3,702
issue a decision or the commission fails to refuse to hear an 3,703
appeal within the time periods required by this section, payments 3,704
to a claimant shall cease until the staff hearing officer or 3,705
87
commission issues a decision or hears the appeal, unless the 3,706
failure was due to the fault or neglect of the employer or the 3,707
employer agrees that the payments should continue for a longer 3,708
period of time. 3,709
(L) Except as provided in section 4123.522 of the Revised 3,711
Code, no appeal is timely filed under this section unless the 3,712
appeal is filed with the time limits set forth in this section. 3,713
(M) No person who is not an employee of the bureau or 3,715
commission or who is not by law given access to the contents of a 3,716
claims file shall have a file in the person's possession. 3,717
Sec. 4123.512. (A) The claimant or the employer may 3,727
appeal an order of the industrial commission made under division 3,728
(E) of section 4123.511 of the Revised Code in any injury or 3,729
occupational disease case, other than a decision as to the extent 3,730
of disability OR IMPAIRMENT, OR PERCENTAGE OF IMPAIRMENT 3,731
DETERMINED PURSUANT TO DIVISION (A) OF SECTION 4123.57 OF THE 3,732
REVISED CODE, to the court of common pleas of the county in which 3,735
the injury was inflicted or in which the contract of employment 3,736
was made if the injury occurred outside the state, or in which 3,737
the contract of employment was made if the exposure occurred 3,738
outside the state. If no common pleas court has jurisdiction for 3,739
the purposes of an appeal by the use of the jurisdictional 3,740
requirements described in this division, the appellant may use 3,741
the venue provisions in the Rules of Civil Procedure to vest 3,742
jurisdiction in a court. If the claim is for an occupational 3,743
disease the appeal shall be to the court of common pleas of the 3,744
county in which the exposure which caused the disease occurred. 3,745
Like appeal may be taken from an order of a staff hearing officer 3,746
made under division (D) of section 4123.511 of the Revised Code 3,747
from which the commission has refused to hear an appeal. The 3,748
appellant shall file the notice of appeal with a court of common 3,749
pleas within sixty days after the date of the receipt of the 3,750
order appealed from or the date of receipt of the order of the 3,751
commission refusing to hear an appeal of a staff hearing 3,752
88
officer's decision under division (D) of section 4123.511 of the 3,753
Revised Code. The filing of the notice of the appeal with the 3,754
court is the only act required to perfect the appeal.
If an action has been commenced in a court of a county 3,756
other than a court of a county having jurisdiction over the 3,757
action, the court, upon notice by any party or upon its own 3,758
motion, shall transfer the action to a court of a county having 3,759
jurisdiction. 3,760
Notwithstanding anything to the contrary in this section, 3,762
if the commission determines under section 4123.522 of the 3,763
Revised Code that an employee, employer, or their respective 3,764
representatives have not received written notice of an order or 3,765
decision which is appealable to a court under this section and 3,766
which grants relief pursuant to section 4123.522 of the Revised 3,767
Code, the party granted the relief has sixty days from receipt of 3,768
the order under section 4123.522 of the Revised Code to file a 3,769
notice of appeal under this section. 3,770
(B) The notice of appeal shall state the names of the 3,772
claimant and the employer, the number of the claim, the date of 3,773
the order appealed from, and the fact that the appellant appeals 3,774
therefrom. 3,775
The administrator, the claimant, and the employer shall be 3,777
parties to the appeal and the court, upon the application of the 3,778
commission, shall make the commission a party. The administrator 3,779
shall notify the employer that, if he THE EMPLOYER fails to 3,781
become an active party to the appeal, then the administrator may 3,783
act on behalf of the employer and the results of the appeal could 3,784
have an adverse effect upon the employer's premium rates. 3,785
(C) The attorney general or one or more of his THE 3,787
ATTORNEY GENERAL'S assistants or special counsel designated by 3,789
him THE ATTORNEY GENERAL shall represent the administrator and 3,791
the commission. In the event IF the attorney general or his THE 3,792
ATTORNEY GENERAL'S designated assistants or special counsel are 3,793
absent, the administrator or the commission shall select one or 3,794
89
more of the attorneys in the employ of the administrator or the 3,795
commission as his THE ADMINISTRATOR'S ATTORNEY or its THE 3,797
COMMISSION'S attorney in the appeal. Any attorney so employed 3,799
shall continue his THE representation during the entire period of 3,800
the appeal and in all hearings thereof except where the continued 3,801
representation becomes impractical.
(D) Upon receipt of notice of appeal the clerk of courts 3,803
shall provide notice to all parties who are appellees and to the 3,804
commission. 3,805
The claimant shall, within thirty days after the filing of 3,807
the notice of appeal, SHALL file a petition containing a 3,808
statement of facts in ordinary and concise language showing a 3,809
cause of action to participate or to continue to participate in 3,810
the fund and setting forth the basis for the jurisdiction of the 3,811
court over the action. Further pleadings shall be had in 3,812
accordance with the Rules of Civil Procedure, provided that 3,813
service of summons on such petition shall not be required. The 3,814
clerk of the court shall, upon receipt thereof, SHALL transmit by 3,815
certified mail a copy thereof to each party named in the notice 3,817
of appeal other than the claimant. Any party may file with the 3,818
clerk prior to the trial of the action a deposition of any 3,819
physician taken in accordance with the provisions of the Revised 3,820
Code, which deposition may be read in the trial of the action 3,821
even though the physician is a resident of or subject to service 3,822
in the county in which the trial is had. The bureau of workers' 3,823
compensation shall pay the cost of the deposition filed in court 3,824
and of copies of the deposition for each party from the surplus 3,825
fund and charge the costs thereof against the unsuccessful party 3,826
if the claimant's right to participate or continue to participate 3,827
is finally sustained or established in the appeal. In the event 3,828
the deposition is taken and filed, the physician whose deposition 3,829
is taken is not required to respond to any subpoena issued in the 3,830
trial of the action. The court, or the jury under the 3,831
instructions of the court, if a jury is demanded, shall determine 3,832
90
the right of the claimant to participate or to continue to 3,833
participate in the fund upon the evidence adduced at the hearing 3,834
of the action. 3,835
(E) The court shall certify its decision to the commission 3,837
and the certificate shall be entered in the records of the court. 3,838
Appeals from the judgment are governed by the law applicable to 3,839
the appeal of civil actions. 3,840
(F) The cost of any legal proceedings authorized by this 3,842
section, including an attorney's fee to the claimant's attorney 3,843
to be fixed by the trial judge, based upon the effort expended, 3,844
in the event the claimant's right to participate or to continue 3,845
to participate in the fund is established upon the final 3,846
determination of an appeal, shall be taxed against the employer 3,847
or the commission if the commission or the administrator rather 3,848
than the employer contested the right of the claimant to 3,849
participate in the fund. The attorney's fee shall not exceed 3,850
twenty-five hundred dollars. 3,851
(G) If the finding of the court or the verdict of the jury 3,853
is in favor of the claimant's right to participate in the fund, 3,854
the commission and the administrator shall thereafter proceed in 3,855
the matter of the claim as if the judgment were the decision of 3,856
the commission, subject to the power of modification provided by 3,857
section 4123.52 of the Revised Code. 3,858
(H) An appeal from an order issued under division (E) of 3,860
section 4123.511 of the Revised Code or any action filed in court 3,861
in a case in which an award of compensation has been made shall 3,862
not stay the payment of compensation under the award or payment 3,863
of compensation for subsequent periods of total disability OR 3,864
IMPAIRMENT during the pendency of the appeal. If, in a final 3,866
administrative or judicial action, it is determined that payments 3,867
of compensation or benefits, or both, made to or on behalf of a 3,868
claimant should not have been made, the amount thereof shall be 3,869
charged to the surplus fund under division (B) of section 4123.34 3,870
of the Revised Code. In the event the employer is a state risk, 3,871
91
the amount shall not be charged to the employer's experience. In 3,872
the event the employer is a self-insuring employer, the 3,873
self-insuring employer shall deduct the amount from the paid 3,874
compensation he reports to the administrator under division (K) 3,875
of section 4123.35 of the Revised Code. All actions and 3,876
proceedings under this section which are the subject of an appeal 3,877
to the court of common pleas or the court of appeals shall be 3,878
preferred over all other civil actions except election causes, 3,879
irrespective of position on the calendar. 3,880
This section applies to all decisions of the commission or 3,882
the administrator on November 2, 1959, and all claims filed 3,883
thereafter are governed by sections 4123.511 and 4123.512 of the 3,884
Revised Code. 3,885
Any action pending in common pleas court or any other court 3,887
on January 1, 1986, under this section is governed by former 3,888
sections 4123.514, 4123.515, 4123.516, and 4123.519 and section 3,889
4123.522 of the Revised Code. 3,890
Sec. 4123.52. The (A)(1) EXCEPT AS OTHERWISE PROVIDED IN 3,899
THIS SECTION, THE jurisdiction of the industrial commission and 3,901
the authority of the administrator of workers' compensation over 3,902
each case is continuing, and the commission may make such 3,903
modification or change with respect to former findings or orders 3,904
with respect thereto, as, in its opinion is justified. No EXCEPT 3,905
AS PROVIDED IN DIVISIONS (A), (B), AND (C) OF THIS SECTION, THE 3,906
COMMISSION SHALL MAKE NO modification or, change nor any, 3,909
finding, or award in ANY CLAIM WITH respect of any claim shall be 3,911
made with respect to disability, compensation, dependency, or 3,912
MEDICAL benefits, after six FIVE years from the date of injury in 3,914
the absence of the payment of medical benefits under this
chapter, in which event the modification, change, finding, or 3,915
award shall be made within six years after the payment of medical 3,917
benefits, or in the absence of payment of compensation under 3,918
section 4123.57, 4123.58, or division (A) or (B) of section 3,920
4123.56 of the Revised Code or wages in lieu of compensation in a 3,921
92
manner so as to satisfy the requirements of section 4123.84 of 3,922
the Revised Code, in which event the modification, change, 3,923
finding, or award shall be made within ten years from the date of 3,925
the last payment of compensation or from the date of death, nor 3,926
unless written notice of claim for the specific part or parts of 3,927
the body injured or disabled has been given as provided in 3,929
section 4123.84 or 4123.85 of the Revised Code, and the 3,930
commission shall not make any modification, change, finding, or 3,931
award which shall award compensation for a back period in excess 3,932
of two years prior to the date of filing application therefor OR 3,934
THE DATE OF FIRST DIAGNOSIS OF AN OCCUPATIONAL DISEASE, UNLESS
COMPENSATION UNDER SECTION 4123.56 OF THE REVISED CODE, WAGES IN 3,936
LIEU OF THAT COMPENSATION IN A MANNER THAT SATISFIES THE 3,937
REQUIREMENTS OF SECTION 4123.84 OF THE REVISED CODE, COMPENSATION 3,938
UNDER DIVISION (B) OF SECTION 4123.57 OR SECTION 4123.58 OR 3,940
4123.59 OF THE REVISED CODE, OR MEDICAL BENEFITS HAVE BEEN PAID, 3,941
IN WHICH EVENT, IN CASES IN WHICH COMPENSATION OR WAGES IN LIEU 3,942
OF THAT COMPENSATION HAS BEEN PAID UNDER SECTION 4123.56 OF THE 3,944
REVISED CODE, OR IN CASES IN WHICH COMPENSATION HAS BEEN PAID 3,945
UNDER DIVISION (B) OF SECTION 4123.57 OR SECTION 4123.58 OR
4123.59 OF THE REVISED CODE, THE COMMISSION MAY ONLY MAKE A 3,947
MODIFICATION, CHANGE, FINDING, OR AWARD IN A CLAIM WITH RESPECT 3,948
TO COMPENSATION, DEPENDENCY, OR MEDICAL BENEFITS WITHIN FIVE 3,949
YEARS AFTER THE DATE OF THE LAST PAYMENT OF COMPENSATION UNDER
SECTION 4123.56, WAGES IN LIEU OF THAT COMPENSATION, OR 3,950
COMPENSATION UNDER DIVISION (B) OF SECTION 4123.57 OR SECTION 3,951
4123.58 OR 4123.59 OF THE REVISED CODE. 3,953
(2) THE COMMISSION MAY MAKE A MODIFICATION, CHANGE, 3,956
FINDING, OR AWARD IN ANY CLAIM WITH RESPECT TO MEDICAL BENEFITS 3,957
WITHIN FIVE YEARS AFTER THE DATE OF THE LAST TREATMENT FOR WHICH 3,958
MEDICAL BENEFITS HAVE BEEN PAID OR ORDERED TO BE PAID.
(B) IN ALL CASES FOR A CLAIM INVOLVING AN OCCUPATIONAL 3,960
DISEASE DESCRIBED IN DIVISIONS (A) THROUGH (AA) OF SECTION 3,962
4123.68 OF THE REVISED CODE OR OTHER OCCUPATIONAL DISEASE THAT 3,963
93
RESULTS FROM EXPOSURE TO FIBROSIS-PRODUCING OR TOXIC DUSTS, 3,964
FUMES, MISTS, VAPORS, GASES, OR LIQUIDS, OR OTHER TOXIC
MATERIALS, OR A COMBINATION OF THOSE, THE JURISDICTION OF THE 3,965
COMMISSION AND THE AUTHORITY OF THE ADMINISTRATOR OVER EACH CASE 3,966
IS CONTINUING PURSUANT TO DIVISION (A) OF THIS SECTION, EXCEPT 3,967
THAT THE JURISDICTION TO MAKE A MODIFICATION, CHANGE, FINDING, OR 3,968
AWARD IN THE CLAIM WITH RESPECT TO COMPENSATION, DEPENDENCY, OR 3,969
MEDICAL BENEFITS MAY EXTEND BEYOND THE TIME LIMITATIONS CONTAINED 3,970
IN THAT DIVISION, UP TO A MAXIMUM OF SIX MONTHS AFTER THE DATE AN 3,971
EMPLOYEE FIRST BECOMES TOTALLY DISABLED AS A RESULT OF THE
OCCUPATIONAL DISEASE THAT IS THE SUBJECT OF THE EMPLOYEE'S CLAIM, 3,972
AND THEREAFTER, THE TIME LIMITATIONS CONTAINED IN DIVISION (A) OF 3,973
THIS SECTION APPLY TO THAT CASE. 3,974
(C)(1) IN ALL CASES FOR A CLAIM DESCRIBED IN DIVISION 3,977
(C)(2) OF THIS SECTION, THE JURISDICTION OF THE COMMISSION AND
THE AUTHORITY OF THE ADMINISTRATOR OVER EACH CASE IS CONTINUING, 3,978
EXCEPT THAT THE COMMISSION MAY MAKE A MODIFICATION, CHANGE, 3,979
FINDING, OR AWARD IN THAT CLAIM ONLY WITH RESPECT TO MEDICAL 3,980
BENEFITS AND COMPENSATION UNDER DIVISION (A) OF SECTION 4123.56 3,981
OF THE REVISED CODE, SUBJECT TO THE LIMITATION DESCRIBED IN 3,982
DIVISION (C)(3) OF THIS SECTION. 3,983
(2) THIS DIVISION APPLIES ONLY TO A CLAIM INVOLVING AN 3,985
EMPLOYEE TO WHOM EITHER OF THE FOLLOWING APPLIES: 3,986
(a) THE EMPLOYEE HAS A PROSTHETIC DEVICE THAT WAS PROVIDED 3,989
UNDER AN ALLOWED CLAIM UNDER THIS CHAPTER OR CHAPTER 4121., 3,990
4127., OR 4131. OF THE REVISED CODE AND THE EMPLOYEE'S PHYSICIAN
DETERMINES THAT THE PROSTHETIC DEVICE NEEDS TO BE REPLACED OR 3,991
REPAIRED;
(b) THE EMPLOYEE'S PHYSICIAN DETERMINES THAT AN EMPLOYEE 3,995
WILL REQUIRE A PROSTHETIC DEVICE, OR THE REPLACEMENT OR REPAIR OF 3,996
AN EXISTING PROSTHETIC DEVICE AS A DIRECT RESULT OF AN ALLOWED
CONDITION IN A CLAIM UNDER THIS CHAPTER OR CHAPTER 4121., 4127., 3,997
OR 4131. OF THE REVISED CODE, REGARDLESS OF WHEN THAT CLAIM WAS 3,998
ALLOWED.
94
(3) COMPENSATION UNDER DIVISION (A) OF SECTION 4123.56 OF 4,001
THE REVISED CODE ALLOWED UNDER THIS DIVISION SHALL BE FOR A 4,002
PERIOD NOT TO EXCEED NINE MONTHS AFTER THE DATE OF THE PROVISION, 4,004
IMPLANTING, AFFIXING, REPAIR, OR REPLACEMENT OF THE PROSTHETIC 4,005
DEVICE PROVIDED PURSUANT TO THIS DIVISION. 4,006
(4) THE ADMINISTRATOR SHALL ADOPT RULES ESTABLISHING A 4,008
PROCEDURE TO ENSURE THAT AN EMPLOYEE'S PHYSICIAN MAKES THE 4,009
DETERMINATION DESCRIBED IN DIVISION (C)(2)(b) OF THIS SECTION IN 4,010
A TIMELY MANNER AND THAT THE DETERMINATION IS RECORDED AND FILED 4,011
IN THE EMPLOYEE'S CLAIM FILE IN A TIMELY MANNER. 4,012
(5) FOR PURPOSES OF DIVISION (C) OF THIS SECTION, 4,013
"PROSTHETIC DEVICE" MEANS AN INTERNAL OR EXTERNAL ARTIFICIAL PART 4,015
PROVIDED TO AN EMPLOYEE THAT SUBSTITUTES FOR A MISSING OR
RECONSTRUCTED LIMB OR JOINT OF THE EMPLOYEE. 4,016
(D) UNLESS WRITTEN NOTICE HAS BEEN GIVEN AS PROVIDED IN 4,019
SECTION 4123.84 OR 4123.85 OF THE REVISED CODE, THE COMMISSION 4,021
SHALL MAKE NO MODIFICATION, CHANGE, FINDING, OR AWARD THAT AWARDS 4,022
COMPENSATION FOR A BACK PERIOD IN EXCESS OF TWO YEARS PRIOR TO
THE DATE OF FILING AN APPLICATION FOR THAT COMPENSATION. This 4,023
section does not affect the right of a claimant to compensation 4,025
accruing subsequent to the filing of any such application, 4,026
provided IF the application is filed within the time limit 4,027
provided in this section.
(E) This section does not deprive the commission of its 4,029
continuing jurisdiction to determine the questions raised by any 4,030
application for modification of award which has been filed with 4,031
the commission after June 1, 1932, and prior to the expiration of 4,032
the applicable period but in respect to which no award has been 4,033
granted or denied during the applicable period. 4,034
(F) The commission may, by general rules, MAY provide for 4,037
the destruction of files of cases in which no further action may 4,038
be taken. 4,039
The commission and administrator of workers' compensation 4,041
each may, by general rules, MAY provide for the retention and 4,042
95
destruction of all other records in their possession or under 4,043
their control pursuant to section 121.211 and sections 149.34 to 4,044
149.36 of the Revised Code. The bureau of workers' compensation 4,045
may purchase or rent required equipment for the document 4,046
retention media, as determined necessary to preserve the records. 4,047
Photographs, microphotographs, microfilm, films, or other direct 4,048
document retention media, when properly identified, have the same 4,049
effect as the original record and may be offered in like manner 4,050
and may be received as evidence in any court where the original 4,051
record could have been introduced. 4,052
(G) AS USED IN DIVISION (A) OF THIS SECTION, "MEDICAL 4,054
BENEFITS" MEANS PAYMENTS TO, OR ON BEHALF OF, AN EMPLOYEE FOR A 4,055
HOSPITAL BILL, MEDICAL BILL FOR A LICENSED PHYSICIAN OR HOSPITAL, 4,056
AN ORTHOPEDIC OR PROSTHETIC DEVICE, OR A PRESCRIPTION MEDICATION. 4,057
Sec. 4123.531. THE ADMINISTRATOR OF WORKERS' COMPENSATION 4,059
OR THE INDUSTRIAL COMMISSION MAY REQUIRE ANY EMPLOYEE CLAIMING 4,060
THE RIGHT TO RECEIVE COMPENSATION TO SUBMIT TO A VOCATIONAL 4,061
REHABILITATION EVALUATION. IF THE PERSON WHO CONDUCTS THE 4,062
EVALUATION RECOMMENDS A VOCATIONAL REHABILITATION PLAN FOR THE 4,063
EMPLOYEE, THE EMPLOYEE SHALL COMPLY WITH THE REHABILITATION PLAN. 4,065
IF AN EMPLOYEE REFUSES TO SUBMIT TO ANY VOCATIONAL 4,067
REHABILITATION EVALUATION SCHEDULED PURSUANT TO THIS SECTION OR 4,068
OBSTRUCTS THE EVALUATION, THE EMPLOYEE'S RIGHT TO HAVE THE 4,069
EMPLOYEE'S CLAIM FOR COMPENSATION CONSIDERED, IF THE CLAIM IS 4,070
PENDING BEFORE THE BUREAU OR COMMISSION, OR TO RECEIVE ANY 4,071
PAYMENT FOR COMPENSATION THAT HAS BEEN GRANTED, IS SUSPENDED 4,072
DURING THE PERIOD OF THE REFUSAL OR OBSTRUCTION, AND NO 4,073
COMPENSATION SUBSEQUENTLY SHALL BE AWARDED FOR ANY PERIOD OF 4,074
SUSPENSION.
