(B) Except as provided in division (C) of this section, no | 13 |
court in this state has jurisdiction over a claim for damages | 14 |
suffered by an illegal alien or an unauthorized alien by reason of | 15 |
personal injury sustained or occupational disease contracted by | 16 |
the illegal alien or unauthorized alien in the course of | 17 |
employment caused by the wrongful act or omission or neglect of | 18 |
the employer. Except as provided in division (C) of this section, | 19 |
an illegal alien or unauthorized alien assumes the risk of | 20 |
incurring such injury or contracting an occupational disease, and | 21 |
that assumption is a complete bar to a recovery of damages for | 22 |
such injury or occupational disease. | 23 |
(C) A court in this state has jurisdiction over a claim | 24 |
brought by an illegal alien or unauthorized alien against an | 25 |
employer for damages suffered by reason of personal injury | 26 |
sustained or occupational disease contracted in the course of | 27 |
employment caused by the wrongful act or omission or neglect of | 28 |
the employer if the employer employed the illegal alien or | 29 |
unauthorized alien knowing that the illegal alien or unauthorized | 30 |
alien was not authorized to work under section 101(a) of the | 31 |
"Immigration Reform and Control Act of 1986," 100 Stat. 3360, 8 | 32 |
U.S.C. 1324a. | 33 |
Sec. 2743.02. (A)(1) The state hereby waives its immunity | 40 |
from liability, except as provided for the office of the state | 41 |
fire marshal in division (G)(1) of section 9.60 and division (B) | 42 |
of section 3737.221 of the Revised Code, except as provided in | 43 |
division (I) of this section, and subject to division (H) of this | 44 |
section, and consents to be sued, and have its liability | 45 |
determined, in the court of claims created in this chapter in | 46 |
accordance with the same rules of law applicable to suits between | 47 |
private parties, except that the determination of liability is | 48 |
subject to the limitations set forth in this chapter and, in the | 49 |
case of state universities or colleges, in section 3345.40 of the | 50 |
Revised Code, and except as provided in division (A)(2) or (3) of | 51 |
this section. To the extent that the state has previously | 52 |
consented to be sued, this chapter has no applicability. | 53 |
Except in the case of a civil action filed by the state, | 54 |
filing a civil action in the court of claims results in a complete | 55 |
waiver of any cause of action, based on the same act or omission, | 56 |
that the filing party has against any officer or employee, as | 57 |
defined in section 109.36 of the Revised Code. The waiver shall be | 58 |
void if the court determines that the act or omission was | 59 |
manifestly outside the scope of the officer's or employee's office | 60 |
or employment or that the officer or employee acted with malicious | 61 |
purpose, in bad faith, or in a wanton or reckless manner. | 62 |
(2) If a claimant proves in the court of claims that an | 63 |
officer or employee, as defined in section 109.36 of the Revised | 64 |
Code, would have personal liability for the officer's or | 65 |
employee's acts or omissions but for the fact that the officer or | 66 |
employee has personal immunity under section 9.86 of the Revised | 67 |
Code, the state shall be held liable in the court of claims in any | 68 |
action that is timely filed pursuant to section 2743.16 of the | 69 |
Revised Code and that is based upon the acts or omissions. | 70 |
(B) The state hereby waives the immunity from liability of | 92 |
all hospitals owned or operated by one or more political | 93 |
subdivisions and consents for them to be sued, and to have their | 94 |
liability determined, in the court of common pleas, in accordance | 95 |
with the same rules of law applicable to suits between private | 96 |
parties, subject to the limitations set forth in this chapter. | 97 |
This division is also applicable to hospitals owned or operated by | 98 |
political subdivisions that have been determined by the supreme | 99 |
court to be subject to suit prior to July 28, 1975. | 100 |
(C) Any hospital, as defined in section 2305.113 of the | 101 |
Revised Code, may purchase liability insurance covering its | 102 |
operations and activities and its agents, employees, nurses, | 103 |
interns, residents, staff, and members of the governing board and | 104 |
committees, and, whether or not such insurance is purchased, may, | 105 |
to the extent that its governing board considers appropriate, | 106 |
indemnify or agree to indemnify and hold harmless any such person | 107 |
against expense, including attorney's fees, damage, loss, or other | 108 |
liability arising out of, or claimed to have arisen out of, the | 109 |
death, disease, or injury of any person as a result of the | 110 |
negligence, malpractice, or other action or inaction of the | 111 |
