As Reported by the Senate Insurance, Commerce 2
and Labor Committee 2
123rd General Assembly 5
Regular Session Am. H. B. No. 611 6
1999-2000 7
REPRESENTATIVES CATES-CORBIN-WILLIAMS-BUEHRER-TRAKAS-HARRIS- 9
ROBINSON-YOUNG-HOOD-CALLENDER-HARTNETT-METZGER-AMSTUTZ-VESPER- 10
WILLAMOWSKI-BUCHY-JONES-SYKES-BARRETT-REDFERN-TERWILLEGER-HOOPS- 11
AUSTRIA-PATTON-SENATOR NEIN 12
_________________________________________________________________ 14
A B I L L
To amend sections 4121.31, 4123.511, 4123.52, and 16
4123.84 of the Revised Code to require the 17
Administrator of Workers' Compensation and the 18
Industrial Commission jointly to adopt rules
governing the submission and sending of documents 19
via electronic transmission, to modify the 20
processing requirements for claim applications
that are not written, and to declare an 21
emergency.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO: 23
Section 1. That sections 4121.31, 4123.511, 4123.52, and 25
4123.84 of the Revised Code be amended to read as follows: 26
Sec. 4121.31. (A) The administrator of workers' 35
compensation and the industrial commission jointly shall adopt 36
rules covering the following general topics with respect to this 37
chapter and Chapter 4123. of the Revised Code: 38
(A)(1) Rules that set forth any general policy and the 40
principal operating procedures of the bureau of workers' 41
compensation or commission, including but not limited to: 42
(1)(a) Assignment to various operational units of any 44
duties placed upon the administrator or the commission by 45
statute;
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(2)(b) Procedures for decision-making; 47
(3)(c) Procedures governing the appearances of a claimant, 49
employer, or their representatives before the agency in a 50
hearing; 51
(4)(d) Procedures that inform claimants, on request, of 53
the status of a claim and any actions necessary to maintain the 54
claim; 55
(5)(e) Time goals for activities of the bureau or 57
commission;
(6)(f) Designation of the person or persons authorized to 59
issue directives with directives numbered and distributed from a 60
central distribution point to persons on a list maintained for 61
that purpose. 62
(B)(2) A rule barring any employee of the bureau or 64
commission from having a workers' compensation claims file in the 65
employee's possession unless the file is necessary to the 66
performance of the employee's duties. 67
(C)(3) All claims, whether of a state fund or 69
self-insuring employer, be processed in an orderly, uniform, and 70
timely fashion. 71
(4) RULES GOVERNING THE SUBMISSION AND SENDING OF 73
APPLICATIONS, NOTICES, EVIDENCE, AND OTHER DOCUMENTS BY 74
ELECTRONIC MEANS. THE RULES SHALL PROVIDE THAT WHERE THIS 75
CHAPTER OR CHAPTER 4123., 4127., OR 4131. OF THE REVISED CODE 77
REQUIRES THAT A DOCUMENT BE IN WRITING OR REQUIRES A SIGNATURE,
THE ADMINISTRATOR AND THE COMMISSION, TO THE EXTENT OF THEIR 79
RESPECTIVE JURISDICTIONS, MAY APPROVE OF AND PROVIDE FOR THE 80
ELECTRONIC SUBMISSION AND SENDING OF THOSE DOCUMENTS, AND THE USE 81
OF AN ELECTRONIC SIGNATURE ON THOSE DOCUMENTS. 82
(B) AS USED IN THIS SECTION: 84
(1) "ELECTRONIC" INCLUDES ELECTRICAL, DIGITAL, MAGNETIC, 86
OPTICAL, ELECTROMAGNETIC, FACSIMILE, OR ANY OTHER FORM OF 87
TECHNOLOGY THAT ENTAILS CAPABILITIES SIMILAR TO THESE 88
TECHNOLOGIES.