Sec. 4123.54. Every employee, who is injured or who 4,083
contracts an occupational disease, and the dependents of each 4,084
employee who is killed, or dies as the result of an occupational 4,085
disease contracted in the course of employment, wherever such 4,086
injury has occurred or occupational disease has been contracted, 4,087
96
provided the same were not: 4,088
(A) Purposely self-inflicted; or 4,090
(B) Caused by the employee being intoxicated or under the 4,092
influence of a controlled substance not prescribed by a physician 4,093
where the intoxication or being under the influence of the 4,094
controlled substance not prescribed by a physician was the 4,095
proximate cause of the injury, is entitled to receive, either 4,096
directly from his THE EMPLOYEE'S self-insuring employer as 4,097
provided in section 4123.35 of the Revised Code, or from the 4,099
state insurance fund, the compensation for loss sustained on 4,100
account of the injury, occupational disease, or death, and the 4,101
medical, nurse, and hospital services and medicines, and the 4,102
amount of funeral expenses in case of death, as are provided by 4,103
this chapter.
AN EMPLOYER MAY REQUEST AN EMPLOYEE WHO SUSTAINS AN INJURY 4,106
TO SUBMIT TO A CHEMICAL TEST OR A TEST OF THE EMPLOYEE'S BLOOD, 4,107
BREATH, OR URINE IF THE EMPLOYER HAS REASON TO BELIEVE THAT THE 4,108
EMPLOYEE'S INJURY WAS THE RESULT OF BEING INTOXICATED OR UNDER 4,109
THE INFLUENCE OF A CONTROLLED SUBSTANCE NOT PRESCRIBED FOR USE IN 4,110
THE EMPLOYEE'S SYSTEM BY THE EMPLOYEE'S PHYSICIAN. IF THE 4,111
EMPLOYEE SUBMITS TO THAT TEST, THE EMPLOYER SHALL PAY FOR THE 4,112
COST OF THE TEST. FOR THE PURPOSE OF THIS DIVISION, IF THE 4,113
EMPLOYEE, THROUGH A CHEMICAL TEST OR A TEST OF THE EMPLOYEE'S 4,114
BLOOD, BREATH, OR URINE ADMINISTERED WITHIN A REASONABLE TIME 4,115
AFTER THE OCCURRENCE OF THE EMPLOYEE'S INJURY, IS DETERMINED TO 4,116
HAVE AN ALCOHOL CONTENT EQUAL TO OR IN EXCESS OF THAT SPECIFIED 4,117
IN SECTION 4511.19 OF THE REVISED CODE OR HAVE A CONTROLLED 4,118
SUBSTANCE NOT PRESCRIBED FOR USE IN THE EMPLOYEE'S SYSTEM BY THE 4,119
EMPLOYEE'S PHYSICIAN, IT IS A REBUTTABLE PRESUMPTION THAT THE 4,120
EMPLOYEE WAS INTOXICATED OR UNDER THE INFLUENCE OF THE CONTROLLED 4,121
SUBSTANCE AND THAT THE INTOXICATION OR BEING UNDER THE INFLUENCE
IS THE PROXIMATE CAUSE OF THE INJURY. AN EMPLOYEE'S REFUSAL TO 4,123
SUBMIT TO, OR RELEASE OR EXECUTE A RELEASE OF THE RESULTS OF, A 4,124
CHEMICAL TEST OR A TEST OF THE EMPLOYEE'S BLOOD, BREATH, OR URINE 4,125
97
IS ADMISSIBLE AS EVIDENCE OF THE EMPLOYEE'S INTOXICATION OR BEING 4,126
UNDER THE INFLUENCE OF A CONTROLLED SUBSTANCE NOT PRESCRIBED FOR 4,127
THE EMPLOYEE'S USE IN THE EMPLOYEE'S SYSTEM BY THE EMPLOYEE'S 4,128
PHYSICIAN AT ANY HEARING PURSUANT TO SECTION 4123.511 OF THE 4,129
REVISED CODE TO DETERMINE THE ALLOWANCE OF THE EMPLOYEE'S CLAIM
AND ON ANY APPEAL TO COURT PURSUANT TO SECTION 4123.512 OF THE 4,130
REVISED CODE.
IF AN INJURY DESCRIBED IN DIVISION (C)(4) OF SECTION 4,133
4123.01 OF THE REVISED CODE OCCURS, COMPENSATION AND MEDICAL 4,134
BENEFITS ARE PAYABLE ONLY FOR THE IMPAIRMENT OR DISABILITY THAT 4,135
RESULTS FROM THE SUBSTANTIAL WORSENING OF THE PRE-EXISTING 4,136
CONDITION OR IMPAIRMENT OR THE SUBSTANTIAL ACCELERATION OF THE 4,137
DISEASE PROCESS. NO COMPENSATION OR BENEFITS ARE PAYABLE BECAUSE 4,138
OF THE PRE-EXISTING CONDITION, IMPAIRMENT, OR DISEASE PROCESS 4,139
ONCE THAT CONDITION, IMPAIRMENT, OR DISEASE PROCESS HAS RETURNED 4,141
TO A LEVEL THAT WOULD HAVE EXISTED WITHOUT THE INJURY. 4,142
Whenever, with respect to an employee of an employer who is 4,144
subject to and has complied with this chapter, there is 4,145
possibility of conflict with respect to the application of 4,146
workers' compensation laws because the contract of employment is 4,147
entered into and all or some portion of the work is or is to be 4,148
performed in a state or states other than Ohio, the employer and 4,149
the employee may agree to be bound by the laws of this state or 4,150
by the laws of some other state in which all or some portion of 4,151
the work of the employee is to be performed. The agreement shall 4,152
be in writing and shall be filed with the bureau of workers' 4,153
compensation within ten days after it is executed and shall 4,154
remain in force until terminated or modified by agreement of the 4,155
parties similarly filed. If the agreement is to be bound by the 4,156
laws of this state and the employer has complied with this 4,157
chapter, then the employee is entitled to compensation and 4,158
benefits regardless of where the injury occurs or the disease is 4,159
contracted and the rights of the employee and his THE EMPLOYEE'S 4,160
dependents under the laws of this state are the exclusive remedy 4,162
98
against the employer on account of injury, disease, or death in 4,163
the course of and arising out of his THE EMPLOYEE'S employment. 4,164
If the agreement is to be bound by the laws of another state and 4,166
the employer has complied with the laws of that state, the rights 4,167
of the employee and his THE EMPLOYEE'S dependents under the laws 4,169
of that state are the exclusive remedy against the employer on 4,170
account of injury, disease, or death in the course of and arising 4,171
out of his THE EMPLOYEE'S employment without regard to the place 4,173
where the injury was sustained or the disease contracted. 4,174
If any employee or his THE EMPLOYEE'S dependents are 4,176
awarded workers' compensation benefits or recover damages from 4,178
the employer under the laws of another state, the amount awarded 4,179
or recovered, whether paid or to be paid in future installments, 4,180
shall be credited on the amount of any award of compensation or 4,181
benefits made to the employee or his THE EMPLOYEE'S dependents by 4,182
the bureau. 4,183
If an employee is a resident of a state other than this 4,185
state and is insured under the workers' compensation law or 4,186
similar laws of a state other than this state, the employee and 4,187
his THE EMPLOYEE'S dependents are not entitled to receive 4,188
compensation or benefits under this chapter, on account of 4,190
injury, disease, or death arising out of or in the course of 4,191
employment while temporarily within this state and the rights of 4,192
the employee and his THE EMPLOYEE'S dependents under the laws of 4,193
the other state are the exclusive remedy against the employer on 4,195
account of the injury, disease, or death. 4,196
Compensation or benefits are not payable to a claimant 4,198
during the period of confinement of the claimant in any state or 4,199
federal correctional institution whether in this or any other 4,200
state for conviction of violation of any state or federal 4,201
criminal law.
Sec. 4123.541. In the event that IF any person who is 4,210
entitled to receive benefits for TEMPORARY total disability OR 4,212
PERMANENT TOTAL IMPAIRMENT, loss of member, or death through the 4,214
99
application of section 4123.033 of the Revised Code, receives, in 4,215
connection with the injury giving rise to such entitlement, 4,216
benefits under an act of congress or federal program providing 4,217
benefits for civil defense workers and their survivors, the 4,218
benefits payable hereunder, shall be reduced in proportion to the 4,219
benefits received under such other act or program.
Sec. 4123.55. No compensation shall be allowed for the 4,228
first week after an injury is received or occupational disease 4,229
contracted IS FIRST DIAGNOSED and no compensation shall be 4,232
allowed for the first week of total disability OR IMPAIRMENT,
whenever it may occur, unless and until the employee is totally 4,234
disable DISABLED OR IMPAIRED for a continuous period of two weeks 4,236
or more, in which event compensation for the first week of total 4,237
disability OR IMPAIRMENT, whenever it has occurred, shall be
paid, in addition to any other weekly benefits which are due, 4,239
immediately following the second week of total disability OR 4,240
IMPAIRMENT. There shall be no waiting period in connection with 4,241
the disbursements provided by section 4123.66 of the Revised 4,242
Code.
Sec. 4123.56. (A) Except as provided in division (D)(E) 4,251
of this section, in the case of temporary disability, an employee 4,252
shall receive sixty-six and two-thirds per cent of his THE 4,253
EMPLOYEE'S average weekly wage so long as such disability is 4,255
total, not to exceed a maximum amount of weekly compensation 4,256
which is equal to the statewide average weekly wage as defined in 4,257
division (C) of section 4123.62 of the Revised Code, and not less 4,258
than a minimum amount of compensation which is equal to 4,259
thirty-three and one-third per cent of the statewide average 4,260
weekly wage as defined in division (C) of section 4123.62 of the 4,261
Revised Code unless the employee's wage is less than thirty-three 4,262
and one-third per cent of the minimum statewide average weekly 4,263
wage, in which event he THE EMPLOYEE shall receive compensation 4,264
equal to his THE EMPLOYEE'S full wages; provided that for the 4,266
first twelve weeks of total disability the employee shall receive 4,267
100
seventy-two per cent of his THE EMPLOYEE'S full weekly wage, but 4,269
not to exceed a maximum amount of weekly compensation which is 4,270
equal to the lesser of the statewide average weekly wage as 4,271
defined in division (C) of section 4123.62 of the Revised Code or 4,272
one hundred per cent of the employee's net take home weekly wage. 4,273
In the case of a self-insuring employer, payments 4,274
AS USED IN THIS DIVISION, "NET TAKE HOME WEEKLY WAGE" MEANS 4,277
THE AMOUNT OBTAINED BY DIVIDING AN EMPLOYEE'S TOTAL REMUNERATION, 4,278
AS DEFINED IN SECTION 4141.01 OF THE REVISED CODE, PAID TO OR 4,280
EARNED BY THE EMPLOYEE DURING THE FIRST FOUR OF THE LAST FIVE 4,281
COMPLETED CALENDAR QUARTERS WHICH IMMEDIATELY PRECEDE THE FIRST 4,282
DAY OF THE EMPLOYEE'S ENTITLEMENT TO BENEFITS UNDER THIS 4,283
DIVISION, BY THE NUMBER OF WEEKS DURING WHICH THE EMPLOYEE WAS 4,284
PAID OR EARNED REMUNERATION DURING THOSE FOUR QUARTERS, LESS THE 4,285
AMOUNT OF LOCAL, STATE, AND FEDERAL INCOME TAXES DEDUCTED FOR 4,286
EACH SUCH WEEK. 4,287
(B)(1) IF THE PAYMENT OF COMPENSATION FOR TEMPORARY 4,290
DISABILITY IS COMMENCED VOLUNTARILY BY A SELF-INSURING EMPLOYER, 4,291
PAYMENTS OF COMPENSATION SHALL BE CONTINUED AT THE DISCRETION OF 4,293
THE SELF-INSURING EMPLOYER. WHEN A SELF-INSURING EMPLOYER MAKES 4,295
ITS FIRST PAYMENT OF COMPENSATION TO AN EMPLOYEE UNDER THIS 4,296
DIVISION, THE SELF-INSURING EMPLOYER SHALL NOTIFY THE EMPLOYEE, 4,297
IN WRITING, OF ALL OF THE FOLLOWING: 4,298
(a) THAT THE SELF-INSURING EMPLOYER VOLUNTARILY HAS 4,300
COMMENCED THE PAYMENTS; 4,301
(b) THAT THE SELF-INSURING EMPLOYER MAY TERMINATE THE 4,303
PAYMENTS AT ANY TIME; 4,304
(c) THAT THE EMPLOYEE HAS A RIGHT TO A HEARING ON THE 4,306
EMPLOYEE'S CLAIM; 4,307
(d) IF THE EMPLOYEE'S CLAIM THAT IS THE SUBJECT OF THE 4,309
PAYMENTS COMMENCED UNDER THIS DIVISION IS DETERMINED TO BE VALID, 4,311
THAT ANY COMPENSATION TO WHICH THE EMPLOYEE IS OR BECOMES
ENTITLED UNDER THIS SECTION FOR THAT CLAIM SHALL BE OFFSET BY THE 4,312
PAYMENTS THE EMPLOYEE RECEIVES FROM THE SELF-INSURING EMPLOYER 4,313
101
UNDER THIS DIVISION. 4,314
A SELF-INSURING EMPLOYER EITHER SHALL CERTIFY OR CONTEST 4,316
THE CLAIM FOR WHICH IT VOLUNTARILY IS MAKING PAYMENTS UNDER THIS 4,317
DIVISION WITHIN SEVENTY-FIVE DAYS AFTER THE SELF-INSURING 4,319
EMPLOYER MAKES THE FIRST PAYMENT OF COMPENSATION TO AN EMPLOYEE 4,320
UNDER THIS DIVISION. A CLAIM IS DEEMED CONTESTED IF THE 4,321
SELF-INSURING EMPLOYER FAILS EITHER TO CERTIFY OR CONTEST THE 4,322
CLAIM WITHIN SEVENTY-FIVE DAYS AFTER MAKING THE FIRST PAYMENT OF 4,323
COMPENSATION UNDER THIS DIVISION TO AN EMPLOYEE.
(2) PAYMENT OF COMPENSATION FOR ALL CLAIMS FOR TEMPORARY 4,325
DISABILITY OTHER THAN THOSE DESCRIBED IN DIVISION (B)(1) OF THIS 4,327
SECTION, shall be for a duration based upon the medical reports 4,328
of the attending physician. If the employer disputes the 4,329
attending physician's report, payments may be terminated only 4,330
upon application and hearing by a district hearing officer 4,331
pursuant to division (C) of section 4123.511 of the Revised Code. 4,332
Payments shall continue pending the determination of the matter, 4,333
however, payment shall not be made for the period when any 4,334
employee has returned to work, when an employee's treating 4,335
physician has made a written statement that the employee is 4,336
capable of returning to his THE EMPLOYEE'S former position of 4,337
employment, when work within the physical capabilities of the 4,339
employee is made available by the employer or another employer, 4,340
or when the employee has reached the maximum medical improvement. 4,341
Where IF the employee is capable of work activity, but his THE 4,343
EMPLOYEE'S employer is unable to offer him THE EMPLOYEE any 4,346
employment, the employee shall register with the bureau of 4,348
employment services, which shall assist the employee in finding 4,349
suitable employment. The
(3) THE termination of temporary total disability, whether 4,352
by order or otherwise, does not preclude the commencement of 4,353
temporary total disability at another point in time if the 4,354
employee again becomes temporarily totally disabled.
(4) IF A DISTRICT HEARING OFFICER, STAFF HEARING OFFICER, 4,356
102
OR THE INDUSTRIAL COMMISSION DETERMINES, BASED UPON THE EVIDENCE, 4,358
THAT AN EMPLOYEE WAS NOT ENTITLED PURSUANT TO THIS CHAPTER OR 4,359
CHAPTER 4121., 4127., OR 4131. OF THE REVISED CODE TO RECEIVE 4,360
TEMPORARY TOTAL DISABILITY COMPENSATION PRIOR TO THE DATE OF THE 4,361
HEARING IN WHICH THAT DETERMINATION IS MADE, THE HEARING OFFICER
OR THE COMMISSION SHALL DECLARE AN OVERPAYMENT EFFECTIVE FROM THE 4,363
DATE THE EMPLOYEE WAS NOT ENTITLED TO RECEIVE THAT COMPENSATION. 4,364
IF THE EMPLOYER PAYS PREMIUMS TO THE STATE INSURANCE FUND, THE 4,365
AMOUNT OF THE OVERPAYMENT SHALL NOT BE CHARGED TO THE EMPLOYER'S 4,366
EXPERIENCE. IF THE EMPLOYER IS A SELF-INSURING EMPLOYER, THE 4,367
SELF-INSURING EMPLOYER SHALL DEDUCT THE AMOUNT OF THE OVERPAYMENT 4,368
FROM THE PAID COMPENSATION IT REPORTS TO THE ADMINISTRATOR UNDER 4,369
DIVISION (K) OF SECTION 4123.35 OF THE REVISED CODE. THE 4,370
SELF-INSURING EMPLOYER OR THE BUREAU, AS APPROPRIATE, SHALL 4,371
WITHHOLD THE AMOUNT OF THE OVERPAYMENT FROM ANY AMOUNT TO WHICH 4,372
THE EMPLOYEE BECOMES ENTITLED UNDER ANY CLAIM PAST, PRESENT, OR 4,373
FUTURE UNDER CHAPTER 4121., 4123., 4127., OR 4131. OF THE REVISED 4,374
CODE PURSUANT TO DIVISION (J) OF SECTION 4123.511 OF THE REVISED 4,375
CODE.
(5) After two hundred weeks of temporary total disability 4,377
benefits, the bureau medical section shall schedule the claimant 4,378
EMPLOYEE for an examination for an evaluation to determine 4,379
whether or not the temporary disability has become permanent. A 4,381
self-insuring employer shall notify the bureau of workers' 4,382
compensation immediately after payment of two hundred weeks of 4,383
temporary total disability and request that the bureau of 4,384
workers' compensation schedule the claimant EMPLOYEE for such an 4,385
examination.
(6) When the employee is awarded compensation for 4,387
temporary total disability for a period for which he THE EMPLOYEE 4,388
has received benefits under Chapter 4141. of the Revised Code, 4,390
the bureau of workers' compensation shall pay an amount equal to 4,391
the amount received from the award to the bureau of employment 4,392
services and the administrator OF THE BUREAU of employment 4,393
103
services shall credit the amount to the accounts of the employers 4,395
to whose accounts the payment of benefits was charged or is 4,396
chargeable to the extent it was charged or is chargeable. 4,397
(7) If any compensation under this section has been paid 4,399
for the same period or periods for which temporary 4,400
nonoccupational accident and sickness insurance is or has been 4,401
paid pursuant to an insurance policy or program to which the 4,402
employer has made the entire contribution or payment for 4,403
providing insurance or under a nonoccupational accident and 4,404
sickness program fully funded by the employer, compensation paid 4,405
under this section for the period or periods shall be paid only 4,406
to the extent by which the payment or payments exceeds the amount 4,407
of the nonoccupational insurance or program paid or payable. 4,408
Offset of the compensation shall be made only upon the prior 4,409
order of the bureau of workers' compensation or industrial 4,410
commission or agreement of the claimant. 4,411
As used in this division, "net take home weekly wage" means 4,413
the amount obtained by dividing an employee's total remuneration, 4,414
as defined in section 4141.01 of the Revised Code, paid to or 4,415
earned by the employee during the first four of the last five 4,416
completed calendar quarters which immediately precede the first 4,417
day of the employee's entitlement to benefits under this 4,418
division, by the number of weeks during which the employee was 4,419
paid or earned remuneration during those four quarters, less the 4,420
amount of local, state, and federal income taxes deducted for 4,421
each such week. 4,422
(B) Where (C)(1) IF an employee in a claim allowed under 4,425
this chapter suffers a wage loss as a DIRECT result of returning 4,426
to employment other than his THE EMPLOYEE'S former position of 4,427
employment or as a result of being unable to find employment 4,429
consistent with DUE TO A LIMITATION IN the claimant's physical 4,431
capabilities CAUSED SOLELY BY THE ALLOWED CONDITION OR CONDITIONS 4,432
IN THE EMPLOYEE'S CLAIM, he THE EMPLOYEE shall receive 4,433
compensation at sixty-six and two-thirds per cent of his THE 4,434
104
DIFFERENCE BETWEEN THE EMPLOYEE'S AVERAGE weekly wage loss AT THE 4,435
TIME OF THE INJURY OR DATE OF DISEASE AND THE EMPLOYEE'S PRESENT 4,436
EARNINGS not to exceed the statewide average weekly wage for a 4,437
period not to exceed two hundred weeks. THE PAYMENTS MAY 4,438
CONTINUE FOR UP TO A MAXIMUM OF TWO HUNDRED WEEKS, BUT THE 4,439
PAYMENTS SHALL BE REDUCED BY THE CORRESPONDING NUMBER OF WEEKS IN 4,440
WHICH THE EMPLOYEE RECEIVES PAYMENTS PURSUANT TO DIVISION (B) OF 4,441
SECTION 4121.67 OF THE REVISED CODE.