indemnified person while acting within the scope of the | 112 |
indemnified person's duties or engaged in activities at the | 113 |
request or direction, or for the benefit, of the hospital. Any | 114 |
hospital electing to indemnify those persons, or to agree to so | 115 |
indemnify, shall reserve any funds that are necessary, in the | 116 |
exercise of sound and prudent actuarial judgment, to cover the | 117 |
potential expense, fees, damage, loss, or other liability. The | 118 |
superintendent of insurance may recommend, or, if the hospital | 119 |
requests the superintendent to do so, the superintendent shall | 120 |
recommend, a specific amount for any period that, in the | 121 |
superintendent's opinion, represents such a judgment. This | 122 |
authority is in addition to any authorization otherwise provided | 123 |
or permitted by law. | 124 |
(D) Recoveries against the state shall be reduced by the | 125 |
aggregate of insurance proceeds, disability award, or other | 126 |
collateral recovery received by the claimant. This division does | 127 |
not apply to civil actions in the court of claims against a state | 128 |
university or college under the circumstances described in section | 129 |
3345.40 of the Revised Code. The collateral benefits provisions of | 130 |
division (B)(2) of that section apply under those circumstances. | 131 |
(F) A civil action against an officer or employee, as defined | 136 |
in section 109.36 of the Revised Code, that alleges that the | 137 |
officer's or employee's conduct was manifestly outside the scope | 138 |
of the officer's or employee's employment or official | 139 |
responsibilities, or that the officer or employee acted with | 140 |
malicious purpose, in bad faith, or in a wanton or reckless manner | 141 |
shall first be filed against the state in the court of claims that | 142 |
has exclusive, original jurisdiction to determine, initially, | 143 |
whether the officer or employee is entitled to personal immunity | 144 |
under section 9.86 of the Revised Code and whether the courts of | 145 |
common pleas have jurisdiction over the civil action. The officer | 146 |
or employee may participate in the immunity determination | 147 |
proceeding before the court of claims to determine whether the | 148 |
officer or employee is entitled to personal immunity under section | 149 |
9.86 of the Revised Code. | 150 |
(G) If a claim lies against an officer or employee who is a | 156 |
member of the Ohio national guard, and the officer or employee | 157 |
was, at the time of the act or omission complained of, subject to | 158 |
the "Federal Tort Claims Act," 60 Stat. 842 (1946), 28 U.S.C. | 159 |
2671, et seq., the Federal Tort Claims Act is the exclusive remedy | 160 |
of the claimant and the state has no liability under this section. | 161 |
(H) If an inmate of a state correctional institution has a | 162 |
claim against the state for the loss of or damage to property and | 163 |
the amount claimed does not exceed three hundred dollars, before | 164 |
commencing an action against the state in the court of claims, the | 165 |
inmate shall file a claim for the loss or damage under the rules | 166 |
adopted by the director of rehabilitation and correction pursuant | 167 |
to this division. The inmate shall file the claim within the time | 168 |
allowed for commencement of a civil action under section 2743.16 | 169 |
of the Revised Code. If the state admits or compromises the claim, | 170 |
the director shall make payment from a fund designated by the | 171 |
director for that purpose. If the state denies the claim or does | 172 |
not compromise the claim at least sixty days prior to expiration | 173 |
of the time allowed for commencement of a civil action based upon | 174 |
the loss or damage under section 2743.16 of the Revised Code, the | 175 |
inmate may commence an action in the court of claims under this | 176 |
chapter to recover damages for the loss or damage. | 177 |
(I) The state is not liable in any civil action brought by or | 181 |
on behalf of an illegal alien or an unauthorized alien for damages | 182 |
suffered by reason of personal injury sustained or occupational | 183 |
disease contracted in the course of employment caused by the | 184 |
wrongful act or omission or neglect of the state acting as an | 185 |
employer unless the state employed that illegal alien or | 186 |
unauthorized alien knowing that the illegal alien or unauthorized | 187 |
alien was not authorized to work under section 101(a) of the | 188 |
"Immigration Reform and Control Act of 1986," 100 Stat. 3360, 8 | 189 |
U.S.C. 1324a. | 190 |
Sec. 2744.02. (A)(1) For the purposes of this chapter, the | 194 |
functions of political subdivisions are hereby classified as | 195 |
governmental functions and proprietary functions. Except as | 196 |
provided in division (B) of this section, a political subdivision | 197 |