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(2) "ELECTRONIC RECORD" MEANS A RECORD GENERATED, 90
COMMUNICATED, RECEIVED, OR STORED BY ELECTRONIC MEANS FOR USE IN 91
AN INFORMATION SYSTEM OR FOR TRANSMISSION FROM ONE INFORMATION 92
SYSTEM TO ANOTHER.
(3) "ELECTRONIC SIGNATURE" MEANS A SIGNATURE IN ELECTRONIC 94
FORM ATTACHED TO OR LOGICALLY ASSOCIATED WITH AN ELECTRONIC 95
RECORD.
Sec. 4123.511. (A) Within seven days after receipt of any 105
claim under this chapter, the bureau of workers' compensation
shall notify the claimant and the employer of the claimant of the 106
receipt of the claim and of the facts alleged therein. If the 107
bureau receives from a person other than the claimant written or 108
telecommunicated FACSIMILE information OR INFORMATION 109
COMMUNICATED VERBALLY OVER THE TELEPHONE indicating that an 112
injury or occupational disease has occurred or been contracted 113
with WHICH may be compensable under this chapter, the bureau 115
shall notify the employee and the employer of the information. 116
If the information is provided by any method of telecommunication 117
VERBALLY OVER THE TELEPHONE, the person providing the information 119
shall provide written verification of the information to the 120
bureau according to division (E) of section 4123.84 of the 121
Revised Code. The receipt of the information in writing OR 122
FACSIMILE, or if INITIALLY by a method of telecommunications 124
TELEPHONE, the SUBSEQUENT written verification, and the notice by 125
the bureau shall be considered an application for compensation 126
under section 4123.84 or 4123.85 of the Revised Code, provided 127
that the conditions of division (E) of section 4123.84 of the 128
Revised Code apply to information provided by a method of 129
telecommunication VERBALLY OVER THE TELEPHONE. Upon receipt of a 130
claim, the bureau shall advise the claimant of the claim number 131
assigned and the claimant's right to representation in the 133
processing of a claim or to elect no representation. If the 134
bureau determines that a claim is determined to be a compensable 135
lost-time claim, the bureau shall notify the claimant and the 136
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employer of the availability of rehabilitation services. No 137
bureau or industrial commission employee shall directly or
indirectly convey any information in derogation of this right. 138
This section shall in no way abrogate the bureau's responsibility 139
to aid and assist a claimant in the filing of a claim and to 140
advise the claimant of the claimant's rights under the law. 141
The administrator of workers' compensation shall assign all 143
claims and investigations to the bureau service office from which 144
investigation and determination may be made most expeditiously. 145
The bureau shall investigate the facts concerning an injury 147
or occupational disease and ascertain such facts in whatever 148
manner is most appropriate and may obtain statements of the 149
employee, employer, attending physician, and witnesses in 150
whatever manner is most appropriate. 151
(B)(1) Except as provided in division (B)(2) of this 153
section, in claims other than those in which the employer is a 154
self-insuring employer, if the administrator determines under 155
division (A) of this section that a claimant is or is not 156
entitled to an award of compensation or benefits, the 157
administrator shall issue an order no later than twenty-eight 159
days after the sending of the notice under division (A) of this 160
section, granting or denying the payment of the compensation or 161
benefits, or both as is appropriate to the claimant. 162
Notwithstanding the time limitation specified in this division
for the issuance of an order, if a medical examination of the 163
claimant is required by statute, the administrator promptly shall 164
schedule the claimant for that examination and shall issue an 165
order no later than twenty-eight days after receipt of the report 166
of the examination. The administrator shall notify the claimant 167
and the employer of the claimant and their respective 168
representatives in writing of the nature of the order and the 169
amounts of compensation and benefit payments involved. The 170
employer or claimant may appeal the order pursuant to division 171
(C) of this section within fourteen days after the date of the 172
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receipt of the order. The employer and claimant may waive, in 173
writing, their rights to an appeal under this division. 174
(2) Notwithstanding the time limitation specified in 176
division (B)(1) of this section for the issuance of an order, if 177
the employer certifies a claim for payment of compensation or 178
benefits, or both, to a claimant, and the administrator has 179
completed the investigation of the claim, the payment of benefits 181
or compensation, or both, as is appropriate, shall commence upon 182
the later of the date of the certification or completion of the 183
investigation and issuance of the order by the administrator, 184
provided that the administrator shall issue the order no later 185
than the time limitation specified in division (B)(1) of this 186
section. 187
(3) If an appeal is made under division (B)(1) or (2) of 189
this section, the administrator shall forward the claim file to 190
the appropriate district hearing officer within seven days of the 191