(2) IF AN EMPLOYEE IN A CLAIM ALLOWED UNDER THIS CHAPTER 4,444
SUFFERS A WAGE LOSS AS A DIRECT RESULT OF BEING UNABLE TO FIND 4,445
EMPLOYMENT CONSISTENT WITH THE EMPLOYEE'S PHYSICAL CAPABILITIES 4,446
RESULTING FROM THE EMPLOYEE'S INJURY OR OCCUPATIONAL DISEASE, THE
EMPLOYEE SHALL RECEIVE COMPENSATION AT SIXTY-SIX AND TWO-THIRDS 4,449
PER CENT OF THE DIFFERENCE BETWEEN THE EMPLOYEE'S AVERAGE WEEKLY 4,450
WAGE AT THE TIME OF THE INJURY OR DATE OF DISEASE AND THE 4,452
EMPLOYEE'S PRESENT EARNINGS, NOT TO EXCEED THE STATEWIDE AVERAGE 4,453
WEEKLY WAGE. THE PAYMENTS MAY CONTINUE FOR UP TO A MAXIMUM OF 4,454
TWENTY-SIX WEEKS; HOWEVER, AN EMPLOYEE IN A CLAIM ALLOWED UNDER 4,455
THIS CHAPTER MAY RECEIVE COMPENSATION UNDER DIVISION (C)(2) OF 4,457
THIS SECTION FOR UP TO A MAXIMUM OF FIFTY-TWO WEEKS IF, AT ANY 4,458
TIME DURING THE PERIOD IN WHICH THE EMPLOYEE IS RECEIVING 4,459
COMPENSATION UNDER DIVISION (C)(2) OF THIS SECTION, THE BENEFIT 4,460
PERIOD FOR UNEMPLOYMENT IS IN EXTENSION PURSUANT TO SECTION 4,461
4141.301 OF THE REVISED CODE. NEITHER THE FILING OF A REQUEST 4,462
FOR NOR THE RECEIPT OF COMPENSATION PURSUANT TO DIVISION (C)(2) 4,464
OF THIS SECTION SHALL AFFECT AN EMPLOYEE'S APPLICATION FOR
COMPENSATION PROVIDED UNDER SECTION 4123.58 OF THE REVISED CODE. 4,466
(3) THE NUMBER OF WEEKS OF WAGE LOSS PAYABLE TO AN 4,468
EMPLOYEE UNDER DIVISIONS (C)(1) AND (2) OF THIS SECTION SHALL NOT 4,469
EXCEED TWO HUNDRED WEEKS IN THE AGGREGATE. 4,470
(4) AS USED IN THIS DIVISION, "DATE OF DISEASE" MEANS THE 4,472
DATE AN OCCUPATIONAL DISEASE IS FIRST DIAGNOSED BY A LICENSED 4,473
PHYSICIAN, OR FOR AN OCCUPATIONAL DISEASE DESCRIBED IN DIVISIONS 4,474
(A) THROUGH (AA) OF SECTION 4123.68 OF THE REVISED CODE, OR OTHER 4,478
105
OCCUPATIONAL DISEASE THAT RESULTS FROM EXPOSURE TO
FIBROSIS-PRODUCING OR TOXIC DUSTS, FUMES, MISTS, VAPORS, GASES, 4,479
OR LIQUIDS, OR OTHER TOXIC MATERIALS, OR A COMBINATION OF THOSE, 4,480
THE DATE THAT THE EMPLOYEE FIRST MISSES WORK AS A RESULT OF THE 4,481
OCCUPATIONAL DISEASE.
(C)(D) In the event an employee of a professional sports 4,483
franchise domiciled in this state is disabled OR IMPAIRED as the 4,484
result of an injury or occupational disease, the total amount of 4,486
payments made under a contract of hire or collective bargaining 4,487
agreement to the employee during a period of disability OR 4,488
IMPAIRMENT is deemed an advanced payment of compensation payable 4,490
under sections 4123.56 to 4123.58 of the Revised Code. The 4,491
employer shall be reimbursed the total amount of the advanced 4,492
payments out of any award of compensation made pursuant to 4,493
sections 4123.56 to 4123.58 of the Revised Code.
(D)(E) If an employee receives temporary total disability 4,495
benefits pursuant to division (A) of this section and social 4,496
security retirement benefits pursuant to the "Social Security 4,497
Act," the weekly benefit amount under division (A) of this 4,498
section shall not exceed sixty-six and two-thirds per cent of the 4,499
statewide average weekly wage as defined in division (C) of 4,500
section 4123.62 of the Revised Code. 4,501
(F) THE COMMENCEMENT OF THE PAYMENT OF COMPENSATION UNDER 4,504
DIVISION (B) OF THIS SECTION SHALL NOT CONSTITUTE A RECOGNITION 4,506
BY A SELF-INSURING EMPLOYER OF A CLAIM OR OF A CONDITION IN THE 4,507
CLAIM AS COMPENSABLE, BUT SHALL DO NO MORE THAN SATISFY THE 4,508
REQUIREMENTS OF SECTION 4123.84 OF THE REVISED CODE. 4,510
Sec. 4123.57. Partial disability compensation shall be 4,520
paid as follows.
(A)(1) Except as provided in DIVISION (A)(2) OF this 4,522
section, not earlier than forty weeks after the date of 4,524
termination of the latest period of payments under section 4,525
4123.56 of the Revised Code, or not earlier than forty weeks 4,526
after the date of the injury or contraction THE DATE OF FIRST 4,527
106
DIAGNOSIS of an occupational disease BY A LICENSED PHYSICIAN in 4,528
the absence of payments under section 4123.56 of the Revised 4,529
Code, the AN employee may file an application with the bureau of 4,530
workers' compensation for the determination of the percentage of 4,532
his THE EMPLOYEE'S permanent partial disability IMPAIRMENT 4,534
resulting from the AN injury or occupational disease. 4,535
(2) AN EMPLOYEE MAY FILE THE APPLICATION SPECIFIED IN 4,538
DIVISION (A)(1) OF THIS SECTION WITHOUT WAITING FORTY WEEKS WHEN 4,540
EITHER OF THE FOLLOWING OCCURS:
(a) THE RECEIPT OF PAYMENTS UNDER DIVISION (A) OF SECTION 4,543
4123.56 OF THE REVISED CODE IS TERMINATED BY A HEARING OFFICER 4,545
BECAUSE THE EMPLOYEE HAS REACHED MAXIMUM MEDICAL IMPROVEMENT. 4,547
(b) THE RECEIPT OF BENEFITS UNDER DIVISION (A) OF SECTION 4,550
4123.56 OF THE REVISED CODE IS TERMINATED BECAUSE THE EMPLOYEE'S 4,551
ATTENDING PHYSICIAN CERTIFIES THAT THE EMPLOYEE HAS REACHED 4,552
MAXIMUM MEDICAL IMPROVEMENT.
(3) Whenever the AN application is filed UNDER DIVISION 4,555
(A)(1) OR (2) OF THIS SECTION, the bureau shall send a copy of 4,556
the application to the employee's employer or the employer's 4,557
representative and, EXCEPT WHEN THE OPTION PROVIDED IN DIVISION 4,558
(A)(7) OF THIS SECTION IS CHOSEN, shall schedule the employee for 4,559
a medical examination by the bureau medical section. The bureau 4,560
shall send a copy of the report of the medical examination to the 4,561
employee, the employer, and their representatives. Thereafter, 4,562
the administrator of workers' compensation shall review the 4,563
employee's claim file and make a tentative order as the evidence 4,564
before him at the time of the making of the order warrants. If 4,565
the administrator determines that there is a conflict of 4,566
evidence, he shall send the application, along with the 4,567
claimant's file, to the district hearing officer who shall set 4,568
the application for a hearing THE REPORT OF THE MEDICAL 4,569
EXAMINATION SHALL CONTAIN A STATEMENT OF THE EXAMINER'S FINDING 4,571
ON THE EMPLOYEE'S PERCENTAGE OF PERMANENT PARTIAL IMPAIRMENT 4,572
RESULTING FROM ALLOWED CONDITIONS IN THE CLAIM UNDER THE MOST 4,573
107
RECENT EDITION OF THE AMERICAN MEDICAL ASSOCIATION'S GUIDES TO 4,575
THE EVALUATION OF PERMANENT IMPAIRMENT. AFTER RECEIVING THE 4,576
REPORT OF THE MEDICAL EXAMINATION, THE ADMINISTRATOR OF WORKERS' 4,577
COMPENSATION SHALL MAKE A TENTATIVE ORDER FINDING THAT THE 4,578
EMPLOYEE'S PERCENTAGE OF PERMANENT PARTIAL IMPAIRMENT IS THE SAME 4,579
PERCENTAGE SHOWN BY THE REPORT OF THE MEDICAL EXAMINATION, UNLESS 4,580
THE ADMINISTRATOR DETERMINES THAT THE REPORT CLEARLY IS 4,581
ERRONEOUS. IF THE ADMINISTRATOR DETERMINES THAT THE REPORT 4,582
CLEARLY IS ERRONEOUS, THE ADMINISTRATOR SHALL DISREGARD THE 4,583
REPORT, SCHEDULE THE EMPLOYEE FOR ANOTHER EXAMINATION BY THE 4,584
BUREAU MEDICAL SECTION, AND ISSUE A TENTATIVE ORDER THAT FINDS 4,585
THAT THE EMPLOYEE'S PERCENTAGE OF PERMANENT PARTIAL IMPAIRMENT IS 4,586
THE SAME PERCENTAGE SHOWN BY THE SECOND MEDICAL EXAMINATION 4,587
REPORT. 4,588
(4) The administrator shall notify the employee, the 4,590
employer, and their representatives, in writing, of the tentative 4,591
order and of the parties' right to request a hearing. Unless the 4,592
employee, the employer, or their representative notifies the 4,593
administrator, in writing, of an objection to the tentative order 4,594
within twenty days after receipt of the notice thereof, the 4,595
tentative order shall go into effect and the employee shall 4,596
receive the compensation provided in the order. In no event 4,597
shall there be a reconsideration of a tentative order issued 4,598
under this division WITHIN FOURTEEN DAYS AFTER RECEIPT OF THE 4,599
TENTATIVE ORDER, THE EMPLOYEE, THE EMPLOYER, OR THEIR 4,600
REPRESENTATIVES, MAY FILE WITH THE BUREAU AN OBJECTION TO THE 4,602
TENTATIVE ORDER. THE OPPOSING PARTY MUST BE SERVED BY THE FILING 4,604
PARTY WITH A COPY OF THE OBJECTION TO THE TENTATIVE ORDER NOT
LATER THAN THE DAY OF FILING. PROPER MAILING OF THE OBJECTION TO 4,606
THE TENTATIVE ORDER TO THE OPPOSING PARTY CONSTITUTES SERVICE. 4,607
IF AN OBJECTION TO THE TENTATIVE ORDER IS NOT FILED BY A PARTY BY 4,608
THE DEADLINE ESTABLISHED BY DIVISION (A)(4) OF THIS SECTION, THE 4,609
ORDER BECOMES FINAL. 4,610
(5) If the employee, the employer, or their 4,612
108
representatives timely notify the administrator of an objection 4,613
to the tentative order, EITHER PARTY, WITHIN FOURTEEN DAYS AFTER 4,616
THE DATE OF FILING OR OF RECEIPT OF AN OBJECTION, WHICHEVER IS
LATER, MAY REQUEST ANOTHER EXAMINATION BY THE BUREAU MEDICAL 4,618
SECTION. THE PARTY REQUESTING THAT EXAMINATION SHALL PAY THE 4,619
COST OF THAT EXAMINATION. UPON THAT REQUEST, THE BUREAU SHALL 4,620
SCHEDULE THE EMPLOYEE FOR ANOTHER MEDICAL EXAMINATION BY THE 4,622
BUREAU MEDICAL SECTION. ALL PROVISIONS OF DIVISION (A)(3) OF 4,623
THIS SECTION APPLICABLE TO THE FIRST MEDICAL EXAMINATION APPLY TO 4,624
A SUBSEQUENT MEDICAL EXAMINATION REQUESTED PURSUANT TO DIVISION 4,625
(A)(5) OF THIS SECTION. THE BUREAU SHALL SEND A COPY OF THE 4,626
REPORT OF THE MEDICAL EXAMINATION TO THE EMPLOYEE, THE EMPLOYER, 4,627
AND THEIR REPRESENTATIVES.
UPON THE FILING OF AN OBJECTION TO THE TENTATIVE ORDER OR 4,629
UPON THE COMPLETION OF THE MEDICAL EXAMINATION REQUESTED PURSUANT 4,630
TO DIVISION (A)(5) OF THIS SECTION, WHICHEVER IS LATER, the 4,633
matter shall be referred to a district hearing officer who shall 4,634
set the application for hearing with written notices to all 4,635
interested persons. Upon referral to a district hearing officer, 4,636
the employer may obtain a medical examination of the employee, 4,637
pursuant to rules of the industrial commission AT THE HEARING, 4,638
THE DISTRICT HEARING OFFICER FIRST SHALL MAKE A FINDING AS TO
WHETHER ANY OF THE FOLLOWING HAS OCCURRED: 4,640
(a) THE BUREAU MEDICAL SECTION BASED ITS REPORT, AT LEAST 4,643
IN PART, ON CONDITIONS NOT ALLOWED IN THE CLAIM;
(b) THE BUREAU MEDICAL SECTION FAILED TO CONSIDER ALL OF 4,646
THE ALLOWED CONDITIONS IN THE CLAIM;
(c) THE BUREAU MEDICAL SECTION'S EXAMINER WAS PREJUDICED 4,649
AGAINST THE EMPLOYER OR THE EMPLOYEE;
(d) THE BUREAU MEDICAL SECTION FAILED TO PROPERLY APPLY 4,652
THE MOST RECENT EDITION OF THE AMERICAN MEDICAL ASSOCIATION'S 4,653
GUIDES TO THE EVALUATION OF PERMANENT IMPAIRMENT IN DETERMINING 4,654
THE EMPLOYEE'S PERCENTAGE OF PERMANENT IMPAIRMENT; 4,655
(e) THE TENTATIVE ORDER PROVIDES FOR THE PAYMENT OF 4,657
109
COMPENSATION UNDER A CIRCUMSTANCE IN WHICH THAT COMPENSATION IS 4,658
BARRED BY THIS SECTION OR ANY OTHER PROVISION OF LAW. 4,659
(A) The district hearing officer, upon the application, 4,662
shall determine the percentage of the employee's permanent
disability, except as is subject to division (B) of this section, 4,663
based upon that condition of the employee resulting from the 4,664
injury or occupational disease and causing permanent impairment 4,665
evidenced by medical or clinical findings reasonably 4,666
demonstrable. The employee shall receive sixty-six and 4,667
two-thirds per cent of his average weekly wage, but not more than 4,668
a maximum of thirty-three and one-third per cent of the statewide 4,669
average weekly wage as defined in division (C) of section 4123.62 4,670
of the Revised Code, per week regardless of the average weekly 4,671
wage, for the number of weeks which equals the percentage of two 4,672
hundred weeks. Except on application for reconsideration, 4,673
review, or modification, which is filed within ten days after the 4,674
date of receipt of the decision of the district hearing officer, 4,675
in no instance shall the former award be modified unless it is 4,676
found from medical or clinical findings that the condition of the 4,677
claimant resulting from the injury has so progressed as to have 4,678
increased the percentage of permanent partial disability. A 4,679
staff hearing officer shall hear an application for 4,680
reconsideration filed and his decision is final. An IF THE 4,681
DISTRICT HEARING OFFICER FINDS ONE OF THE SITUATIONS DESCRIBED IN 4,683
DIVISION (A)(5)(a), (b), (c) OR (d) OF THIS SECTION, THE DISTRICT 4,684
HEARING OFFICER SHALL ISSUE AN ORDER REJECTING THE REPORT OF THE 4,686
MEDICAL EXAMINATION AND REQUIRING THE BUREAU MEDICAL SECTION TO 4,687
PERFORM A NEW MEDICAL EXAMINATION. ALL PROVISIONS OF THIS 4,688
DIVISION APPLICABLE TO THE FIRST MEDICAL EXAMINATION AND THE 4,690
DETERMINATION OF THE PERCENTAGE OF PERMANENT PARTIAL IMPAIRMENT
APPLY TO ANY SUBSEQUENT MEDICAL EXAMINATION THAT IS ORDERED UNDER 4,691
THIS DIVISION. IF THE DISTRICT HEARING OFFICER FINDS THE 4,692
SITUATION DESCRIBED IN DIVISION (A)(5)(e) OF THIS SECTION, THE 4,694
DISTRICT HEARING OFFICER SHALL ISSUE AN ORDER DENYING THE 4,695
110
APPLICATION. IF THE DISTRICT HEARING OFFICER FINDS NONE OF THE 4,696
SITUATIONS DESCRIBED IN DIVISION (A)(5)(a), (b), (c), (d), OR (e) 4,698
OF THIS SECTION, THE DISTRICT HEARING OFFICER SHALL ISSUE AN 4,699
ORDER FINDING THAT THE EMPLOYEE'S PERCENTAGE OF PERMANENT PARTIAL 4,700
IMPAIRMENT IS THE SAME PERCENTAGE SHOWN BY EITHER THE FIRST OR 4,701
ANY SUBSEQUENT BUREAU MEDICAL EXAMINATION REPORT. 4,702
(6) AN employee may file an application for a subsequent 4,705
determination of the percentage of his THE EMPLOYEE'S permanent 4,706
disability IMPAIRMENT. NO APPLICATION FOR SUBSEQUENT PERCENTAGE 4,708
DETERMINATIONS ON THE SAME CLAIM FOR INJURY OR OCCUPATIONAL
DISEASE SHALL BE ACCEPTED UNLESS SUPPORTED BY SUBSTANTIAL 4,709
EVIDENCE OF NEW AND CHANGED CIRCUMSTANCES DEVELOPING SINCE THE 4,710
TIME OF THE LAST DETERMINATION. If such an application is filed 4,712
UNDER DIVISION (A)(6) OF THIS SECTION, the bureau shall send a 4,713
copy of the application to the employer or the employer's 4,714
representative. No sooner than sixty days from the date of the 4,715
mailing of the application to the employer or the employer's 4,716
representative, the administrator shall review the application. 4,717
The administrator may require a medical examination or medical 4,718
review of the employee. The administrator shall issue a 4,719
tentative order based upon the evidence before him, provided that 4,720
if he requires a medical examination or medical review, the 4,721
administrator shall not issue the tentative order until the 4,722
completion of the examination or review. 4,723
The employer may obtain a medical examination of the 4,725
employee and may submit medical evidence at any stage of the 4,726
process up to a hearing before the district hearing officer, 4,727
pursuant to rules of the commission. The administrator shall 4,728
notify the employee, the employer, and their representatives, in 4,729
writing, of the nature and amount of any tentative order issued 4,730
on an application requesting a subsequent determination of the 4,731
percentage of an employee's permanent disability. An employee, 4,732
employer, or their representatives may object to the tentative 4,733
order within twenty days after the receipt of the notice thereof. 4,734
111
If no timely objection is made, the tentative order shall go into 4,735
effect. In no event shall there be a reconsideration of a 4,736
tentative order issued under this division. If an objection is 4,737
timely made, the application for a subsequent determination shall 4,738
be referred to a district hearing officer who shall set the 4,739
application for a hearing with written notice to all interested 4,740
persons. No application for subsequent percentage determinations 4,741
on the same claim for injury or occupational disease shall be 4,742
accepted for review by the district hearing officer unless 4,743
supported by substantial evidence of new and changed 4,744
circumstances developing since the time of the hearing on the 4,745
original or last determination. 4,746
No award shall be made under this division based upon a 4,749
percentage of disability which, when taken with all other 4,751
percentages of permanent disability, exceeds one hundred per 4,753
cent. If the percentage of the permanent disability of the 4,754
employee equals or exceeds ninety per cent, compensation for
permanent partial disability shall be paid for two hundred weeks. 4,757
TREAT THE APPLICATION AS THOUGH IT WAS AN ORIGINAL APPLICATION 4,758
FOR THE DETERMINATION OF THE PERCENTAGE OF PERMANENT PARTIAL 4,759
IMPAIRMENT. IN NO INSTANCE SHALL THE FORMER AWARD BE MODIFIED 4,760
UNLESS IT IS FOUND FROM MEDICAL OR CLINICAL FINDINGS THAT THE
CONDITION OF THE EMPLOYEE RESULTING FROM THE INJURY OR 4,761
OCCUPATIONAL DISEASE HAS SO PROGRESSED AS TO HAVE INCREASED THE 4,763
PERCENTAGE OF PERMANENT PARTIAL IMPAIRMENT. ALL PROVISIONS OF 4,764
THIS DIVISION APPLICABLE TO AN ORIGINAL APPLICATION APPLY TO AN 4,765
APPLICATION FOR SUBSEQUENT DETERMINATION. THE DECISION OF A 4,767
DISTRICT HEARING OFFICER ON AN EMPLOYEE'S APPLICATION FILED UNDER
DIVISION (A)(1), (2), AND (6) OF THIS SECTION IS FINAL. 4,770
(7) NOTWITHSTANDING DIVISIONS (A)(3) THROUGH (6) OF THIS 4,773
SECTION, THE DETERMINATION OF AN EMPLOYEE'S PERCENTAGE OF 4,774
PERMANENT PARTIAL IMPAIRMENT SHALL BE MADE IN ACCORDANCE WITH 4,775
DIVISION (A)(7) OF THIS SECTION, UPON THE WRITTEN AGREEMENT BY AN 4,777
EMPLOYEE AND EMPLOYER TO UTILIZE THE ALTERNATIVE METHOD OF 4,778
112
DETERMINATION PROVIDED IN DIVISION (A)(7) OF THIS SECTION. 4,780
WITHIN SEVEN DAYS AFTER RECEIPT OF THE WRITTEN AGREEMENT, THE 4,781
ADMINISTRATOR SHALL ASSIGN A PHYSICIAN FROM THE IMPAIRMENT 4,782
EVALUATION PANEL WITHIN THE BUREAU MEDICAL SECTION TO CONDUCT A 4,783
MEDICAL EXAMINATION OF THE EMPLOYEE AND SEND WRITTEN NOTICE TO 4,784
THE EMPLOYEE AND EMPLOYER OF THAT ASSIGNMENT. THE EMPLOYEE AND 4,785
EMPLOYER EACH SHALL SELECT A PHYSICIAN FROM THE IMPAIRMENT 4,786
EVALUATION PANEL WHO SHALL SERVE AS CONSULTANTS TO THE ASSIGNED 4,787
PHYSICIAN IF THE EMPLOYEE OR EMPLOYER OBJECTS TO THE ASSIGNED 4,788
PHYSICIAN'S DETERMINATION.