is not liable in damages in a civil action for injury, death, or | 198 |
loss to person or property allegedly caused by any act or omission | 199 |
of the political subdivision or an employee of the political | 200 |
subdivision in connection with a governmental or proprietary | 201 |
function. A political subdivision is not liable in any civil | 202 |
action brought by or on behalf of an illegal alien or an | 203 |
unauthorized alien for damages suffered by reason of personal | 204 |
injury sustained or occupational disease contracted in the course | 205 |
of employment caused by the wrongful act or omission or neglect of | 206 |
the political subdivision acting as an employer unless the | 207 |
political subdivision employed that illegal alien or unauthorized | 208 |
alien knowing that the illegal alien or unauthorized alien was not | 209 |
authorized to work under section 101(a) of the "Immigration Reform | 210 |
and Control Act of 1986," 100 Stat. 3360, 8 U.S.C. 1324a. | 211 |
(c) A member of an emergency medical service owned or | 246 |
operated by a political subdivision was operating a motor vehicle | 247 |
while responding to or completing a call for emergency medical | 248 |
care or treatment, the member was holding a valid commercial | 249 |
driver's license issued pursuant to Chapter 4506. or a driver's | 250 |
license issued pursuant to Chapter 4507. of the Revised Code, the | 251 |
operation of the vehicle did not constitute willful or wanton | 252 |
misconduct, and the operation complies with the precautions of | 253 |
section 4511.03 of the Revised Code. | 254 |
(3) Except as otherwise provided in section 3746.24 of the | 260 |
Revised Code, political subdivisions are liable for injury, death, | 261 |
or loss to person or property caused by their negligent failure to | 262 |
keep public roads in repair and other negligent failure to remove | 263 |
obstructions from public roads, except that it is a full defense | 264 |
to that liability, when a bridge within a municipal corporation is | 265 |
involved, that the municipal corporation does not have the | 266 |
responsibility for maintaining or inspecting the bridge. | 267 |
(4) Except as otherwise provided in section 3746.24 of the | 268 |
Revised Code, political subdivisions are liable for injury, death, | 269 |
or loss to person or property that is caused by the negligence of | 270 |
their employees and that occurs within or on the grounds of, and | 271 |
is due to physical defects within or on the grounds of, buildings | 272 |
that are used in connection with the performance of a governmental | 273 |
function, including, but not limited to, office buildings and | 274 |
courthouses, but not including jails, places of juvenile | 275 |
detention, workhouses, or any other detention facility, as defined | 276 |
in section 2921.01 of the Revised Code. | 277 |
(5) In addition to the circumstances described in divisions | 278 |
(B)(1) to (4) of this section, a political subdivision is liable | 279 |
for injury, death, or loss to person or property when civil | 280 |
liability is expressly imposed upon the political subdivision by a | 281 |
section of the Revised Code, including, but not limited to, | 282 |
sections 2743.02 and 5591.37 of the Revised Code. Civil liability | 283 |
shall not be construed to exist under another section of the | 284 |
Revised Code merely because that section imposes a responsibility | 285 |
or mandatory duty upon a political subdivision, because that | 286 |
section provides for a criminal penalty, because of a general | 287 |
authorization in that section that a political subdivision may sue | 288 |
and be sued, or because that section uses the term "shall" in a | 289 |
provision pertaining to a political subdivision. | 290 |
(4) Alter, falsify, destroy, conceal, or remove any record or | 308 |
document that is necessary to fully establish the validity of any | 309 |
claim filed with, or necessary to establish the nature and | 310 |
validity of all goods and services for which reimbursement or | 311 |
payment was received or is requested from, the bureau of workers' | 312 |
compensation, or a self-insuring employer under Chapter 4121., | 313 |
4123., 4127., or 4131. of the Revised Code; | 314 |
(B) Whoever violates this section is guilty of workers' | 331 |
compensation fraud. Except as otherwise provided in this division, | 332 |
a violation of this section is a misdemeanor of the first degree. | 333 |
If the value of premiums and assessments unpaid pursuant to | 334 |
actions described in division (A)(5), (6), or (7), or (8) of this | 335 |
section, or of goods, services, property, or money stolen is one | 336 |
thousand dollars or more and is less than seven thousand five | 337 |
hundred dollars, a violation of this section is a felony of the | 338 |
fifth degree. If the value of premiums and assessments unpaid | 339 |