appeal. In contested claims other than state fund claims, the 192
administrator shall forward the claim within seven days of the 193
administrator's receipt of the claim to the commission, which 195
shall refer the claim to an appropriate district hearing officer 196
for a hearing in accordance with division (C) of this section. 197
(C) If an employer or claimant timely appeals the order of 199
the administrator issued under division (B) of this section or in 200
the case of other contested claims other than state fund claims, 201
the commission shall refer the claim to an appropriate district 202
hearing officer according to rules the commission adopts under 203
section 4121.36 of the Revised Code. The district hearing 204
officer shall notify the parties and their respective 205
representatives of the time and place of the hearing. 206
The district hearing officer shall hold a hearing on a 208
disputed issue or claim within forty-five days after the filing 210
of the appeal under this division and issue a decision within 211
seven days after holding the hearing. The district hearing 212
officer shall notify the parties and their respective
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representatives in writing of the order. Any party may appeal an 214
order issued under this division pursuant to division (D) of this 215
section within fourteen days after receipt of the order under 216
this division. 217
(D) Upon the timely filing of an appeal of the order of 219
the district hearing officer issued under division (C) of this 220
section, the commission shall refer the claim file to an 221
appropriate staff hearing officer according to its rules adopted 222
under section 4121.36 of the Revised Code. The staff hearing 223
officer shall hold a hearing within forty-five days after the 224
filing of an appeal under this division and issue a decision 225
within seven days after holding the hearing under this division. 228
The staff hearing officer shall notify the parties and their 229
respective representatives in writing of the staff hearing
officer's order. Any party may appeal an order issued under this 231
division pursuant to division (E) of this section within fourteen 232
days after receipt of the order under this division. 233
(E) Upon the filing of a timely appeal of the order of the 235
staff hearing officer issued under division (D) of this section, 236
the commission or a designated staff hearing officer, on behalf 237
of the commission, shall determine whether the commission will 239
hear the appeal. If the commission or the designated staff
hearing officer decides to hear the appeal, the commission or the 241
designated staff hearing officer shall notify the parties and 242
their respective representatives in writing of the time and place 243
of the hearing. The commission shall hold the hearing within 244
forty-five days after the filing of the notice of appeal and, 245
within seven days after the conclusion of the hearing, the 246
commission shall issue its order affirming, modifying, or 247
reversing the order issued under division (D) of this section. 248
The commission shall notify the parties and their respective 249
representatives in writing of the order. If the commission or 250
the designated staff hearing officer determines not to hear the 251
appeal, within fourteen days after the filing of the notice of 252
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appeal, the commission or the designated staff hearing officer 253
shall issue an order to that effect and notify the parties and
their respective representatives in writing of that order. 254
Except as otherwise provided in this chapter and Chapters 256
4121., 4127., and 4131. of the Revised Code, any party may appeal 257
an order issued under this division to the court pursuant to 258
section 4123.512 of the Revised Code within sixty days after 259
receipt of the order, subject to the limitations contained in 260
that section. 261
(F) Every notice of an appeal from an order issued under 263
divisions (B), (C), (D), and (E) of this section shall state the 264
names of the claimant and employer, the number of the claim, the 265
date of the decision appealed from, and the fact that the 266
appellant appeals therefrom. 267
(G) All of the following apply to the proceedings under 269
divisions (C), (D), and (E) of this section: 270
(1) The parties shall proceed promptly and without 272
continuances except for good cause; 273
(2) The parties, in good faith, shall engage in the free 275
exchange of information relevant to the claim prior to the 276
conduct of a hearing according to the rules the commission adopts 277
under section 4121.36 of the Revised Code; 278
(3) The administrator is a party and may appear and 280
participate at all administrative proceedings on behalf of the 281
state insurance fund. However, in cases in which the employer is 282
represented, the administrator shall neither present arguments 283
nor introduce testimony that is cumulative to that presented or 284
introduced by the employer or the employer's representative. The 285
administrator may file an appeal under this section on behalf of
the state insurance fund; however, except in cases arising under 286
section 4123.343 of the Revised Code, the administrator only may 287
appeal questions of law or issues of fraud when the employer 288
appears in person or by representative.