WITHIN TWENTY-ONE DAYS AFTER ASSIGNMENT, THE ASSIGNED 4,790
PHYSICIAN SHALL CONDUCT A MEDICAL EXAMINATION OF THE EMPLOYEE AND 4,792
PROVIDE TO THE ADMINISTRATOR A REPORT OF THE MEDICAL EXAMINATION 4,793
STATING THE EMPLOYEE'S PERCENTAGE OF PERMANENT PARTIAL IMPAIRMENT 4,794
RESULTING FROM THE ALLOWED CONDITIONS IN THE CLAIM UNDER THE MOST 4,795
RECENT EDITION OF THE AMERICAN MEDICAL ASSOCIATION'S GUIDES TO 4,797
THE EVALUATION OF PERMANENT IMPAIRMENT. IMMEDIATELY UPON RECEIPT 4,798
OF THE REPORT, THE ADMINISTRATOR SHALL SEND A COPY OF THE REPORT 4,799
TO THE EMPLOYEE AND EMPLOYER.
WITHIN TWENTY-ONE DAYS AFTER RECEIPT OF THE REPORT, AN 4,801
EMPLOYEE OR EMPLOYER MAY SEND WRITTEN NOTICE TO THE ADMINISTRATOR 4,803
OBJECTING TO THE REPORT. IF A WRITTEN NOTICE OF OBJECTION IS NOT 4,804
TIMELY RECEIVED, THE ASSIGNED PHYSICIAN'S DETERMINATION OF THE 4,805
PERCENTAGE OF PERMANENT PARTIAL IMPAIRMENT OF AN EMPLOYEE IS 4,806
FINAL, NOTWITHSTANDING SECTION 4123.511 OF THE REVISED CODE. IF 4,808
A WRITTEN NOTICE OF OBJECTION IS TIMELY RECEIVED, THE 4,809
ADMINISTRATOR SHALL PROVIDE A COPY OF THE ASSIGNED PHYSICIAN'S 4,810
REPORT TO THE CONSULTING PHYSICIANS SELECTED BY THE EMPLOYEE AND 4,811
EMPLOYER, WITHIN SEVEN DAYS AFTER RECEIPT OF THE OBJECTION. 4,812
WITHIN TWENTY-ONE DAYS AFTER RECEIPT OF THE REPORT, BOTH 4,814
CONSULTING PHYSICIANS SHALL CONFER WITH THE ASSIGNED PHYSICIAN 4,815
AND JOINTLY, ON THE BASIS OF THE OPINION OF A MAJORITY OF THE 4,816
PHYSICIANS, ISSUE A FINAL REPORT STATING THE EMPLOYEE'S 4,817
PERCENTAGE OF PERMANENT PARTIAL IMPAIRMENT RESULTING FROM THE 4,818
113
ALLOWED CONDITIONS IN THE CLAIM UNDER THE MOST RECENT EDITION OF 4,819
THE AMERICAN MEDICAL ASSOCIATION'S GUIDES TO THE EVALUATION OF 4,821
PERMANENT IMPAIRMENT. WITHIN FOURTEEN DAYS AFTER RECEIPT OF THE 4,822
FINAL REPORT, THE ADMINISTRATOR SHALL SEND A COPY OF THE FINAL 4,823
REPORT TO THE EMPLOYEE AND EMPLOYER. NOTWITHSTANDING SECTION 4,824
4123.511 OF THE REVISED CODE, THE PERCENTAGE OF PERMANENT PARTIAL 4,826
IMPAIRMENT OF AN EMPLOYEE STATED IN THE FINAL REPORT ISSUED 4,827
PURSUANT TO DIVISION (A)(7) OF THIS SECTION IS FINAL. 4,829
(8) Compensation payable under this division (A) OF THIS 4,832
SECTION accrues and is payable to the employee from the date of 4,833
last payment of compensation, or, in cases where no previous 4,834
compensation has been paid, from the date of the injury or, FOR 4,835
OCCUPATIONAL DISEASES, the date of the diagnosis of the 4,836
occupational disease. THE EMPLOYEE SHALL RECEIVE SIXTY-SIX AND 4,837
TWO-THIRDS PER CENT OF THE EMPLOYEE'S AVERAGE WEEKLY WAGE, BUT 4,838
NOT MORE THAN A MAXIMUM OF THIRTY-THREE AND ONE-THIRD PER CENT OF 4,839
THE STATEWIDE AVERAGE WEEKLY WAGE AS DEFINED IN DIVISION (C) OF 4,841
SECTION 4123.62 OF THE REVISED CODE, PER WEEK REGARDLESS OF THE 4,842
AVERAGE WEEKLY WAGE FOR THE NUMBER OF WEEKS THAT EQUALS THE 4,843
PERCENTAGE OF TWO HUNDRED WEEKS. IF THE PERCENTAGE OF THE 4,845
PERMANENT IMPAIRMENT OF THE EMPLOYEE EQUALS OR EXCEEDS NINETY PER 4,846
CENT, COMPENSATION FOR PERMANENT PARTIAL IMPAIRMENT SHALL BE PAID 4,847
FOR TWO HUNDRED WEEKS. NO AWARD SHALL BE MADE UNDER DIVISION (A) 4,848
OF THIS SECTION BASED UPON A PERCENTAGE OF IMPAIRMENT THAT, WHEN 4,849
TAKEN WITH ALL OTHER PERCENTAGES OF PERMANENT IMPAIRMENT, EXCEEDS 4,850
ONE HUNDRED PER CENT. NOTWITHSTANDING DIVISION (H) OF SECTION 4,851
4123.511 OF THE REVISED CODE, THE BUREAU OR A SELF-INSURING 4,853
EMPLOYER SHALL PAY A PERMANENT PARTIAL IMPAIRMENT AWARD WITHIN 4,854
TWENTY-ONE DAYS AFTER THE DATE ON WHICH AN ORDER FIXING THE 4,856
EMPLOYEE'S PERCENTAGE OF PERMANENT PARTIAL IMPAIRMENT BECOMES 4,857
FINAL.
AS USED IN THIS DIVISION, "DATE OF DISEASE" MEANS THE DATE 4,860
AN OCCUPATIONAL DISEASE IS FIRST DIAGNOSED BY A LICENSED
PHYSICIAN, OR FOR AN OCCUPATIONAL DISEASE DESCRIBED IN DIVISIONS 4,861
114
(A) THROUGH (AA) OF SECTION 4123.68 OF THE REVISED CODE OR OTHER 4,865
OCCUPATIONAL DISEASE THAT RESULTS FROM EXPOSURE TO 4,866
FIBROSIS-PRODUCING OR TOXIC DUSTS, FUMES, MISTS, VAPORS, GASES, 4,867
OR LIQUIDS, OR OTHER TOXIC MATERIALS, OR A COMBINATION OF THOSE, 4,868
THE DATE THAT THE EMPLOYEE FIRST MISSES WORK AS A RESULT OF THE 4,869
OCCUPATIONAL DISEASE. 4,870
(9) When an award under this division (A) OF THIS SECTION 4,873
has been made prior to the death of an employee, all unpaid 4,875
installments accrued or to accrue under the provisions of the 4,876
award are payable to the surviving spouse, or if there is no 4,877
surviving spouse, to the dependent children of the employee, and 4,878
if there are no children surviving, then to other dependents as 4,879
the administrator determines. 4,880
(B) In cases included in the following schedule the 4,882
compensation payable per week to the employee is the statewide 4,883
average weekly wage as defined in division (C) of section 4123.62 4,884
of the Revised Code per week and shall continue during the 4,885
periods provided in the following schedule: 4,886
For the loss of a thumb, sixty weeks. 4,888
For the loss of a first finger, commonly called index 4,890
finger, thirty-five weeks. 4,891
For the loss of a second finger, thirty weeks. 4,893
For the loss of a third finger, twenty weeks. 4,895
For the loss of a fourth finger, commonly known as the 4,897
little finger, fifteen weeks. 4,898
The loss of a second, or distal, phalange of the thumb is 4,900
considered equal to the loss of one half of such thumb; the loss 4,901
of more than one half of such thumb is considered equal to the 4,902
loss of the whole thumb. 4,903
The loss of the third, or distal, phalange of any finger is 4,905
considered equal to the loss of one-third of the finger. 4,906
The loss of the middle, or second, phalange of any finger 4,908
is considered equal to the loss of two-thirds of the finger. 4,909
The loss of more than the middle and distal phalanges of 4,911
115
any finger is considered equal to the loss of the whole finger. 4,912
In no case shall the amount received for more than one finger 4,913
exceed the amount provided in this schedule for the loss of a 4,914
hand. 4,915
For the loss of the metacarpal bone (bones of the palm) for 4,917
the corresponding thumb, or fingers, add ten weeks to the number 4,918
of weeks under this division. 4,919
For ankylosis (total stiffness of) or contractures (due to 4,921
scars or injuries) which makes any of the fingers, thumbs, or 4,922
parts of either useless, the same number of weeks apply to the 4,923
members or parts thereof as given for the loss thereof. 4,924
If the claimant has suffered the loss of two or more 4,926
fingers by amputation or ankylosis and the nature of his THE 4,927
CLAIMANT'S employment in the course of which the claimant was 4,929
working at the time of the injury or occupational disease is such 4,930
that the handicap or disability IMPAIRMENT resulting from the 4,931
loss of fingers, or loss of use of fingers, exceeds the normal 4,933
handicap or disability IMPAIRMENT resulting from the loss of 4,935
fingers, or loss of use of fingers, the administrator may take 4,936
that fact into consideration and increase the award of 4,937
compensation accordingly, but the award made shall not exceed the 4,938
amount of compensation for loss of a hand. 4,939
For the loss of a hand, one hundred seventy-five weeks. 4,941
For the loss of an arm, two hundred twenty-five weeks. 4,943
For the loss of a great toe, thirty weeks. 4,945
For the loss of one of the toes other than the great toe, 4,947
ten weeks. 4,948
The loss of more than two-thirds of any toe is considered 4,950
equal to the loss of the whole toe. 4,951
The loss of less than two-thirds of any toe is considered 4,953
no loss, except as to the great toe; the loss of the great toe up 4,954
to the interphalangeal joint is co-equal to the loss of one-half 4,955
of the great toe; the loss of the great toe beyond the 4,956
interphalangeal joint is considered equal to the loss of the 4,957
116
whole great toe. 4,958
For the loss of a foot, one hundred fifty weeks. 4,960
For the loss of a leg, two hundred weeks. 4,962
For the loss of the sight of an eye, one hundred 4,964
twenty-five weeks. 4,965
For the permanent partial loss of sight of an eye, the 4,967
portion of one hundred twenty-five weeks as the administrator in 4,968
each case determines, based upon the percentage of vision 4,969
actually lost as a result of the injury or occupational disease, 4,970
but, in no case shall an award of compensation be made for less 4,971
than twenty-five per cent loss of uncorrected vision. "Loss of 4,972
uncorrected vision" means the percentage of vision actually lost 4,973
as the result of the injury or occupational disease. 4,974
For the permanent and total loss of hearing of one ear, 4,976
twenty-five weeks; but in no case shall an award of compensation 4,977
be made for less than permanent and total loss of hearing of one 4,978
ear. 4,979
For the permanent and total loss of hearing, one hundred 4,981
twenty-five weeks; but, except pursuant to the next preceding 4,982
paragraph, in no case shall an award of compensation be made for 4,983
less than permanent and total loss of hearing. 4,984
In case an injury or occupational disease results in 4,986
serious facial or head disfigurement which either impairs or may 4,987
in the future impair the opportunities to secure or retain 4,988
employment, the administrator shall make an award of compensation 4,989
as it THE ADMINISTRATOR deems proper and equitable, in view of 4,990
the nature of the disfigurement, and not to exceed the sum of 4,992
five thousand dollars. For the purpose of making the award, it 4,993
is not material whether the employee is gainfully employed in any 4,994
occupation or trade at the time of the administrator's 4,995
determination.
When an award under this division has been made prior to 4,997
the death of an employee all unpaid installments accrued or to 4,998
accrue under the provisions of the award shall be payable to the 4,999
117
surviving spouse, or if there is no surviving spouse, to the 5,000
dependent children of the employee and if there are no such 5,001
children, then to such dependents as the administrator 5,002
determines. 5,003
When an employee has sustained the loss of a member by 5,005
severance, but no award has been made on account thereof prior to 5,006
his THE EMPLOYEE'S death, the administrator shall make an award 5,007
in accordance with this division for the loss which shall be 5,009
payable to the surviving spouse, or if there is no surviving 5,010
spouse, to the dependent children of the employee and if there 5,011
are no such children, then to such dependents as the 5,012
administrator determines. 5,013
(C) Compensation for partial disability IMPAIRMENT under 5,015
divisions (A) and (B) of this section is in addition to the 5,017
compensation paid the employee pursuant to section 4123.56 of the 5,018
Revised Code. A claimant may receive compensation under 5,019
divisions (A) and (B) of this section. NO EMPLOYEE MAY RECEIVE 5,020
COMPENSATION UNDER DIVISION (A) OF THIS SECTION OR RECEIVE A 5,022
MEDICAL EXAMINATION PROVIDED FOR BY THIS SECTION DURING THE TIME 5,023
IN WHICH THAT EMPLOYEE IS RECEIVING COMPENSATION UNDER SECTION
4123.58 OF THE REVISED CODE IN ANY CLAIM OR IS RECEIVING 5,026
COMPENSATION UNDER SECTION 4123.56 OF THE REVISED CODE ON THE 5,028
SAME CLAIM IN WHICH THE EMPLOYEE IS SEEKING COMPENSATION UNDER 5,029
THIS SECTION. THE EMPLOYEE SHALL LIST ON THE APPLICATION 5,030
SPECIFIED IN DIVISIONS (A)(1) AND (2) OF THIS SECTION THE CLAIM 5,031
NUMBERS OF ALL OTHER CLAIMS FOR WHICH THE EMPLOYEE IS A CLAIMANT. 5,032
In all cases arising under division (B) of this section, if 5,034
it is determined by any one of the following: (1) the amputee 5,035
clinic at University hospital, Ohio state university; (2) the 5,036
rehabilitation services commission; (3) an amputee clinic or 5,037
prescribing physician approved by the administrator or his THE 5,038
ADMINISTRATOR'S designee, that an injured or disabled IMPAIRED 5,040
employee is in need of an artificial appliance, or in need of a 5,042
repair thereof, regardless of whether the appliance or its repair 5,043
118
will be serviceable in the vocational rehabilitation of the 5,044
injured employee, and regardless of whether the employee has 5,045
returned to or can ever again return to any gainful employment, 5,046
the bureau shall pay the cost of the artificial appliance or its 5,047
repair out of the surplus created by division (B) of section 5,048
4123.34 of the Revised Code.
In those cases where a rehabilitation services commission 5,050
recommendation that an injured or disabled IMPAIRED employee is 5,051
in need of an artificial appliance would conflict with their 5,053
state plan, adopted pursuant to the "Rehabilitation Act of 1973," 5,054
87 Stat. 355, 29 U.S.C.A. 701, the administrator or his THE 5,055
ADMINISTRATOR'S designee or the bureau may obtain a 5,057
recommendation from an amputee clinic or prescribing physician 5,058
that they determine appropriate.
(D) If an employee of a state fund employer makes 5,060
application for a finding and the administrator finds that he has 5,062
IS FOUND TO HAVE contracted silicosis as defined in division (X), 5,063
or coal miners' pneumoconiosis as defined in division (Y), or 5,064
asbestosis as defined in division (AA) of section 4123.68 of the 5,065
Revised Code, and IT IS FOUND that a change of such employee's 5,066
occupation is medically advisable in order to decrease 5,068
substantially further exposure to silica dust, asbestos, or coal 5,069
dust and if the employee, after the finding, has changed or shall 5,070
change his THE EMPLOYEE'S occupation to an occupation in which 5,072
the exposure to silica dust, asbestos, or coal dust is 5,073
substantially decreased, the administrator shall allow to the 5,074
employee SHALL RECEIVE an amount equal to fifty per cent of the 5,075
statewide average weekly wage per week for a period of thirty 5,076
weeks, commencing as of the date of the discontinuance or change, 5,077
and for a period of one hundred weeks immediately following the 5,078
expiration of the period of thirty weeks the administrator shall 5,079
allow, the employee SHALL RECEIVE sixty-six and two-thirds per 5,081
cent of the loss of wages resulting directly and solely from the 5,082
change of occupation but not to exceed a maximum of an amount 5,083
119
equal to fifty per cent of the statewide average weekly wage per 5,084
week. No such employee is entitled to receive more than one 5,085
allowance on account of discontinuance of employment or change of 5,086
occupation and benefits shall cease for any period during which 5,087
the employee is employed in an occupation in which the exposure 5,088
to silica dust, asbestos, or coal dust is not substantially less 5,089
than the exposure in the occupation in which he THE EMPLOYEE was 5,090
formerly employed or for any period during which the employee may 5,092
be entitled to receive compensation or benefits under section 5,093
4123.68 of the Revised Code on account of disability from 5,094
silicosis, asbestosis, or coal miners' pneumoconiosis. An award 5,095
for change of occupation for a coal miner who has contracted coal 5,096
miners' pneumoconiosis may be granted under this division even 5,097
though he THE COAL MINER continues his employment with the same 5,099
employer, so long as his THE COAL MINER'S employment subsequent 5,101
to the change is such that his THE COAL MINER'S exposure to coal 5,103
dust is substantially decreased and a change of occupation is 5,104
certified by the claimant as permanent. The administrator may
accord to the employee medical MEDICAL and other benefits SHALL 5,105
BE PAID TO THE EMPLOYEE in accordance with section 4123.66 of the 5,107
Revised Code.