pursuant to actions described in division (A)(5), (6), or (7), or | 340 |
(8) of this section, or of goods, services, property, or money | 341 |
stolen is seven thousand five hundred dollars or more and is less | 342 |
than one hundred fifty thousand dollars, a violation of this | 343 |
section is a felony of the fourth degree. If the value of premiums | 344 |
and assessments unpaid pursuant to actions described in division | 345 |
(A)(5), (6), or (7), or (8) of this section, or of goods, | 346 |
services, property, or money stolen is one hundred fifty thousand | 347 |
dollars or more, a violation of this section is a felony of the | 348 |
third degree. | 349 |
(8) "Statement" includes, but is not limited to, any oral, | 384 |
written, electronic, electronic impulse, or magnetic communication | 385 |
notice, letter, memorandum, receipt for payment, invoice, account, | 386 |
financial statement, or bill for services; a diagnosis, prognosis, | 387 |
prescription, hospital, medical, or dental chart or other record; | 388 |
and a computer generated document. | 389 |
(a) Every person in the service of the state, or of any | 400 |
county, municipal corporation, township, or school district | 401 |
therein, including regular members of lawfully constituted police | 402 |
and fire departments of municipal corporations and townships, | 403 |
whether paid or volunteer, and wherever serving within the state | 404 |
or on temporary assignment outside thereof, and executive officers | 405 |
of boards of education, under any appointment or contract of hire, | 406 |
express or implied, oral or written, including any elected | 407 |
official of the state, or of any county, municipal corporation, or | 408 |
township, or members of boards of education. | 409 |
As used in division (A)(1)(a) of this section, the term | 410 |
"employee" includes the following persons when responding to an | 411 |
inherently dangerous situation that calls for an immediate | 412 |
response on the part of the person, regardless of whether the | 413 |
person is within the limits of the jurisdiction of the person's | 414 |
regular employment or voluntary service when responding, on the | 415 |
condition that the person responds to the situation as the person | 416 |
otherwise would if the person were on duty in the person's | 417 |
jurisdiction: | 418 |
(b) Every person in the service of any person, firm, or | 430 |
private corporation, including any public service corporation, | 431 |
that (i) employs one or more persons regularly in the same | 432 |
business or in or about the same establishment under any contract | 433 |
of hire, express or implied, oral or written, including aliens and | 434 |
authorized to work by the United States department of homeland | 435 |
security or its successor; minors,; household workers who earn one | 436 |
hundred sixty dollars or more in cash in any calendar quarter from | 437 |
a single household; and casual workers who earn one hundred sixty | 438 |
dollars or more in cash in any calendar quarter from a single | 439 |
employer,; or (ii) is bound by any such contract of hire or by any | 440 |
other written contract, to pay into the state insurance fund the | 441 |
premiums provided by this chapter. | 442 |
Every person in the service of any independent contractor or | 489 |
subcontractor who has failed to pay into the state insurance fund | 490 |
the amount of premium determined and fixed by the administrator of | 491 |
workers' compensation for the person's employment or occupation or | 492 |
if a self-insuring employer has failed to pay compensation and | 493 |
benefits directly to the employer's injured and to the dependents | 494 |
of the employer's killed employees as required by section 4123.35 | 495 |
of the Revised Code, shall be considered as the employee of the | 496 |
person who has entered into a contract, whether written or verbal, | 497 |
with such independent contractor unless such employees or their | 498 |
legal representatives or beneficiaries elect, after injury or | 499 |
death, to regard such independent contractor as the employer. | 500 |
Any employer may elect to include as an "employee" within | 521 |
this chapter, any person excluded from the definition of | 522 |
"employee" pursuant to divisiondivisions (A)(2)(a) to (d) of this | 523 |
section. If an employer is a partnership, sole proprietorship, | 524 |
individual incorporated as a corporation, or family farm | 525 |
corporation, such employer may elect to include as an "employee" | 526 |
within this chapter, any member of such partnership, the owner of | 527 |
the sole proprietorship, the individual incorporated as a | 528 |
corporation, or the officers of the family farm corporation. In | 529 |
the event of an election, the employer shall serve upon the bureau | 530 |
of workers' compensation written notice naming the persons to be | 531 |