(H) Except as provided in section 4121.63 of the Revised 290
8
Code and division (J) of this section, payments of compensation 291
to a claimant or on behalf of a claimant as a result of any order 292
issued under this chapter shall commence upon the earlier of the 293
following:
(1) Fourteen days after the date the administrator issues 295
an order under division (B) of this section, unless that order is 296
appealed; 297
(2) The date when the employer has waived the right to 300
appeal a decision issued under division (B) of this section; 301
(3) If no appeal of an order has been filed under this 303
section or to a court under section 4123.512 of the Revised Code, 304
the expiration of the time limitations for the filing of an 305
appeal of an order; 306
(4) The date of receipt by the employer of an order of a 308
district hearing officer, a staff hearing officer, or the 310
industrial commission issued under division (C), (D), or (E) of 311
this section.
(I) No medical benefits payable under this chapter or 313
Chapter 4121., 4127., or 4131. of the Revised Code are payable 314
until the earlier of the following: 315
(1) The date of the issuance of the staff hearing 317
officer's order under division (D) of this section; 318
(2) The date of the final administrative or judicial 320
determination. 321
(J) Upon the final administrative or judicial 323
determination under this section or section 4123.512 of the 324
Revised Code of an appeal of an order to pay compensation, if a 325
claimant is found to have received compensation pursuant to a 326
prior order which is reversed upon subsequent appeal, the 327
claimant's employer, if a self-insuring employer, or the bureau, 329
shall withhold from any amount to which the claimant becomes 330
entitled pursuant to any claim, past, present, or future, under 331
Chapter 4121., 4123., 4127., or 4131. of the Revised Code, the 332
amount of previously paid compensation to the claimant which, due 333
9
to reversal upon appeal, the claimant is not entitled, pursuant 334
to the following criteria: 335
(1) No withholding for the first twelve weeks of temporary 337
total disability compensation pursuant to section 4123.56 of the 338
Revised Code shall be made; 339
(2) Forty per cent of all awards of compensation paid 341
pursuant to sections 4123.56 and 4123.57 of the Revised Code, 342
until the amount overpaid is refunded; 343
(3) Twenty-five per cent of any compensation paid pursuant 345
to section 4123.58 of the Revised Code until the amount overpaid 346
is refunded; 347
(4) If, pursuant to an appeal under section 4123.512 of 349
the Revised Code, the court of appeals or the supreme court 350
reverses the allowance of the claim, then no amount of any 351
compensation will be withheld. 352
The administrator and self-insuring employers, as 354
appropriate, are subject to the repayment schedule of this 355
division only with respect to an order to pay compensation that 356
was properly paid under a previous order, but which is
subsequently reversed upon an administrative or judicial appeal. 357
The administrator and self-insuring employers are not subject to, 358
but may utilize, the repayment schedule of this division, or any 359
other lawful means, to collect payment of compensation made to a 360
person who was not entitled to the compensation due to fraud as 361
determined by the administrator or the industrial commission. 362
(K) If a staff hearing officer or the commission fails to 364
issue a decision or the commission fails to refuse to hear an 365
appeal within the time periods required by this section, payments 366
to a claimant shall cease until the staff hearing officer or 367
commission issues a decision or hears the appeal, unless the 368
failure was due to the fault or neglect of the employer or the 369
employer agrees that the payments should continue for a longer 370
period of time. 371
(L) Except as otherwise provided in this section or 373
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section 4123.522 of the Revised Code, no appeal is timely filed 374
under this section unless the appeal is filed with the time 375
limits set forth in this section.