(E) If a fire fighter FIREFIGHTER or police officer makes 5,109
application for a finding and the administrator finds that he THE 5,111
FIREFIGHTER OR POLICE OFFICER has contracted a cardiovascular and 5,113
pulmonary disease as defined in division (W) of section 4123.68 5,114
of the Revised Code, and that a change of the fire fighter's 5,115
FIREFIGHTER'S or police officer's occupation is medically 5,116
advisable in order to decrease substantially further exposure to 5,117
smoke, toxic gases, chemical fumes, and other toxic vapors, and 5,118
if the fire fighter FIREFIGHTER, or police officer, after the 5,119
finding, has changed or changes his occupation to an occupation 5,121
in which the exposure to smoke, toxic gases, chemical fumes, and 5,122
other toxic vapors is substantially decreased, the administrator 5,123
shall allow to the fire fighter FIREFIGHTER or police officer an 5,124
120
amount equal to fifty per cent of the statewide average weekly 5,126
wage per week for a period of thirty weeks, commencing as of the 5,127
date of the discontinuance or change, and for a period of 5,128
seventy-five weeks immediately following the expiration of the 5,129
period of thirty weeks the administrator shall allow the fire 5,130
fighter FIREFIGHTER or police officer sixty-six and two-thirds 5,132
per cent of the loss of wages resulting directly and solely from 5,133
the change of occupation but not to exceed a maximum of an amount 5,134
equal to fifty per cent of the statewide average weekly wage per 5,135
week. No such fire fighter FIREFIGHTER or police officer is 5,137
entitled to receive more than one allowance on account of 5,138
discontinuance of employment or change of occupation and benefits 5,139
shall cease for any period during which the fire fighter 5,140
FIREFIGHTER or police officer is employed in an occupation in 5,142
which the exposure to smoke, toxic gases, chemical fumes, and
other toxic vapors is not substantially less than the exposure in 5,143
the occupation in which he THE FIREFIGHTER OR POLICE OFFICER was 5,144
formerly employed or for any period during which the fire fighter 5,146
FIREFIGHTER or police officer may be entitled to receive 5,148
compensation or benefits under section 4123.68 of the Revised 5,149
Code on account of disability from a cardiovascular and pulmonary 5,150
disease. The administrator may accord to the fire fighter 5,151
FIREFIGHTER or police officer medical and other benefits in 5,153
accordance with section 4123.66 of the Revised Code.
(F) An order issued under DIVISION (B), (D), OR (E) OF 5,156
this section is appealable pursuant to section 4123.511 of the 5,157
Revised Code but is not appealable to court under section 5,158
4123.512 of the Revised Code.
Sec. 4123.58. (A) In cases of permanent total disability 5,167
IMPAIRMENT, the employee shall receive an award to continue until 5,169
his death in the amount of sixty-six and two-thirds per cent of 5,170
his THE EMPLOYEE'S average weekly wage, but, except as otherwise 5,172
provided in division (B) of this section, not more than a maximum 5,173
amount of weekly compensation which is equal to sixty-six and 5,174
121
two-thirds per cent of the statewide average weekly wage as 5,175
defined in division (C) of section 4123.62 of the Revised Code, 5,176
nor not less than a minimum amount of weekly compensation which 5,177
is equal to fifty per cent of the statewide average weekly wage 5,178
as defined in division (C) of section 4123.62 of the Revised 5,179
Code, unless the employee's average weekly wage is less than 5,180
fifty per cent of the statewide average weekly wage at the time 5,181
of the injury, in which event he THE EMPLOYEE shall receive 5,182
compensation in an amount equal to his THE EMPLOYEE'S average 5,183
weekly wage. PERMANENT TOTAL IMPAIRMENT MEANS THAT THE PHYSICAL 5,184
OR MENTAL LIMITATIONS THAT DIRECTLY RESULT FROM THE ALLOWED 5,185
CONDITIONS IN THE EMPLOYEE'S CLAIM OR CLAIMS PREVENT THE EMPLOYEE 5,186
FROM ENGAGING IN SUSTAINED REMUNERATIVE EMPLOYMENT. A STAFF 5,187
HEARING OFFICER MAY CONSIDER AN EMPLOYEE'S AGE IN DETERMINING 5,189
WHETHER THE EMPLOYEE IS PREVENTED FROM ENGAGING IN SUSTAINED 5,190
REMUNERATIVE EMPLOYMENT OR FROM ACQUIRING THE CAPACITY TO ENGAGE 5,191
IN SUSTAINED REMUNERATIVE EMPLOYMENT THROUGH TRAINING,
REHABILITATION, EDUCATION, OR OTHER SIMILAR EFFORTS, SUBJECT TO 5,192
BOTH OF THE FOLLOWING: 5,193
(1) AN EMPLOYEE IS NOT ENTITLED TO COMPENSATION FOR 5,195
PERMANENT TOTAL IMPAIRMENT WHEN THE EMPLOYEE'S AGE IS THE PRIMARY 5,197
REASON THAT THE EMPLOYEE IS PREVENTED FROM ENGAGING IN OR FROM 5,198
ACQUIRING THE CAPACITY TO ENGAGE IN SUSTAINED REMUNERATIVE 5,199
EMPLOYMENT;
(2) A STAFF HEARING OFFICER MAY DETERMINE WHETHER AN 5,201
EMPLOYEE IS ENTITLED TO COMPENSATION FOR PERMANENT TOTAL 5,202
IMPAIRMENT WHEN THE EMPLOYEE'S AGE IS A REASON, BUT NOT THE 5,204
PRIMARY REASON, THAT THE EMPLOYEE IS PREVENTED FROM ENGAGING IN 5,205
OR FROM ACQUIRING THE CAPACITY TO ENGAGE IN SUSTAINED
REMUNERATIVE EMPLOYMENT. 5,206
(B) In the event the weekly workers' compensation amount 5,208
when combined with disability benefits received pursuant to the 5,209
Social Security Act is less than the statewide average weekly 5,210
wage as defined in division (C) of section 4123.62 of the Revised 5,211
122
Code, then the maximum amount of weekly compensation shall be the 5,212
statewide average weekly wage as defined in division (C) of 5,213
section 4123.62 of the Revised Code. At any time that social 5,214
security disability benefits terminate or are reduced, the 5,215
workers' compensation award shall be recomputed to pay the 5,216
maximum amount permitted under this division. 5,217
(C) The loss or loss of use of both hands or both arms, or 5,219
both feet or both legs, or both eyes, or of any two thereof, 5,220
constitutes total and permanent disability IMPAIRMENT, to be 5,221
compensated according to this section. Compensation payable 5,223
under this section for permanent total disability IMPAIRMENT is 5,224
in addition to benefits payable under division (B) of section 5,226
4123.57 of the Revised Code. 5,227
Sec. 4123.59. In case an injury to or an occupational 5,236
disease contracted by an employee causes his THE EMPLOYEE'S 5,237
death, benefits shall be in the amount and to the persons 5,239
following:
(A) If there are no dependents, the disbursements from the 5,241
state insurance fund is limited to the expenses provided for in 5,242
section 4123.66 of the Revised Code. 5,243
(B) If there are wholly dependent persons at the time of 5,245
the death, the weekly payment is sixty-six and two-thirds per 5,246
cent of the average weekly wage, but not to exceed a maximum 5,247
aggregate amount of weekly compensation which is equal to 5,248
sixty-six and two-thirds per cent of the statewide average weekly 5,249
wage as defined in division (C) of section 4123.62 of the Revised 5,250
Code, and not in any event less than a minimum amount of weekly 5,251
compensation which is equal to fifty per cent of the statewide 5,252
average weekly wage as defined in division (C) of section 4123.62 5,253
of the Revised Code, regardless of the average weekly wage; 5,254
provided however, that if the death is due to injury received or 5,255
occupational disease first diagnosed after January 1, 1976, the 5,256
weekly payment is sixty-six and two-thirds per cent of the 5,257
average weekly wage but not to exceed a maximum aggregate amount 5,258
123
of weekly compensation which is equal to the statewide average 5,259
weekly wage as defined in division (C) of section 4123.62 of the 5,260
Revised Code; provided that when any claimant is receiving total 5,261
disability OR IMPAIRMENT compensation at the time of death the 5,262
wholly dependent person is eligible for the maximum compensation 5,264
provided for in this section. Where there is more than one person 5,265
who is wholly dependent at the time of the death of the employee, 5,266
the administrator of workers' compensation shall promptly 5,267
apportion the weekly amount of compensation payable under this 5,268
section among the dependent persons as provided in division (D) 5,269
of this section. 5,270
(1) The payment as provided in this section shall continue 5,272
from the date of death of an injured, IMPAIRED, or disabled 5,274
employee until the death or remarriage of such dependent spouse. 5,276
If the dependent spouse remarries, an amount equal to two years 5,277
of compensation benefits at the weekly amount determined to be 5,278
applicable to and being paid to the dependent spouse shall be 5,279
paid in a lump sum to such spouse and no further compensation 5,280
shall be paid to such spouse. 5,281
(2) That portion of the payment provided in division (B) 5,283
of this section applicable to wholly dependent persons other than 5,284
a spouse shall continue from the date of death of an injured, 5,285
IMPAIRED, or disabled employee to a dependent as of the date of 5,287
death, other than a spouse, at the weekly amount determined to be 5,288
applicable and being paid to such dependent other than a spouse, 5,289
until he THE DEPENDENT: 5,290
(a) Reaches eighteen years of age; 5,292
(b) If pursuing a full time educational program while 5,294
enrolled in an accredited educational institution and program, 5,295
reaches twenty-five years of age; 5,296
(c) If mentally or physically incapacitated from having 5,298
any earnings, is no longer so incapacitated. 5,299
(C) If there are partly dependent persons at the time of 5,301
the death the weekly payment is sixty-six and two-thirds per cent 5,302
124
of the employee's average weekly wage, not to exceed sixty-six 5,303
and two-thirds per cent of the statewide average weekly wage as 5,304
defined in division (C) of section 4123.62 of the Revised Code, 5,305
and shall continue for such time as the administrator in each 5,306
case determines. 5,307
(D) The following persons are presumed to be wholly 5,309
dependent for their support upon a deceased employee: 5,310
(1) A surviving spouse who was living with the employee at 5,312
the time of death or a surviving spouse who was separated from 5,313
the employee at the time of death because of the aggression of 5,314
the employee; 5,315
(2) A child under the age of eighteen years, or 5,317
twenty-five years if pursuing a full-time educational program 5,318
while enrolled in an accredited educational institution and 5,319
program, or over said THAT age if physically or mentally 5,320
incapacitated from earning, upon only the one parent who is 5,322
contributing more than one-half of the support for such child and 5,323
with whom he THAT CHILD is living at the time of the death of 5,325
such parent, or for whose maintenance such parent was legally 5,326
liable at the time of his THE PARENT'S death. 5,328
It is presumed that there is sufficient dependency to 5,330
entitle a surviving natural parent or surviving natural parents, 5,331
share and share alike, with whom the decedent was living at the 5,332
time of his death, to a total minimum award of three AT LEAST 5,333
FIVE thousand dollars. 5,334
The administrator may take into consideration any 5,336
circumstances which, at the time of the death of the decedent, 5,337
clearly indicate prospective dependency on the part of the 5,338
claimant and potential support on the part of the decedent. No 5,339
person shall be considered a prospective dependent unless such 5,340
person is a member of the family of the deceased employee and 5,341
bears to him THE DECEDENT the relation of surviving spouse, 5,342
lineal descendant, ancestor, or brother, or sister. The total 5,344
award for any or all prospective dependency to all such 5,345
125
claimants, except to a natural parent or natural parents of the 5,346
deceased, shall not exceed three FIVE thousand dollars to be 5,347
apportioned among them as the administrator orders. 5,348
In all other cases, the question of dependency, in whole or 5,350
in part, shall be determined in accordance with the facts in each 5,351
particular case existing at the time of the injury resulting in 5,352
the death of such employee, but no person shall be considered as 5,353
dependent unless such person is a member of the family of the 5,354
deceased employee, or bears to him THE DECEDENT the relation of 5,355
surviving spouse, lineal descendant, ancestor, or brother, or 5,357
sister.
(E) An order issued by the administrator under this 5,359
section is appealable pursuant to sections 4123.511 to 4123.512 5,360
of the Revised Code. 5,361
Sec. 4123.60. (A) Benefits in case of death shall be paid 5,370
to such one or more of the dependents of the decedent, for the 5,371
benefit of all the dependents as the administrator of workers' 5,372
compensation determines. The administrator may apportion the 5,373
benefits among the dependents in such manner as he THE 5,374
ADMINISTRATOR deems just and equitable. Payment to a dependent 5,376
subsequent in right may be made, if the administrator deems it 5,377
proper, and operates to discharge all other claims therefor. The 5,378
dependents or person to whom benefits are paid shall apply the 5,379
same to the use of the several beneficiaries thereof according to 5,380
their respective claims upon the decedent for support, in 5,381
compliance with the finding and direction of the administrator. 5,382
In all cases of death where the dependents are a surviving 5,384
spouse and one or more children, it is sufficient for the 5,385
surviving spouse to apply to the administrator on behalf of the 5,386
spouse and minor children. In cases where all the dependents are 5,387
minors, a guardian or next friend of such minor dependents shall 5,388
apply. 5,389
In all cases where an award had been made on account of 5,391
temporary DISABILITY, or permanent partial IMPAIRMENT, or total 5,393
126
disability OR IMPAIRMENT, in which there remains an unpaid 5,395
balance, representing payments accrued and due to the decedent at 5,396
the time of his death, the administrator may, after satisfactory 5,397
proof has been made warranting such action, MAY award or pay any 5,398
unpaid balance of such award to such of the dependents of the 5,399
decedent, or for services rendered on account of the last illness 5,400
or death of such THAT decedent, as the administrator determines 5,401
in accordance with the circumstances in each such case. If the 5,402
decedent would have been lawfully entitled to have applied for an 5,403
award at the time of his death, the administrator may, after 5,404
satisfactory proof to warrant an award and payment, MAY award and 5,406
pay an amount, not exceeding the compensation which the decedent 5,407
might have received, but for his THE DECEDENT'S death, for the 5,409
period prior to the date of his death, to such of the dependents 5,410
of the decedent, or for services rendered on account of the last 5,411
illness or death of such decedent, as the administrator 5,412
determines in accordance with the circumstances in each such 5,413
case, but such payments may be made only in cases in which 5,414
application for compensation was made in the manner required by 5,415
this chapter, during the lifetime of such injured, IMPAIRED, or 5,416
disabled person, or within one year after the death of such THAT 5,417
injured, IMPAIRED, or disabled person. 5,418
An order issued by the administrator under this section 5,420
DIVISION is appealable pursuant to section 4123.511 of the 5,422
Revised Code but is not appealable to court under section 5,423
4123.512 of the Revised Code. 5,424
(B) THE DEATH OF A CLAIMANT WHO IS ENTITLED TO PAYMENT 5,426
UNDER A SETTLEMENT AGREED TO AND EFFECTIVE IN ACCORDANCE WITH 5,427
SECTION 4123.65 OF THE REVISED CODE DOES NOT ABATE THAT 5,428
SETTLEMENT. PAYMENT OF THAT SETTLEMENT SHALL BE MADE TO THE 5,429
DEPENDENTS OF THE DECEDENT OR, IF THERE ARE NO DEPENDENTS, TO THE
CLAIMANT'S ESTATE. 5,430
Sec. 4123.61. The average weekly wage of an injured 5,439
employee at the time of the injury or at the time disability due 5,441
127
to the occupational disease begins is the basis upon which to
compute benefits. FOR OCCUPATIONAL DISEASE CLAIMS, THE AVERAGE 5,442
WEEKLY WAGE AT THE DATE OF DISEASE IS THE BASIS UPON WHICH TO 5,444
COMPUTE BENEFITS.
In cases of temporary total disability the compensation for 5,446
the first twelve weeks for which compensation is payable shall be 5,447
based on the full weekly wage of the claimant at the time of the 5,448
injury or at the time disability due to occupational DATE OF 5,449
disease begins; when a factory, mine, or other place of 5,451
employment is working short time in order to divide work among 5,452
the employees, the bureau of workers' compensation shall take 5,453
that fact into consideration when determining the wage for the 5,454
first twelve weeks of temporary total disability. 5,455
Compensation for all further temporary total disability 5,457
shall be based as provided for permanent disability IMPAIRMENT 5,458
claims. 5,459
In death, permanent total disability IMPAIRMENT CLAIMS, 5,461
permanent partial disability IMPAIRMENT claims, and impairment of 5,464
earnings claims, the claimant's or the decedent's average weekly 5,466
wage for the year preceding the injury or AT the date the 5,467
disability due to the occupational OF disease begins is the 5,468
weekly wage upon which compensation shall be based. In 5,470
ascertaining the average weekly wage for the year previous to the 5,471
injury, or the date the disability due to the occupational OF 5,472
disease begins, any period of unemployment due to sickness, 5,474
industrial depression, strike, lockout, or other cause beyond the 5,475
employee's control shall be eliminated. 5,476
In cases where there are special circumstances under which 5,478
the average weekly wage cannot justly be determined by applying 5,479
this section, the administrator of workers' compensation, in 5,480
determining the average weekly wage in such cases, shall use such 5,481
method as will enable him THE ADMINISTRATOR to do substantial 5,482
justice to the claimants, PROVIDED THAT THE ADMINISTRATOR SHALL 5,484
NOT ADJUST THE AVERAGE WEEKLY WAGE FOR OR COMPENSATION AWARDED TO 5,485
128
A CLAIMANT PURSUANT TO THIS CHAPTER FOR ANY PERIOD OF TIME IN
WHICH THE CLAIMANT IS ENROLLED AS A FULL- OR PART-TIME STUDENT IN 5,486
A PUBLIC OR PRIVATE COLLEGE OR UNIVERSITY, INCLUDING A TECHNICAL 5,487
COLLEGE CREATED PURSUANT TO CHAPTER 3357. OF THE REVISED CODE OR 5,490
A COMMUNITY COLLEGE AS DEFINED IN SECTION 3354.01 OF THE REVISED 5,491
CODE.
A DETERMINATION MADE BY THE ADMINISTRATOR UNDER THIS 5,493
SECTION IS APPEALABLE PURSUANT TO SECTION 4123.511 OF THE REVISED 5,494
CODE, BUT IT IS NOT APPEALABLE TO COURT UNDER SECTION 4123.512 OF 5,495
THE REVISED CODE.
AS USED IN THIS SECTION, "DATE OF DISEASE" MEANS THE DATE 5,497
AN OCCUPATIONAL DISEASE IS FIRST DIAGNOSED BY A LICENSED 5,498
PHYSICIAN, OR FOR AN OCCUPATIONAL DISEASE DESCRIBED IN DIVISIONS 5,499
(A) THROUGH (AA) OF SECTION 4123.68 OF THE REVISED CODE OR OTHER 5,503
OCCUPATIONAL DISEASE THAT RESULTS FROM EXPOSURE TO
FIBROSIS-PRODUCING OR TOXIC DUSTS, FUMES, MISTS, VAPORS, GASES, 5,504
OR LIQUIDS, OR OTHER TOXIC MATERIALS, OR A COMBINATION OF THOSE, 5,505
THE DATE THAT THE CLAIMANT FIRST MISSES WORK AS A RESULT OF THE 5,506
OCCUPATIONAL DISEASE.
Sec. 4123.62. (A) If it is established that an injured, 5,515
IMPAIRED, or disabled employee was of such age and experience 5,517
when injured, IMPAIRED, or disabled as that under natural 5,519
conditions his THE EMPLOYEE'S wages would be expected to 5,521
increase, the administrator of workers' compensation may consider 5,522
that fact in arriving at his THE EMPLOYEE'S average weekly wage, 5,523
EXCEPT THAT THE ADMINISTRATOR SHALL NOT ADJUST THE AVERAGE WEEKLY 5,524
WAGE OR COMPENSATION AWARDED TO AN EMPLOYEE PURSUANT TO THIS 5,525
CHAPTER FOR ANY PERIOD OF TIME IN WHICH THE EMPLOYEE IS ENROLLED 5,526
AS A FULL- OR PART-TIME STUDENT IN A PUBLIC OR PRIVATE COLLEGE OR 5,527
UNIVERSITY, INCLUDING A TECHNICAL COLLEGE CREATED PURSUANT TO 5,528
CHAPTER 3357. OF THE REVISED CODE OR A COMMUNITY COLLEGE AS 5,529
DEFINED IN SECTION 3354.01 OF THE REVISED CODE. 5,531
(B) On each first day of January, the current maximum 5,533
monthly benefit amounts provided in sections 4123.412, 4123.413, 5,534
129
and 4123.414 of the Revised Code in injury cases shall be 5,535
adjusted based on the United States department of labor's 5,536
national consumer price index. The percentage increase in the 5,537
cost of living using the index figure for the first day of 5,538
September of the preceding year and the first day of September of 5,539
the year preceding that year shall be applied to the maximums in 5,540
effect on the preceding thirty-first day of December to obtain 5,541
the increase in the cost of living during that year. 5,542
In determining the increase in the maximum benefits for any 5,544
year after 1972, the base shall be the national consumer price 5,545
index on the first day of September of the preceding year. The 5,546
increase in the index for the applicable twelve-month period 5,547
shall be determined and shall be divided by the base used. The 5,548
resulting percentage shall be applied to the existing maximums to 5,549
arrive at the new maximums. 5,550
(C) Effective January 1, 1974, and each first day of 5,552
January thereafter, the current maximum weekly benefit amounts 5,553
provided in sections 4123.56, 4123.58, and 4123.59, and division 5,554
(B) of section 4123.57 of the Revised Code shall be adjusted 5,555
based on the increase or decrease in the statewide average weekly 5,556
wage. 5,557
"Statewide average weekly wage" means the average weekly 5,559
earnings of all workers in Ohio employment subject to Chapter 5,560
4141. of the Revised Code as determined as of the first day of 5,561
September for the four full calendar quarters preceding the first 5,562
day of July of each year, by the administrator of the bureau of 5,563
employment services. 5,564
The statewide average weekly wage to be used for the 5,566
determination of compensation for any employee who sustains an 5,567
injury, or death WHO DIES, or who contracts an occupational 5,569
disease WITH A DATE OF DISEASE THAT ARISES during the subsequent 5,570
calendar year beginning with the first day of January, shall be 5,571
the statewide average weekly wage so determined as of the prior 5,572
first day of September adjusted to the next higher even multiple 5,573
130
of one dollar.
Any change in benefit amounts is effective with respect to 5,575
injuries sustained, occupational diseases contracted, and deaths 5,577
occurring during the calendar year for which adjustment is made. 5,578
In determining the change in the maximum benefits for any 5,580
year after 1978, the base shall be the statewide average weekly 5,581
wage on the first day of September of the preceding year. 5,582
AS USED IN THIS DIVISION, "DATE OF DISEASE" MEANS THE DATE 5,584
AN OCCUPATIONAL DISEASE IS FIRST DIAGNOSED BY A LICENSED 5,585
PHYSICIAN, OR FOR AN OCCUPATIONAL DISEASE DESCRIBED IN DIVISIONS 5,586
(A) THROUGH (AA) OF SECTION 4123.68 OF THE REVISED CODE, OR OTHER 5,590
OCCUPATIONAL DISEASE THAT RESULTS FROM EXPOSURE TO
FIBROSIS-PRODUCING OR TOXIC DUSTS, FUMES, MISTS, VAPORS, GASES, 5,591
OR LIQUIDS, OR OTHER TOXIC MATERIALS, OR A COMBINATION OF THOSE, 5,592
THE DATE THAT THE EMPLOYEE FIRST MISSES WORK AS A RESULT OF THE 5,593
OCCUPATIONAL DISEASE.
Sec. 4123.64. (A) The administrator of workers' 5,602
compensation, under special circumstances, and when the same is 5,603
deemed advisable for the purpose of rendering the injured, 5,604
IMPAIRED, or disabled employee financial relief or for the 5,606
purpose of furthering his THE EMPLOYEE'S rehabilitation, may 5,607
commute payments of compensation or benefits to one or more 5,609
lump-sum payments.
(B) The administrator shall adopt rules which set forth 5,611
the policy for awarding lump sum payments. The rules shall: 5,612
(1) Enumerate the allowable purposes for payments and the 5,614
conditions for making such awards; 5,615
(2) Enumerate the maximum reduction in compensation 5,617
allowable; 5,618
(3) Enumerate the documentation necessary to award a 5,620
lump-sum payment; 5,621
(4) Require that all checks include the claimant as a 5,623
payee, except where the check is for the payment of attorney's 5,624
fees in accordance with section 4123.06 of the Revised Code, in 5,625
131
which case the attorney shall be named as the only payee on the 5,626
check; 5,627
(5) Require a fully completed and current application 5,629
including notary and seal; and 5,630
(6) Specify procedures to make a claimant aware of the 5,632
reduction in amount of compensation which will occur. 5,633
(C) An order of the administrator issued under this 5,635
section is appealable pursuant to section 4123.551 of the Revised 5,636
Code but is not appealable to court under section 4123.512 of the 5,637
Revised Code. 5,638
Sec. 4123.65. (A) A state fund employer or the employee 5,647
of such an employer may file an application with the 5,648
administrator of workers' compensation for approval of a final 5,649
settlement of a claim under this chapter. The application shall 5,650
include the settlement agreement, AND EXCEPT AS OTHERWISE 5,651
PROVIDED IN THIS DIVISION, be signed by the claimant and 5,652
employer, and clearly set forth the circumstances by reason of 5,653
which the proposed settlement is deemed desirable and that the 5,654
parties agree to the terms of the settlement agreement provided 5,655
that the. A CLAIMANT MAY FILE AN APPLICATION FOR AN AGREEMENT 5,657
WITHOUT AN EMPLOYER'S SIGNATURE. IF A CLAIMANT FILES AN 5,658
AGREEMENT WITHOUT AN EMPLOYER'S SIGNATURE, AND THE EMPLOYER STILL 5,659
IS DOING BUSINESS IN THIS STATE, THE ADMINISTRATOR SHALL SEND 5,660
WRITTEN NOTICE OF THE APPLICATION TO THE EMPLOYER IMMEDIATELY 5,661
UPON RECEIPT OF THE APPLICATION, AND A SECOND WRITTEN NOTICE
WITHIN FORTY-FIVE DAYS AFTER THE FIRST NOTICE IS SENT, IF THE 5,662
EMPLOYER DOES NOT RESPOND TO THE FIRST NOTICE. IF THE EMPLOYER 5,663
FAILS TO RESPOND TO THE NOTICE WITHIN SIXTY DAYS AFTER RECEIPT OF 5,665
THE NOTICE, OR IF THE CLAIM THAT IS THE SUBJECT OF THE AGREEMENT
NO LONGER REMAINS IN THE ACCIDENT OR OCCUPATIONAL DISEASE 5,666
EXPERIENCE OF THE EMPLOYER, THE AGREEMENT NEED NOT CONTAIN THE 5,667
EMPLOYER'S SIGNATURE. AN agreement need not be signed by the AN 5,668
employer if the employer WHO is no longer doing business in Ohio 5,670
THIS STATE. If a state fund employer or an employee of such an 5,672
132
employer has not filed an application for a final settlement 5,673
under this division, the administrator may file an application on 5,674
behalf of the employer or the employee, provided that the 5,675
administrator gives notice of the filing to the employer and the 5,676
employee and to the representative of record of the employer and 5,677
of the employee immediately upon the filing. An application 5,678
filed by the administrator shall contain all of the information 5,679
and signatures required of an employer or an employee who files 5,680
an application under this division. Every self-insuring employer 5,681
that enters into a final settlement agreement with an employee 5,682
shall mail, within seven days of executing the agreement, a copy 5,683
of the agreement to the administrator and the employee's 5,684
representative. The administrator shall place the agreement into 5,685
the claimant's file. 5,686
(B) Except as provided in divisions (C) and (D) of this 5,688
section, a settlement agreed to under this section is binding 5,689
upon all parties thereto and as to items, injuries, and 5,690
occupational diseases to which the settlement applies. 5,691
(C) No settlement agreed to under division (A) of this 5,693
section or agreed to by a self-insuring employer and the 5,694
self-insuring employer's employee shall take effect until thirty 5,695
days after the administrator approves the settlement for state 5,696
fund employees and employers, or after the self-insuring employer 5,697
and employee sign the final settlement agreement. During the 5,698
thirty-day period, the employer, employee, or administrator, for 5,699
state fund settlements, and the employer or employee, for 5,700
self-insuring settlements, may withdraw consent to OR MAY OBJECT 5,701
TO the settlement by an employer providing written notice to the 5,703
employer's employee and the administrator or by an employee 5,705
providing written notice to the employee's employer and the 5,706
administrator, or by the administrator providing written notice
to the state fund employer and employee. 5,707
(D) At the time of agreement to any final settlement 5,709
agreement under division (A) of this section or agreement between 5,710
133
a self-insuring employer and the self-insuring employer's 5,711
employee, IN CASES IN WHICH ONE OR MORE PARTIES TO THE AGREEMENT 5,712
ARE UNREPRESENTED, the administrator, for state fund settlements, 5,713
and the self-insuring employer, for self-insuring settlements, 5,715
immediately shall send a copy of the agreement to the industrial 5,716
commission who shall assign the matter to a staff hearing 5,717
officer. The staff hearing officer shall determine, within the 5,718
time limitations specified in division (C) of this section, 5,719
whether the settlement agreement is or is not a gross miscarriage 5,720
of justice CLEARLY UNFAIR. If the staff hearing officer 5,722
determines within that time period that the settlement agreement 5,723
is clearly unfair, the staff hearing officer shall issue an order
disapproving the settlement agreement. If the staff hearing 5,725
officer determines that the settlement agreement is not clearly 5,726
unfair or fails to act within those time limits, the settlement
agreement is approved. 5,727
(E) A settlement entered into under this section may 5,729
pertain to one or more claims of a claimant, or one or more parts 5,730
of a claim, or the compensation or benefits pertaining to either, 5,731
or any combination thereof, provided that nothing in this section 5,732
shall be interpreted to require a claimant to enter into a 5,733
settlement agreement for every claim that has been filed with the 5,734
bureau of workers' compensation by that claimant under Chapter 5,735
4121., 4123., 4127., or 4131. of the Revised Code. 5,736
(F) A settlement entered into under this section is not 5,738
appealable under section 4123.511 or 4123.512 of the Revised 5,739
Code. 5,740
(G) FOR PURPOSES OF DETERMINING WHETHER A PARTY IS 5,742
UNREPRESENTED AS SPECIFIED IN DIVISION (D) OF THIS SECTION, A 5,744
PARTY IS CONSIDERED REPRESENTED ONLY IF THE PARTY HAS THE 5,745
SERVICES OF ONE OF THE FOLLOWING PERSONS: 5,746
(1) AN ATTORNEY ADMITTED TO THE PRACTICE OF LAW IN THIS 5,748
STATE;
(2) A DULY AUTHORIZED REPRESENTATIVE OF AN EMPLOYEE 5,750
134
ORGANIZATION RECOGNIZED BY THE EMPLOYER FOR COLLECTIVE BARGAINING 5,752
PURPOSES;
(3) A PERSON REGULARLY ENGAGED IN THE BUSINESS OF 5,754
PROVIDING WORKERS' COMPENSATION-RELATED SERVICES TO EMPLOYERS; 5,755
(4) AN EMPLOYEE OF THE SELF-INSURING EMPLOYER WHOSE JOB 5,757
DUTIES OR RESPONSIBILITIES INCLUDE PARTICIPATION IN THE 5,758
ADMINISTRATION OF THE SELF-INSURING EMPLOYER'S WORKERS' 5,759
COMPENSATION PROGRAM.
Sec. 4123.651. (A) The employer of a claimant who is 5,768
injured, IMPAIRED, or disabled in the course of his THE 5,770
CLAIMANT'S employment may require, without the approval of the 5,771
administrator or the industrial commission, that the claimant be 5,772
examined by a physician of the employer's choice one time upon 5,773
any issue asserted by the employee or a physician of the 5,774
employee's choice or which is to be considered by the commission. 5,775
Any further requests for medical examinations shall be made to 5,776
the commission which shall consider and rule on the request. The 5,777
employer shall pay the cost of any examinations initiated by the 5,778
employer.
(B) The bureau of workers' compensation shall prepare a 5,780
form for the release of medical information, records, and reports 5,781
relative to the issues necessary for the administration of a 5,782
claim under this chapter. The claimant promptly shall provide a 5,783
current signed release of the information, records, and reports 5,784
when requested by the employer. The employer promptly shall 5,785
provide copies of all medical information, records, and reports 5,786
to the bureau and to the claimant or his THE CLAIMANT'S 5,787
representative upon request. 5,789
(C) If, without good cause, an employee refuses to submit 5,791
to any examination scheduled under this section or refuses to 5,792
release or execute a release for any medical information, record, 5,793
or report that is required to be released under this section and 5,794
involves an issue pertinent to the condition alleged in the 5,795
claim, his THE EMPLOYEE'S right to have his THE claim for 5,797
135
compensation or benefits considered, if his THE claim is pending 5,798
before the administrator, THE commission, or a district or staff 5,800
hearing officer, or to receive any payment for compensation or 5,801
benefits previously granted, is suspended during the period of 5,802
refusal.
(D) No bureau or commission employee shall alter any 5,804
medical report obtained from a health care provider the bureau or 5,805
commission has selected or cause or request the health care 5,806
provider to alter or change a report. The bureau and commission 5,807
shall make any request for clarification of a health care 5,808
provider's report in writing and shall provide a copy of the 5,809
request to the affected parties and their representatives at the 5,810
time of making the request. 5,811
Sec. 4123.66. (A)(1) In addition to the compensation 5,819
provided for in this chapter, the administrator of workers' 5,820
compensation shall disburse and pay from the state insurance fund 5,821
the amounts for medical, nurse, and hospital services and 5,822
medicine as he THE ADMINISTRATOR deems proper, and, in case death 5,824
ensues from the injury or occupational disease, he THE 5,826
ADMINISTRATOR shall disburse and pay from the fund reasonable 5,828
funeral expenses in an amount not to exceed thirty-two hundred 5,829
EQUAL TO FIVE THOUSAND dollars OR THE TOTAL COST OF THE FUNERAL, 5,830
WHICHEVER IS LESS. The bureau of workers' compensation shall 5,832
reimburse anyone, whether dependent, volunteer, or otherwise, who 5,833
pays the funeral expenses of any employee whose death ensues from 5,834
any injury or occupational disease as provided in this section. 5,835
The administrator may adopt rules, with the advice and consent of 5,836
the workers' compensation oversight commission, with respect to 5,837
furnishing medical, nurse, and hospital service and medicine to 5,838
injured, IMPAIRED, or disabled employees entitled thereto, and 5,840
for the payment therefor. In case an injury or industrial 5,841
accident that injures an employee also causes damage to the 5,843
employee's eyeglasses, artificial teeth or other denture, or 5,844
hearing aid, or in the event an injury or occupational disease 5,845
136
makes it necessary or advisable to replace, repair, or adjust the 5,846
same, the bureau shall disburse and pay a reasonable amount to 5,847
repair or replace the same. 5,848
(2) IF THE ADMINISTRATOR DETERMINES THAT IT IS IN THE 5,850
EMPLOYEE'S BEST INTEREST TO RECEIVE HEALTH CARE IN THE EMPLOYEE'S 5,851
HOME, THE ADMINISTRATOR SHALL DISBURSE AND PAY FROM THE STATE 5,852
INSURANCE FUND, OR THE EMPLOYEE'S SELF-INSURING EMPLOYER, AS 5,853
APPROPRIATE, SHALL PAY THE AMOUNTS NECESSARY FOR IN-HOME HEALTH 5,854
CARE, INCLUDING THE COST OF SERVICES NECESSARY ON A CONTINUOUS 5,855
BASIS, UP TO AND INCLUDING TWENTY-FOUR HOURS A DAY, PROVIDED THAT 5,856
THE ESTIMATED COST OF THAT IN-HOME HEALTH CARE DOES NOT EXCEED 5,857
THE ESTIMATED COST OF RECEIVING THE NECESSARY HEALTH CARE OUTSIDE 5,858
OF THE EMPLOYEE'S HOME. A DETERMINATION MADE UNDER DIVISION 5,860
(A)(2) OF THIS SECTION IS APPEALABLE PURSUANT TO SECTION 4123.511 5,861
OF THE REVISED CODE BUT IS NOT APPEALABLE TO COURT UNDER SECTION 5,862
4123.512 OF THE REVISED CODE. 5,863
(B)(1) If an employer or a welfare plan has provided to or 5,865
on behalf of an employee any benefits or compensation for an 5,866
injury or occupational disease and that injury or occupational 5,867
disease is determined compensable under this chapter, the 5,868
employer or a welfare plan may request that the administrator 5,869
reimburse the employer or welfare plan for the amount the 5,870
employer or welfare plan paid to or on behalf of the employee in 5,871
compensation or benefits. The administrator shall reimburse the 5,872
employer or welfare plan for the compensation and benefits paid 5,873
if, at the time the employer or welfare plan provides the 5,874
benefits or compensation to or on behalf of employee, the injury 5,875
or occupational disease had not been determined to be compensable 5,876
under this chapter and if the employee was not receiving 5,877
compensation or benefits under this chapter for that injury or 5,878
occupational disease. The administrator shall reimburse the 5,879
employer or welfare plan in the amount that the administrator 5,880
would have paid to or on behalf of the employee under this 5,881
chapter if the injury or occupational disease originally would 5,882
137
have been determined compensable under this chapter. If the 5,883
employer is a merit-rated employer, the administrator shall 5,884
adjust the amount of premium next due from the employer according 5,885
to the amount the administrator pays the employer. The 5,886
administrator shall adopt rules, in accordance with Chapter 119. 5,887
of the Revised Code, to implement this division. 5,888
(2) As used in this division, "welfare plan" has the same 5,890
meaning as in division (1) of 29 U.S.C.A. 1002. 5,891
Sec. 4123.68. Every employee who is disabled OR IMPAIRED 5,900
because of the contraction of an occupational disease or the 5,901
dependent of an employee whose death is caused by an occupational 5,902
disease, is entitled to the compensation provided by sections 5,903
4123.55 to 4123.59 and 4123.66 of the Revised Code subject to the 5,904
modifications relating to occupational diseases contained in this 5,905
chapter. An order of the administrator issued under this section 5,906
is appealable pursuant to sections 4123.511 and 4123.512 of the 5,907
Revised Code. 5,908
The following diseases are occupational diseases and 5,910
compensable as such when contracted by an employee in the course 5,911
of the employment in which such employee was engaged and due to 5,912
the nature of any process described in this section. A disease 5,913
which meets the definition of an occupational disease is 5,914
compensable pursuant to this chapter EVEN though it is not 5,915
specifically listed in this section. 5,916
SCHEDULE 5,918
Description of disease or injury and description of 5,920
process: 5,921
(A) Anthrax: Handling of wool, hair, bristles, hides, and 5,923
skins. 5,924
(B) Glanders: Care of any equine animal suffering from 5,926
glanders; handling carcass of such animal. 5,927
(C) Lead poisoning: Any industrial process involving the 5,929
use of lead or its preparations or compounds. 5,930
(D) Mercury poisoning: Any industrial process involving 5,932
138
the use of mercury or its preparations or compounds. 5,933
(E) Phosphorous poisoning: Any industrial process 5,935
involving the use of phosphorous or its preparations or 5,936
compounds. 5,937
(F) Arsenic poisoning: Any industrial process involving 5,939
the use of arsenic or its preparations or compounds. 5,940
(G) Poisoning by benzol or by nitro-derivatives and 5,942
amido-derivatives of benzol (dinitro-benzol, anilin, and others): 5,943
Any industrial process involving the use of benzol or 5,944
nitro-derivatives or amido-derivatives of benzol or its 5,945
preparations or compounds. 5,946
(H) Poisoning by gasoline, benzine, naphtha, or other 5,948
volatile petroleum products: Any industrial process involving 5,949
the use of gasoline, benzine, naphtha, or other volatile 5,950
petroleum products. 5,951
(I) Poisoning by carbon bisulphide: Any industrial 5,953
process involving the use of carbon bisulphide or its 5,954
preparations or compounds. 5,955
(J) Poisoning by wood alcohol: Any industrial process 5,957
involving the use of wood alcohol or its preparations. 5,958
(K) Infection or inflammation of the skin on contact 5,960
surfaces due to oils, cutting compounds or lubricants, dust, 5,961
liquids, fumes, gases, or vapors: Any industrial process 5,962
involving the handling or use of oils, cutting compounds or 5,963
lubricants, or involving contact with dust, liquids, fumes, 5,964
gases, or vapors. 5,965
(L) Epithelion cancer or ulceration of the skin or of the 5,967
corneal surface of the eye due to carbon, pitch, tar, or tarry 5,968
compounds: Handling or industrial use of carbon, pitch, or tarry 5,969
compounds. 5,970
(M) Compressed air illness: Any industrial process 5,972
carried on in compressed air. 5,973
(N) Carbon dioxide poisoning: Any process involving the 5,975
evolution or resulting in the escape of carbon dioxide. 5,976
139
(O) Brass or zinc poisoning: Any process involving the 5,978
manufacture, founding, or refining of brass or the melting or 5,979
smelting of zinc. 5,980
(P) Manganese dioxide poisoning: Any process involving 5,982
the grinding or milling of manganese dioxide or the escape of 5,983
manganese dioxide dust. 5,984
(Q) Radium poisoning: Any industrial process involving 5,986
the use of radium and other radioactive substances in luminous 5,987
paint. 5,988
(R) Tenosynovitis and prepatellar bursitis: Primary 5,990
tenosynovitis characterized by a passive effusion or crepitus 5,991
into the tendon sheath of the flexor or extensor muscles of the 5,992
hand, due to frequently repetitive motions or vibrations, or 5,993
prepatellar bursitis due to continued pressure. 5,994
(S) Chrome ulceration of the skin or nasal passages: Any 5,996
industrial process involving the use of or direct contact with 5,997
chromic acid or bichromates of ammonium, potassium, or sodium or 5,998
their preparations. 5,999
(T) Potassium cyanide poisoning: Any industrial process 6,001
involving the use of or direct contact with potassium cyanide. 6,002
(U) Sulphur dioxide poisoning: Any industrial process in 6,004
which sulphur dioxide gas is evolved by the expansion of liquid 6,005
sulphur dioxide. 6,006
(V) Berylliosis: Berylliosis means a disease of the lungs 6,008
caused by breathing beryllium in the form of dust or fumes, 6,009
producing characteristic changes in the lungs and demonstrated by 6,010
x-ray examination, by biopsy or by autopsy. 6,011
This chapter does not entitle an employee or his THE 6,013
EMPLOYEE'S dependents to compensation, medical treatment, or 6,015
payment of funeral expenses for disability, IMPAIRMENT, or death 6,016
from berylliosis unless the employee has been subjected to 6,018
injurious exposure to beryllium dust or fumes in his THE 6,019
EMPLOYEE'S employment in this state preceding his THE EMPLOYEE'S 6,020
disablement OR IMPAIRMENT and only in the event of such 6,021
140
disability, IMPAIRMENT, or death resulting within eight years 6,024
after the last injurious exposure; provided that such eight-year 6,025
limitation does not apply to disability, IMPAIRMENT, or death 6,026
from exposure occurring after January 1, 1976. In the event of 6,028
death following continuous total disability OR IMPAIRMENT 6,029
commencing within eight years after the last injurious exposure, 6,031
the requirement of death within eight years after the last 6,032
injurious exposure does not apply.