(M) No person who is not an employee of the bureau or 377
commission or who is not by law given access to the contents of a 378
claims file shall have a file in the person's possession. 379
(N) Upon application of a party who resides in an area in 382
which an emergency or disaster is declared, the industrial 383
commission and hearing officers of the commission may waive the 384
time frame within which claims and appeals of claims set forth in 385
this section must be filed upon a finding that the applicant was 386
unable to comply with a filing deadline due to an emergency or a 387
disaster.
As used in this division: 389
(1) "Emergency" means any occasion or instance for which 391
the governor of Ohio or the president of the United States 393
publicly declares an emergency and orders state or federal 394
assistance to save lives and protect property, the public health 395
and safety, or to lessen or avert the threat of a catastrophe. 396
(2) "Disaster" means any natural catastrophe or fire, 398
flood, or explosion, regardless of the cause, that causes damage 399
of sufficient magnitude that the governor of Ohio or the 400
President PRESIDENT of the United States, through a public 401
declaration, orders state or federal assistance to alleviate 403
damage, loss, hardship, or suffering that results from the 404
occurrence.
Sec. 4123.52. The jurisdiction of the industrial 413
commission and the authority of the administrator of workers' 414
compensation over each case is continuing, and the commission may 415
make such modification or change with respect to former findings 416
or orders with respect thereto, as, in its opinion is justified. 417
No modification or change nor any finding or award in respect of 418
any claim shall be made with respect to disability, compensation, 419
dependency, or benefits, after six years from the date of injury 421
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in the absence of the payment of medical benefits under this
chapter, in which event the modification, change, finding, or 422
award shall be made within six years after the payment of medical 424
benefits, or in the absence of payment of compensation under
section 4123.57, 4123.58, or division (A) or (B) of section 426
4123.56 of the Revised Code or wages in lieu of compensation in a 427
manner so as to satisfy the requirements of section 4123.84 of
the Revised Code, in which event the modification, change, 428
finding, or award shall be made within ten years from the date of 429
the last payment of compensation or from the date of death, nor 430
unless written notice of claim for the specific part or parts of 431
the body injured or disabled has been given as provided in 432
section 4123.84 or 4123.85 of the Revised Code, and the 433
commission shall not make any modification, change, finding, or 434
award which shall award compensation for a back period in excess 435
of two years prior to the date of filing application therefor. 436
This section does not affect the right of a claimant to 437
compensation accruing subsequent to the filing of any such 438
application, provided the application is filed within the time 439
limit provided in this section.
This section does not deprive the commission of its 441
continuing jurisdiction to determine the questions raised by any 442
application for modification of award which has been filed with 443
the commission after June 1, 1932, and prior to the expiration of 444
the applicable period but in respect to which no award has been 445
granted or denied during the applicable period. 446
The commission may, by general rules, provide for the 448
destruction of files of cases in which no further action may be 449
taken. 450
The commission and administrator of workers' compensation 452
each may, by general rules, provide for the retention and 453
destruction of all other records in their possession or under 454
their control pursuant to section 121.211 and sections 149.34 to 455
149.36 of the Revised Code. The bureau of workers' compensation 456
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may purchase or rent required equipment for the document 457
retention media, as determined necessary to preserve the records. 458
Photographs, microphotographs, microfilm, films, or other direct 459
document retention media, when properly identified, have the same 460
effect as the original record and may be offered in like manner 461
and may be received as evidence in PROCEEDINGS BEFORE THE 462
INDUSTRIAL COMMISSION, STAFF HEARING OFFICERS, AND DISTRICT 463
HEARING OFFICERS, AND IN any court where the original record 465
could have been introduced.