Before awarding compensation for partial or total 6,034
disability OR IMPAIRMENT or death due to berylliosis, the 6,035
administrator of workers' compensation shall refer the claim to a 6,037
qualified medical specialist for examination and recommendation 6,038
with regard to the diagnosis, the extent of the disability OR 6,039
IMPAIRMENT, the nature of the disability OR IMPAIRMENT, whether 6,040
permanent or temporary, the cause of death, and other medical 6,042
questions connected with the claim. An employee shall submit to 6,043
such examinations, including clinical and x-ray examinations, as 6,044
the administrator requires. In the event that an employee 6,045
refuses to submit to examinations, including clinical and x-ray 6,046
examinations, after notice from the administrator, or in the 6,047
event that a claimant for compensation for death due to 6,048
berylliosis fails to produce necessary consents and permits, 6,049
after notice from the administrator, so that such autopsy 6,050
examination and tests may be performed, then all rights for 6,051
compensation are forfeited. The reasonable compensation of such 6,052
specialist and the expenses of examinations and tests shall be 6,053
paid, if the claim is allowed, as part of the expenses of the
claim, otherwise they shall be paid from the surplus fund. 6,054
(W) Cardiovascular, pulmonary, or respiratory diseases 6,056
incurred by fire fighters FIREFIGHTERS or police officers 6,057
following exposure to heat, smoke, toxic gases, chemical fumes 6,059
and other toxic substances: Any cardiovascular, pulmonary, or 6,060
respiratory disease of a fire fighter FIREFIGHTERS or police 6,061
officer OFFICERS caused or induced by the cumulative effect of 6,063
141
exposure to heat, the inhalation of smoke, toxic gases, chemical 6,064
fumes and other toxic substances in the performance of his THEIR 6,065
duty constitutes a presumption, which may be refuted by 6,067
affirmative evidence, that such occurred in the course of and 6,068
arising out of his THEIR employment. For the purpose of this 6,070
section, "fire fighter FIREFIGHTER" means any regular member of a 6,071
lawfully constituted fire department of a municipal corporation 6,072
or township, whether paid or volunteer, and "police officer" 6,073
means any regular member of a lawfully constituted police 6,074
department of a municipal corporation, township or county, 6,075
whether paid or volunteer. 6,076
This chapter does not entitle a fire fighter FIREFIGHTER, 6,078
or police officer, or his THE FIREFIGHTER'S OR POLICE OFFICER'S 6,080
dependents to compensation, medical treatment, or payment of 6,082
funeral expenses for disability, IMPAIRMENT, or death from a 6,083
cardiovascular, pulmonary, or respiratory disease, unless the 6,084
fire fighter FIREFIGHTER or police officer has been subject to 6,085
injurious exposure to heat, smoke, toxic gases, chemical fumes, 6,087
and other toxic substances in his THE FIREFIGHTER'S OR POLICE 6,088
OFFICER'S employment in this state preceding his THE disablement 6,090
OR IMPAIRMENT, some portion of which has been after January 1, 6,091
1967, except as provided in division (E) of section 4123.57 of 6,092
the Revised Code. 6,093
Compensation on account of cardiovascular, pulmonary, or 6,095
respiratory diseases of fire fighters FIREFIGHTERS and police 6,096
officers is payable only in the event of temporary total 6,098
disability, permanent total disability IMPAIRMENT, or death, in 6,099
accordance with section 4123.56, 4123.58, or 4123.59 of the 6,101
Revised Code. Medical, hospital, and nursing expenses are 6,102
payable in accordance with this chapter. Compensation, medical, 6,103
hospital, and nursing expenses are payable only in the event of 6,104
such disability, IMPAIRMENT, or death resulting within eight 6,106
years after the last injurious exposure; provided that such 6,107
eight-year limitation does not apply to disability, IMPAIRMENT, 6,108
142
or death from exposure occurring after January 1, 1976. In the 6,110
event of death following continuous total disability OR 6,111
IMPAIRMENT commencing within eight years after the last injurious 6,112
exposure, the requirement of death within eight years after the 6,113
last injurious exposure does not apply. 6,114
This chapter does not entitle a fire fighter FIREFIGHTER or 6,116
police officer, or his THE dependents OF A FIREFIGHTER OR POLICE 6,118
OFFICER, to compensation, medical, hospital, and nursing 6,121
expenses, or payment of funeral expenses for disability, 6,122
IMPAIRMENT, or death due to a cardiovascular, pulmonary, or 6,123
respiratory disease in the event of failure or omission on the 6,124
part of the fire fighter FIREFIGHTER or police officer truthfully 6,126
to state, when seeking employment, the place, duration, and 6,127
nature of previous employment in answer to an inquiry made by the 6,128
employer.
Before awarding compensation for disability, IMPAIRMENT, or 6,131
death under this division, the administrator shall refer the 6,132
claim to a qualified medical specialist for examination and 6,133
recommendation with regard to the diagnosis, the extent of 6,134
disability OR IMPAIRMENT, the cause of death, and other medical 6,136
questions connected with the claim. A fire fighter FIREFIGHTER or 6,137
police officer shall submit to such examinations, including 6,139
clinical and x-ray examinations, as the administrator requires. 6,140
In the event that a fire fighter FIREFIGHTER or police officer 6,142
refuses to submit to examinations, including clinical and x-ray 6,143
examinations, after notice from the administrator, or in the 6,144
event that a claimant for compensation for death under this 6,145
division fails to produce necessary consents and permits, after 6,146
notice from the administrator, so that such autopsy examination 6,147
and tests may be performed, then all rights for compensation are 6,148
forfeited. The reasonable compensation of such specialists and 6,149
the expenses of examination and tests shall be paid, if the claim 6,150
is allowed, as part of the expenses of the claim, otherwise they 6,151
shall be paid from the surplus fund.
143
(X) Silicosis: Silicosis means a disease of the lungs 6,153
caused by breathing silica dust (silicon dioxide) producing 6,154
fibrous nodules distributed through the lungs and demonstrated by 6,155
x-ray examination, by biopsy or by autopsy. 6,156
(Y) Coal miners' pneumoconiosis: Coal miners' 6,158
pneumoconiosis, commonly referred to as "black lung disease," 6,159
resulting from working in the coal mine industry and due to 6,160
exposure to the breathing of coal dust, and demonstrated by x-ray 6,161
examination, biopsy, autopsy or other medical or clinical tests. 6,162
This chapter does not entitle an employee or his THE 6,164
EMPLOYEE'S dependents to compensation, medical treatment, or 6,166
payment of funeral expenses for disability, IMPAIRMENT, or death 6,167
from silicosis, asbestosis, or coal miners' pneumoconiosis unless 6,169
the employee has been subject to injurious exposure to silica 6,170
dust (silicon dioxide), asbestos, or coal dust in his THE 6,171
EMPLOYEE'S employment in this state preceding his THE disablement 6,173
OR IMPAIRMENT, some portion of which has been after October 12, 6,174
1945, except as provided in division (E) of section 4123.57 of 6,175
the Revised Code. 6,176
Compensation on account of silicosis, asbestosis, or coal 6,178
miners' pneumoconiosis are payable only in the event of temporary 6,179
total disability, permanent total disability IMPAIRMENT, or 6,180
death, in accordance with sections 4123.56, 4123.58, and 4123.59 6,182
of the Revised Code. Medical, hospital, and nursing expenses are 6,183
payable in accordance with this chapter. Compensation, medical, 6,184
hospital, and nursing expenses are payable only in the event of 6,185
such disability, IMPAIRMENT, or death resulting within eight 6,187
years after the last injurious exposure; provided that such 6,188
eight-year limitation does not apply to disability, IMPAIRMENT, 6,189
or death occurring after January 1, 1976, and further provided 6,191
that such eight-year limitation does not apply to any asbestosis 6,192
cases. In the event of death following continuous total 6,193
disability OR IMPAIRMENT commencing within eight years after the 6,195
last injurious exposure, the requirement of death within eight 6,196
144
years after the last injurious exposure does not apply. 6,197
This chapter does not entitle an employee or his THE 6,199
EMPLOYEE'S dependents to compensation, medical, hospital, and 6,201
nursing expenses, or payment of funeral expenses for disability, 6,202
IMPAIRMENT, or death due to silicosis, asbestosis, or coal 6,204
miners' pneumoconiosis in the event of the failure or omission on 6,205
the part of the employee truthfully to state, when seeking 6,206
employment, the place, duration, and nature of previous 6,207
employment in answer to an inquiry made by the employer. 6,208
Before awarding WHEN compensation IS REQUESTED for 6,210
disability, IMPAIRMENT, or death due to silicosis, asbestosis, or 6,213
coal miners' pneumoconiosis, the administrator shall refer MAY 6,214
DETERMINE WHETHER THERE IS SUFFICIENT LIKELIHOOD THAT ANY OF 6,215
THOSE DISEASES EXISTS, CAUSES DISABILITY OR IMPAIRMENT, OR CAUSED 6,217
DEATH TO WARRANT REFERRING the claim to a qualified medical
specialist for examination and recommendation with regard to the 6,218
diagnosis, the extent of disability OR IMPAIRMENT, the cause of 6,219
death, and other medical questions connected with the claim. IN 6,221
NO EVENT SHALL COMPENSATION FOR DISABILITY, IMPAIRMENT, OR DEATH 6,222
DUE TO SILICOSIS, ASBESTOSIS, OR COAL MINERS' PNEUMOCONIOSIS BE 6,223
AWARDED WITHOUT THE CLAIM BEING REFERRED TO A QUALIFIED MEDICAL 6,224
SPECIALIST FOR THAT EXAMINATION AND RECOMMENDATION. An employee 6,225
shall submit to such examinations, including clinical and x-ray 6,226
examinations, as the administrator requires. In the event that 6,227
an employee refuses to submit to examinations, including clinical 6,228
and x-ray examinations, after notice from the administrator, or 6,229
in the event that a claimant for compensation for death due to 6,230
silicosis, asbestosis, or coal miners' pneumoconiosis fails to 6,231
produce necessary consents and permits, after notice from the 6,232
commission, so that such autopsy examination and tests may be 6,233
performed, then all rights for compensation are forfeited. The 6,234
reasonable compensation of such specialist and the expenses of 6,235
examinations and tests shall be paid, if the claim is allowed, as 6,236
a part of the expenses of the claim, otherwise they shall be paid 6,237
145
from the surplus fund. 6,238
(Z) Radiation illness: Any industrial process involving 6,240
the use of radioactive materials. 6,241
Claims for compensation and benefits due to radiation 6,243
illness are payable only in the event death, IMPAIRMENT, or 6,245
disability occurred within eight years after the last injurious 6,246
exposure provided that such eight-year limitation does not apply 6,247
to disability, IMPAIRMENT, or death from exposure occurring after 6,249
January 1, 1976. In the event of death following continuous 6,250
disability OR IMPAIRMENT which commenced within eight years of 6,252
the last injurious exposure, the requirement of death within 6,253
eight years after the last injurious exposure does not apply. 6,254
(AA) Asbestosis: Asbestosis means a disease caused by 6,256
inhalation or ingestion of asbestos, demonstrated by x-ray 6,257
examination, biopsy, autopsy, or other objective medical or 6,258
clinical tests. 6,259
All conditions, restrictions, limitations, and other 6,261
provisions of this section, with reference to the payment of 6,262
compensation or benefits on account of silicosis or coal miners' 6,263
pneumoconiosis apply to the payment of compensation or benefits 6,264
on account of any other occupational disease of the respiratory 6,265
tract resulting from injurious exposures to dust. 6,266
The refusal to produce the necessary consents and permits 6,268
for autopsy examination and testing shall not result in 6,269
forfeiture of compensation provided the administrator finds that 6,270
such refusal was the result of bona fide religious convictions or 6,271
teachings to which the claimant for compensation adhered prior to 6,272
the death of the decedent. 6,273
Sec. 4123.70. No compensation shall be awarded on account 6,282
of disability, IMPAIRMENT, or death from disease suffered by an 6,284
employee who, at the time of entering into the employment from 6,285
which the disease is claimed to have resulted, willfully and 6,286
falsely represented himself THE EMPLOYEE as not having previously 6,287
suffered from such disease. Compensation shall not be awarded on 6,289
146
account of both injury and disease, except when the disability OR 6,290
IMPAIRMENT is caused by a disease and an injury, in which event 6,291
the administrator of workers' compensation may apportion the 6,292
payment of compensation provided for in sections 4123.56 to 6,293
4123.59 of the Revised Code between the funds as in his THE 6,294
ADMINISTRATOR'S judgment seems just and proper. 6,295
If an employee is suffering from both occupational disease 6,297
and an injury, and the administrator can determine which is 6,298
causing his THE EMPLOYEE'S disability OR IMPAIRMENT, the 6,299
administrator shall pay compensation therefor from the proper 6,301
fund.
Compensation for loss sustained on account of occupational 6,303
disease by an employee mentioned in division (A)(1) of section 6,304
4123.01 of the Revised Code, or the dependents of such employee, 6,305
shall be paid from the fund provided for in sections 4123.38 to 6,306
4123.41 and 4123.48 of the Revised Code. 6,307
Compensation for loss sustained on account of a disease by 6,309
an employee mentioned in division (A)(2) of section 4123.01 of 6,310
the Revised Code, or the dependents of the employee, shall be 6,311
paid from the occupational disease fund or by the employer of the 6,312
employee, if the employer is a self-insuring employer. 6,313
Sec. 4123.80. No agreement by an employee to waive his THE 6,321
EMPLOYEE'S rights to compensation under this chapter is valid, 6,323
except that:
(A) An employee who is blind may waive the compensation 6,325
that may become due him TO THE EMPLOYEE for injury, IMPAIRMENT, 6,327
or disability in cases where the injury, IMPAIRMENT, or 6,328
disability may be directly caused by or due to his THAT 6,330
blindness. The administrator of workers' compensation, with the 6,332
advice and consent of the workers' compensation oversight 6,334
commission, may adopt and enforce rules governing the employment 6,336
of such persons and the inspection of their places of employment. 6,337
(B) An employee may waive his THE EMPLOYEE'S rights to 6,339
compensation or benefits as authorized pursuant to division 6,340
147
(C)(3) of section 4123.01 OR SECTION 4123.15 of the Revised Code. 6,342
No agreement by an employee to pay any portion of the 6,344
premium paid by his THE EMPLOYEE'S employer into the state 6,346
insurance fund is valid.
Sec. 4123.82. (A) All contracts and agreements are void 6,355
which undertake to indemnify or insure an employer against loss 6,356
or liability for the payment of compensation to workers or their 6,357
dependents for death, injury, or occupational disease occasioned 6,358
in the course of the workers' employment, or which provide that 6,359
the insurer shall pay the compensation, or which indemnify the 6,360
employer against damages when the injury, disease, or death 6,361
arises from the failure to comply with any lawful requirement for 6,362
the protection of the lives, health, and safety of employees, or 6,363
when the same is occasioned by the willful act of the employer or 6,364
any of his THE EMPLOYER'S officers or agents, or by which it is 6,365
agreed that the insurer shall pay any such damages. No license 6,367
or authority to enter into any such agreements or issue any such 6,368
policies of insurance shall be granted or issued by any public 6,369
authority in this state. Any corporation organized or admitted 6,370
under the laws of this state to transact liability insurance as 6,371
defined in section 3929.01 of the Revised Code may by amendment 6,372
of its articles of incorporation or by original articles of 6,373
incorporation, provide therein for the authority and purpose to 6,374
make insurance in states, territories, districts, and counties, 6,375
other than the state of Ohio, and in the state of Ohio in respect 6,376
of contracts permitted by division (B) of this section, 6,377
indemnifying employers against loss or liability for payment of 6,378
compensation to workers and employees and their dependents for 6,379
death, injury, or occupational disease occasioned in the course 6,380
of the employment and to insure and indemnify employers against 6,381
loss, expense, and liability by risk of bodily injury or death by 6,382
accident, disability, IMPAIRMENT, sickness, or disease suffered 6,383
by workers and employees for which the employer may be liable or 6,385
has assumed liability. 6,386
148
(B) Notwithstanding division (A) of this section: 6,388
(1) No contract because of that division is void which 6,390
undertakes to indemnify a self-insuring employer against all or 6,391
part of such employer's loss in excess of at least fifty thousand 6,392
dollars from any one disaster or event arising out of the 6,393
employer's liability under this chapter, but no insurance 6,394
corporation shall, directly or indirectly, SHALL represent an 6,395
employer in the settlement, adjudication, determination, 6,396
allowance, or payment of claims. The superintendent of insurance 6,397
shall enforce this prohibition by such disciplinary orders 6,398
directed against the offending insurance corporation as the 6,399
superintendent of insurance deems appropriate in the 6,400
circumstances and the administrator of workers' compensation 6,401
shall enforce this prohibition by such disciplinary orders 6,402
directed against the offending employer as the administrator 6,403
deems appropriate in the circumstances, which orders may include 6,404
revocation of the insurance corporation's right to enter into 6,405
indemnity contracts and revocation of the employer's status as a 6,406
self-insuring employer. 6,407
(2) The administrator may enter into a contract of 6,409
indemnity with any such employer upon such terms, payment of such 6,410
premium, and for such amount and form of indemnity as the 6,411
administrator determines and the administrator may procure 6,412
reinsurance of the liability of the public and private funds 6,413
under this chapter, or any part of the liability in respect of 6,414
either or both of the funds, upon such terms and premiums or 6,415
other payments from the fund or funds as the administrator deems 6,416
prudent in the maintenance of a solvent fund or funds from year 6,417
to year. When making the finding of fact which the administrator 6,418
is required by section 4123.35 of the Revised Code to make with 6,419
respect to the financial ability of an employer, no contract of 6,420
indemnity, or the ability of the employer to procure such a 6,421
contract, shall be considered as increasing the financial ability 6,422
of the employer. 6,423
149
Sec. 4123.84. (A) In all cases of injury or death, claims 6,432
for compensation or benefits for the specific part or parts of 6,433
the body injured shall be forever barred unless, within two years 6,434
after the injury or death: 6,435
(1) Written notice of the specific part or parts of the 6,437
body claimed to have been injured has been made to the industrial 6,438
commission or the bureau of workers' compensation; 6,439
(2) The employer, with knowledge of a claimed compensable 6,441
injury or occupational disease, has paid wages in lieu of 6,442
compensation for total disability OR IMPAIRMENT; 6,443
(3) In the event the employer is a self-insuring employer, 6,445
one of the following has occurred: 6,446
(a) Written notice of the specific part or parts of the 6,448
body claimed to have been injured has been given to the 6,449
commission or bureau or the employer has furnished treatment by a 6,450
licensed physician in the employ of an employer, provided, 6,451
however, that the furnishing of such treatment shall not 6,452
constitute a recognition of a claim as compensable, but shall do 6,453
no more than satisfy the requirements of this section; 6,454
(b) Compensation or benefits have been paid or furnished 6,456
equal to or greater than is provided for in sections 4123.52, 6,457
4123.55 to 4123.62, and 4123.64 to 4123.67 of the Revised Code, 6,458
PROVIDED THAT THE PAYMENT OR FURNISHING OF THE COMPENSATION OR 6,459
BENEFITS SHALL NOT CONSTITUTE A RECOGNITION OF A CLAIM OR ANY 6,460
CONDITION IN A CLAIM AS COMPENSABLE. THAT PAYMENT, THAT 6,461
COMPENSATION, OR THOSE BENEFITS SHALL DO NO MORE THAN SATISFY THE 6,463
REQUIREMENTS OF THIS SECTION.
(4) Written notice of death has been given to the 6,465
commission or bureau.
(B) The bureau shall provide printed notices quoting in 6,467
full division (A) of this section, and every self-insuring 6,468
employer shall post and maintain at all times one or more of the 6,469
notices in conspicuous places in the workshop or places of 6,470
employment. 6,471
150
(C) The commission has continuing jurisdiction as set 6,473
forth in section 4123.52 of the Revised Code over a claim which 6,474
meets the requirement of this section, including jurisdiction to 6,475
award compensation or benefits for loss or impairment of bodily 6,476
functions developing in a part or parts of the body not specified 6,477
pursuant to division (A)(1) of this section, if the commission 6,478
finds that the loss or impairment of bodily functions was due to 6,479
and a result of or a residual of the injury to one of the parts 6,480
of the body set forth in the written notice filed pursuant to 6,481
division (A)(1) of this section. 6,482
(D) Any claim pending before the administrator, the 6,484
commission, or a court on December 11, 1967, in which the remedy 6,485
is affected by this section is governed by this section. 6,486
(E) Notwithstanding the requirement that the notice 6,488
required to be given to the bureau, commission, or employer under 6,489
this section is to be in writing, the bureau may accept, assign a 6,490
claim number, and process a notice provided by any method of 6,491
telecommunication. Immediately upon receipt of the 6,492
telecommunicated notice, the bureau shall send a written notice 6,493
to the employer of the bureau's receipt of the telecommunicated 6,494
notice. Within fifteen days after receipt of the notice, the 6,495
employer may in writing either MAY verify or not verify the 6,496
telecommunicated notice. If the bureau does not receive the 6,497
written notification from the employer or receives a written 6,498
notification verifying the telecommunicated notice within such 6,499
time period, the claim is validly filed and such telecommunicated 6,500
notice tolls the statute of limitations in regard to the claim 6,501
filed and is considered to meet the requirements of written 6,502
notice required by this section. 6,503
(F) As used in division (A)(3)(b) of this section, 6,505
"benefits" means payments by a self-insuring employer to, or on 6,506
behalf of, an employee for a hospital bill, a medical bill to a 6,507
licensed physician or hospital, or an orthopedic or prosthetic 6,508
device. 6,509
151
Sec. 4123.85. In all cases of occupational disease, or 6,518
death resulting from occupational disease, claims for 6,519
compensation or benefits are forever barred unless, within two 6,520
years after the disability due to the disease began, or within 6,522
such longer period as does not exceed six months after FIRST
diagnosis of the occupational disease by a licensed physician or 6,523
within two years after death occurs, application is made to the 6,524
industrial commission or the bureau of workers' compensation or 6,525
to the employer if he THE EMPLOYER is a self-insuring employer. 6,527
Sec. 4123.90. (A) The bureau ADMINISTRATOR of workers' 6,536
compensation, industrial commission WORKERS' COMPENSATION HEARING 6,537
OFFICERS, or any other PERSON OR body constituted by the statutes 6,539
of this state, or any court of this state, in awarding
compensation to the dependents of employees, or others killed in 6,540
Ohio THIS STATE, shall not make any discrimination against the 6,541
widows SURVIVING SPOUSES, children, or other dependents who 6,543
reside in a foreign country. The bureau ADMINISTRATOR, commission 6,544
HEARING OFFICER, or any other board, PERSON, or court, in 6,546
determining the amount of compensation to be paid to the 6,547
dependents of killed employees, shall pay to the alien dependents 6,548
residing in foreign countries the same benefits as to those 6,549
dependents residing in this state. 6,550
(B) No employer shall discharge, demote, reassign, or take 6,552
any punitive action against any employee because the employee 6,553
filed a claim or instituted, pursued, or testified in any 6,554
proceedings under the workers' compensation act THIS CHAPTER OR 6,555
CHAPTER 4126., 4127., OR 4131. OF THE REVISED CODE for an injury 6,556
or occupational disease which occurred in the course of and 6,557
arising out of his employment with that employer. Any such 6,558
AN employee AFFECTED BY A VIOLATION OF THIS DIVISION may 6,560
file an action in the COURT OF common pleas court of the county 6,561
of such employment in which the relief which may be granted shall 6,563
be limited to reinstatement with back pay, if the action is based 6,564
upon discharge, or an award for wages lost if based upon 6,565
152
demotion, reassignment, or punitive action taken, offset by 6,566
earnings subsequent to discharge, demotion, reassignment, or 6,567
punitive action taken, and payments received pursuant to section 6,568
4123.56 and Chapter 4141. of the Revised Code plus reasonable 6,569
attorney fees. The action shall be IS forever barred unless 6,570
filed within one hundred eighty days immediately following the 6,571
discharge, demotion, reassignment, or punitive action taken, and 6,572
no action may be instituted or maintained unless the employer has 6,573
received written notice of a claimed violation of this paragraph 6,574
within the ninety days immediately following the discharge, 6,575
demotion, reassignment, or punitive action taken. 6,576
Sec. 4123.93. As used in sections 4123.93 and 4123.931 of 6,585
the Revised Code: 6,586
(A) "Claimant" means a person who is eligible to receive 6,589
compensation or medical benefits under this chapter or Chapter 6,590
4121., 4127., or 4131. of the Revised Code, including any 6,592
dependent or person whose eligibility is the result of an injury
to or occupational disease of another person. 6,593
(B) "Statutory subrogee" means the administrator of the 6,596
bureau of workers' compensation, a self-insuring employer, or an 6,597
employer that contracts for the direct payment of medical
services pursuant to division (J)(I) of section 4121.44 of the 6,598
Revised Code. 6,599
(C) "Subrogated amounts" include, but are not limited to, 6,601
the following:
(1) Amounts recoverable from any third party, 6,603
notwithstanding any limitations by the third party concerning its 6,604
responsibility to make payments in cases involving workers' 6,605
compensation under Chapter 4121., 4123., 4127., or 4131. of the 6,606
Revised Code;
(2) Amounts recoverable from a claimant's insurer in 6,608
connection with underinsured or uninsured motorist coverage, 6,609
notwithstanding any limitation contained in Chapter 3937. of the 6,611
Revised Code; 6,612
153
(3) Amounts that a claimant would be entitled to recover 6,614
from a political subdivision, notwithstanding any limitations 6,615
contained in Chapter 2744. of the Revised Code. 6,616
(D) "Third party" means an individual, private insurer, 6,619
public or private entity, or public or private program that is or 6,620
may be liable to make payments to a person without regard to any
statutory duty contained in this chapter or Chapter 4121., 4127., 6,621
or 4131. of the Revised Code. 6,622
Sec. 4127.03. Every work-relief employee who sustains an 6,631
injury and the dependents of such as are killed, in the course of 6,632
and arising out of employment, wheresoever such WHEREVER THAT 6,633
injury or death occurs, except when such injury or death is 6,635
caused by willful misconduct or intent to bring about such injury 6,636
or death, or when the use of intoxicating liquors or drugs is the 6,637
proximate cause of such injury or death, is entitled to receive 6,638
out of the public work-relief employees' compensation fund, 6,639
compensation, death benefits, medical, nurse, and hospital 6,640
services, medicine, and funeral expenses, for loss sustained on 6,641
account of such injury or death, as is provided for by Chapter 6,642
4123. of the Revised Code.
Except as provided in section 4127.06 of the Revised Code, 6,644
no compensation shall be paid from the work-relief employees' 6,645
compensation fund for or on account of any temporary disability 6,646
or partial disability IMPAIRMENT; except that in the cases 6,647
included in the schedule of loss of specific members or sight, 6,649
set forth in section 4123.57 of the Revised Code, the disability 6,650
OR IMPAIRMENT is deemed to continue for the periods mentioned for 6,652
each of such cases in that section. In cases where the injury 6,653
results in the total or partial loss of use of any such member, 6,654
the disability OR IMPAIRMENT is deemed to continue for such 6,656
proportion of the period fixed for the total loss of a member as 6,657
the administrator of workers' compensation finds that the actual 6,658
physical disability OR IMPAIRMENT bears to the total loss of such 6,660
members.
154
All compensation payable under this chapter shall be paid 6,662
on the basis of computation provided for in this chapter. 6,663
Sec. 4127.06. During periods of temporary disability and 6,672
partial disability IMPAIRMENT other than that resulting from loss 6,674
of a member or sight or total or partial loss of use of a member, 6,675
an injured work-relief employee shall be paid directly out of the 6,676
fund from which the employee was receiving relief, the amounts 6,677
required to meet the budgetary needs of the employee and his THE 6,678
EMPLOYEE'S dependents, and in the manner determined by the person 6,679
or agency having control over or supervision of the fund. 6,680
When all of the funds for relief purposes which are 6,682
available to any employer are exhausted, or when, disability OR 6,683
IMPAIRMENT as a result of the injury is continuous beyond a 6,686
period of six months, the injured work-relief employee shall be
compensated for temporary DISABILITY and partial disability 6,687
IMPAIRMENT out of the public work-relief employees' compensation 6,689
fund by the bureau of workers' compensation in the same manner 6,690
and amount as is provided in sections 4127.01 to 4127.14 of the
Revised Code for other disabilities AND IMPAIRMENTS. 6,691
Sec. 4141.31. (A) Benefits otherwise payable for any week 6,700
shall be reduced by the amount of remuneration a claimant 6,701
receives with respect to such week as follows: 6,702
(1) Remuneration in lieu of notice; 6,704
(2) Compensation for wage loss under division (B)(C) of 6,706
section 4123.56 of the Revised Code or temporary partial 6,707
disability under the workers' compensation law of any state or 6,708
under a similar law of the United States; 6,709
(3) Except as provided in section 4141.312 of the Revised 6,711
Code, payments in the form of retirement, or pension allowances 6,712
under a plan wholly financed by an employer which payments are 6,713
paid either directly by the employer, or indirectly through a 6,714
trust, annuity, insurance fund, or under an insurance contract 6,715
whether payable upon retirement, termination, or separation from 6,716
employment, provided that if the claimant has twenty-six weeks or 6,717
155
more of employment with a subsequent employer or employers who 6,718
are not paying him a pension or retirement allowance, then such 6,719
pension or retirement payments shall not reduce the benefits 6,720
payable for the week, and provided further that no benefits shall 6,721
thereafter be charged to the account of the employer who is 6,722
paying the pension, but instead such benefits shall be charged to 6,723
the mutualized account except as provided in division (B)(1)(b) 6,724
of section 4141.241 of the Revised Code if the claimant's 6,725
separation from the employer was disqualifying under division 6,726
(D)(2)(a) of section 4141.29 of the Revised Code. 6,727
(4) Remuneration in the form of separation or termination 6,729
pay paid to an employee at the time of his THE EMPLOYEE'S 6,730
separation from employment; 6,732
(5) Vacation pay or allowance payable under the terms of a 6,734
labor-management contract or agreement, or other contract of 6,735
hire, which payments are allocated to designated weeks. 6,736
If payments under this division are paid with respect to a 6,738
month then the amount of remuneration deemed to be received with 6,739
respect to any week during such month shall be computed by 6,740
multiplying such monthly amount by twelve and dividing the 6,741
product by fifty-two. If there is no designation of the period 6,742
with respect to which payments to an individual are made under 6,743
this section then an amount equal to such individual's normal 6,744
weekly wage shall be attributed to and deemed paid with respect 6,745
to the first and each succeeding week following his THE 6,746
EMPLOYEE'S separation or termination from the employment of the 6,748
employer making the payment until such amount so paid is 6,749
exhausted.
If benefits for any week, when reduced as provided in this 6,751
division, result in an amount not a multiple of one dollar, such 6,752
benefits shall be rounded to the next lower multiple of one 6,753
dollar. 6,754
Any payment allocated by the employer or the administrator 6,756
of the bureau of employment services to weeks under division 6,757
156
(A)(1), (4), or (5) of this section shall be deemed to be 6,758
remuneration for the purposes of establishing a qualifying week 6,759
and a benefit year under divisions (O)(1) and (R) of section 6,760
4141.01 of the Revised Code. 6,761
(B) Benefits payable for any week shall not be reduced by 6,763
the amount of remuneration a claimant receives with respect to 6,764
such week in the form of drill or reserve pay received by a 6,765
member of the Ohio national guard or the armed forces reserve for 6,766
attendance at a regularly scheduled drill or meeting. 6,767
(C) No benefits shall be paid for any week with respect to 6,769
which or a part of which an individual has received or is seeking 6,770
unemployment benefits under an unemployment compensation law of 6,771
any other state or of the United States, provided the 6,772
disqualifications shall not apply if the appropriate agency of 6,773
such other state or of the United States finally determines that 6,774
he is not entitled to such unemployment benefits. A law of the 6,775
United States providing any payment of any type and in any 6,776
amounts for periods of unemployment due to lack of work shall be 6,777
considered an unemployment compensation law of the United States. 6,778
(D) Notwithstanding any other provision in this chapter, 6,780
benefits otherwise payable shall not be reduced by payments that 6,781
were made to an individual on or after August 1, 1991, pursuant 6,782
to "The National Defense Authorization Act for Fiscal Years 1992 6,783
and 1993," Public Law 102-190, 105 Stat. 1394, 1396, 10 U.S.C.A. 6,784
1174a, 1175, in the form of voluntary separation incentive 6,785
payments and special separation pay. 6,786
Section 2. That existing sections 2913.48, 4121.121, 6,788
4121.32, 4121.34, 4121.35, 4121.36, 4121.38, 4121.44, 4121.47, 6,790
4121.61, 4121.67, 4123.01, 4123.032, 4123.033, 4123.07, 4123.25, 6,791
4123.27, 4123.28, 4123.34, 4123.343, 4123.35, 4123.352, 4123.411, 6,792
4123.412, 4123.413, 4123.414, 4123.416, 4123.419, 4123.511, 6,793
4123.512, 4123.52, 4123.54, 4123.541, 4123.55, 4123.56, 4123.57, 6,794
4123.58, 4123.59, 4123.60, 4123.61, 4123.62, 4123.64, 4123.65, 6,795
4123.651, 4123.66, 4123.68, 4123.70. 4123.80, 4123.82, 4123.84, 6,796
157
4123.85, 4123.90, 4123.93, 4127.03, 4127.06, and 4141.31 of the 6,797
Revised Code are hereby repealed. 6,798
Section 3. (A) Except as provided in division (B) of this 6,800
section, the provisions of this act apply to all claims pursuant 6,801
to Chapters 4121., 4123., 4127., and 4131. of the Revised Code 6,803
arising on and after the effective date of this act. 6,804
(B) The following apply to all claims pursuant to Chapters 6,806
4121., 4123., 4127., and 4131. of the Revised Code pending on the 6,808
effective date of this act:
(1) The provision in division (B)(1) of section 4123.56 of 6,810
the Revised Code, as amended by this act, allowing an employer to 6,811
voluntarily commence payment of compensation for temporary 6,812
disability; 6,813
(2) The provision in division (C)(2) of section 4123.56 of 6,815
the Revised Code, as amended by this act, allowing an employee to 6,816
file an application for and receive wage loss compensation 6,817
pursuant to that division without affecting the employee's 6,818
application for permanent total impairment compensation; 6,819
(3) The provision in division (A) of section 4123.57, as 6,821
amended by this act, allowing an employee to file an application 6,822
for the determination of the percentage of the employee's 6,823
permanent partial impairment after the employee has reached 6,824
maximum medical improvement. 6,825
Section 4. The penalties provided for in divisions (B) and 6,827
(C) of section 4121.444 of the Revised Code apply to any 6,828
overpayment, billing, or falsification occurring on or after the 6,829
effective date of this act.
Section 5. The amendments to the definition of 6,831
"occupational disease" made by this act contained in division (F) 6,832
of section 4123.01 of the Revised Code are not intended and shall 6,833
not be construed as altering a firefighter's or police officer's 6,834
rights to compensation pursuant to division (W) of section
4123.68 of the Revised Code as those rights existed on the 6,835
effective date of this act by virtue of statute, administrative 6,836
158
rule, or judicial decision or a combination of statutes, rules, 6,837
or decisions.
Section 6. The Administrator of Workers' Compensation 6,839
shall study the incidence of occupational diseases in the health 6,840
care professions, as the Administrator determines necessary, and 6,841
the adequacy of Chapters 4121., 4123., 4127., and 4131. of the 6,842
Revised Code in addressing occupational diseases that arise in 6,843
those professions. The study shall specifically include latent 6,844
occupational diseases. The Administrator shall report the 6,845
results of the study to the Speaker of the House of 6,846
Representatives and the President of the Senate no later than 6,847
July 1, 1998. 6,848
Section 7. The Administrator of Workers' Compensation 6,850
shall study the quality, thoroughness, and adequacy of the 6,851
medical examinations conducted by the Bureau of Workers' 6,852
Compensation's examining physicians who conduct examinations of 6,853
employees for a determination of employees' percentage of 6,854
permanent partial impairment. The study shall include an 6,855
evaluation of the fees charged by those physicians. The 6,856
Administrator shall report the results of the study to the 6,857
Speaker of the House of Representatives and the President of the 6,858
Senate no later than July 1, 1998. 6,859
Section 8. The Administrator of Workers' Compensation 6,861
shall study the effect of allowing public employers that meet the 6,862
criteria for being granted the status of self-insuring employers 6,863
pursuant to section 4123.35 of the Revised Code to become 6,864
self-insuring employers and of allowing public employers that 6,865
employ less than five hundred employees but that otherwise meet 6,866
all the criteria for being granted the status of self-insuring 6,867
employers to form pools for the purpose of paying compensation 6,868
and benefits under Chapters 4121., 4123., 4127., and 4131. of the 6,870
Revised Code directly, either collectively as a group or by each 6,871
employer individually. The Administrator shall report the
results of the study to the Speaker of the House of 6,872
159
Representatives and the President of the Senate no later than 6,873
October 31, 1997. 6,874
Section 9. The Administrator of Workers' Compensation 6,876
shall study vocational rehabilitation as it relates to assisting 6,877
injured employees return to work. As part of the study, the 6,878
Administrator shall examine the relationship between the Bureau 6,879
of Workers' Compensation, the Industrial Commission, managed care 6,881
organizations certified under the Health Partnership Program or a 6,882
Qualified Health Plan, self-insuring employers, and other state 6,883
agencies assisting injured employees return to work. In 6,884
addition, the Administrator shall review the current rules of the 6,885
Bureau and Commission pertaining to vocational rehabilitation 6,886
and, if necessary, shall recommend changes to these rules to 6,887
better effectuate the purposes of vocational rehabilitation in 6,888
returning injured employees to work. The Administrator shall 6,889
report the results of the study to the Governor, the Speaker of 6,890
the House of Representatives, the President of the Senate, the 6,891
Chairperson of the House of Representatives Commerce and Labor 6,892
Committee, and the Chairperson of the Senate Insurance, Commerce, 6,893
and Labor Committee, within one year after the effective date of 6,894
this act. 6,895
Section 10. Section 4123.54 of the Revised Code, as 6,897
amended by this act, does not abridge, and shall not be construed 6,898
as abridging, any rights of employers or employees under federal 6,899
or state law with respect to drug testing in the workplace. 6,900