Sec. 4123.84. (A) In all cases of injury or death, claims 474
for compensation or benefits for the specific part or parts of 475
the body injured shall be forever barred unless, within two years 476
after the injury or death: 477
(1) Written OR FACSIMILE notice of the specific part or 479
parts of the body claimed to have been injured has been made to 480
the industrial commission or the bureau of workers' compensation; 481
(2) The employer, with knowledge of a claimed compensable 483
injury or occupational disease, has paid wages in lieu of 484
compensation for total disability; 485
(3) In the event the employer is a self-insuring employer, 487
one of the following has occurred: 488
(a) Written OR FACSIMILE notice of the specific part or 490
parts of the body claimed to have been injured has been given to 491
the commission or bureau or the employer has furnished treatment 492
by a licensed physician in the employ of an employer, provided, 493
however, that the furnishing of such treatment shall not 494
constitute a recognition of a claim as compensable, but shall do 495
no more than satisfy the requirements of this section; 496
(b) Compensation or benefits have been paid or furnished 498
equal to or greater than is provided for in sections 4123.52, 499
4123.55 to 4123.62, and 4123.64 to 4123.67 of the Revised Code. 500
(4) Written OR FACSIMILE notice of death has been given to 502
the commission or bureau. 503
(B) The bureau shall provide printed notices quoting in 505
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full division (A) of this section, and every self-insuring 506
employer shall post and maintain at all times one or more of the 507
notices in conspicuous places in the workshop or places of 508
employment. 509
(C) The commission has continuing jurisdiction as set 511
forth in section 4123.52 of the Revised Code over a claim which 512
meets the requirement of this section, including jurisdiction to 513
award compensation or benefits for loss or impairment of bodily 514
functions developing in a part or parts of the body not specified 515
pursuant to division (A)(1) of this section, if the commission 516
finds that the loss or impairment of bodily functions was due to 517
and a result of or a residual of the injury to one of the parts 518
of the body set forth in the written notice filed pursuant to 519
division (A)(1) of this section. 520
(D) Any claim pending before the administrator, the 522
commission, or a court on December 11, 1967, in which the remedy 523
is affected by this section is governed by this section. 524
(E) Notwithstanding the requirement that the notice 526
required to be given to the bureau, commission, or employer under 527
this section is to be in writing OR FACSIMILE, the bureau may 528
accept, assign a claim number, and process a CLAIM WHEN notice IS 530
provided by any method of telecommunication VERBALLY OVER THE 532
TELEPHONE. Immediately upon receipt of the telecommunicated 534
notice PROVIDED VERBALLY OVER THE TELEPHONE, the bureau shall 535
send a written OR FACSIMILE notice to the employer of the 536
bureau's receipt of the telecommunicated VERBAL notice. Within 537
fifteen days after receipt of the BUREAU'S WRITTEN OR FACSIMILE 538
notice, the employer may in writing OR FACSIMILE either verify or 539
not verify the telecommunicated VERBAL notice. If the bureau 540
does not receive the written OR FACSIMILE notification from the 542
employer or receives a written OR FACSIMILE notification 544
verifying the telecommunicated VERBAL notice within such time 546
period, the claim is validly filed and such telecommunicated
VERBAL notice tolls the statute of limitations in regard to the 547
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claim filed and is considered to meet the requirements of written 548
OR FACSIMILE notice required by this section. 550
(F) As used in division (A)(3)(b) of this section, 552
"benefits" means payments by a self-insuring employer to, or on 553
behalf of, an employee for a hospital bill, a medical bill to a 554
licensed physician or hospital, or an orthopedic or prosthetic 555
device. 556
Section 2. That existing sections 4121.31, 4123.511, 558
4123.52, and 4123.84 of the Revised Code are hereby repealed. 559
Section 3. This act is hereby declared to be an emergency 561
measure necessary for the immediate preservation of the public 562
peace, health, and safety. The reason for such necessity is to 563
enable the Bureau of Workers' Compensation to continue processing 564
claims and the Industrial Commission to continue adjudicating 565
claims in a timely and efficient manner and to ensure that 566
unnecessary lapses and avoidable delays do not interfere with the 567
continuing care and treatment of claimants throughout the state. 568
Therefore, this act shall go into immediate effect. 569