covered, include such employee's remuneration for premium purposes | 532 |
in all future payroll reports, and no person excluded from the | 533 |
definition of "employee" pursuant to divisiondivisions (A)(2)(a) | 534 |
to (d) of this section, proprietor, individual incorporated as a | 535 |
corporation, or partner shall be deemed an employee within this | 536 |
division until the employer has served such notice. | 537 |
For informational purposes only, the bureau shall prescribe | 538 |
such language as it considers appropriate, on such of its forms as | 539 |
it considers appropriate, to advise employers of their right to | 540 |
elect to include as an "employee" within this chapter a sole | 541 |
proprietor, any member of a partnership, an individual | 542 |
incorporated as a corporation, the officers of a family farm | 543 |
corporation, or a person excluded from the definition of | 544 |
"employee" under divisiondivisions (A)(2)(a) to (d) of this | 545 |
section, that they should check any health and disability | 546 |
insurance policy, or other form of health and disability plan or | 547 |
contract, presently covering them, or the purchase of which they | 548 |
may be considering, to determine whether such policy, plan, or | 549 |
contract excludes benefits for illness or injury that they might | 550 |
have elected to have covered by workers' compensation. | 551 |
(2) Every person, firm, professional employer organization as | 557 |
defined in section 4125.01 of the Revised Code, and private | 558 |
corporation, including any public service corporation, that (a) | 559 |
has in service one or more employees or shared employees regularly | 560 |
in the same business or in or about the same establishment under | 561 |
any contract of hire, express or implied, oral or written, or (b) | 562 |
is bound by any such contract of hire or by any other written | 563 |
contract, to pay into the insurance fund the premiums provided by | 564 |
this chapter. | 565 |
All such employers are subject to this chapter. Any member of | 566 |
a firm or association, who regularly performs manual labor in or | 567 |
about a mine, factory, or other establishment, including a | 568 |
household establishment, shall be considered an employee in | 569 |
determining whether such person, firm, or private corporation, or | 570 |
public service corporation, has in its service, one or more | 571 |
employees and the employer shall report the income derived from | 572 |
such labor to the bureau as part of the payroll of such employer, | 573 |
and such member shall thereupon be entitled to all the benefits of | 574 |
an employee. | 575 |
(4) A condition that pre-existed an injury unless that | 593 |
pre-existing condition is substantially aggravated by the injury. | 594 |
Such a substantial aggravation must be documented by objective | 595 |
diagnostic findings, objective clinical findings, or objective | 596 |
test results. Subjective complaints may be evidence of such a | 597 |
substantial aggravation. However, subjective complaints without | 598 |
objective diagnostic findings, objective clinical findings, or | 599 |
objective test results are insufficient to substantiate a | 600 |
substantial aggravation. | 601 |
(E) "Family farm corporation" means a corporation founded for | 604 |
the purpose of farming agricultural land in which the majority of | 605 |
the voting stock is held by and the majority of the stockholders | 606 |
are persons or the spouse of persons related to each other within | 607 |
the fourth degree of kinship, according to the rules of the civil | 608 |
law, and at least one of the related persons is residing on or | 609 |
actively operating the farm, and none of whose stockholders are a | 610 |
corporation. A family farm corporation does not cease to qualify | 611 |
under this division where, by reason of any devise, bequest, or | 612 |
the operation of the laws of descent or distribution, the | 613 |
ownership of shares of voting stock is transferred to another | 614 |
person, as long as that person is within the degree of kinship | 615 |
stipulated in this division. | 616 |
(F) "Occupational disease" means a disease contracted in the | 617 |
course of employment, which by its causes and the characteristics | 618 |
of its manifestation or the condition of the employment results in | 619 |
a hazard which distinguishes the employment in character from | 620 |
employment generally, and the employment creates a risk of | 621 |
contracting the disease in greater degree and in a different | 622 |
manner from the public in general. | 623 |
(G) "Self-insuring employer" means an employer who is granted | 624 |
the privilege of paying compensation and benefits directly under | 625 |
section 4123.35 of the Revised Code, including a board of county | 626 |
commissioners for the sole purpose of constructing a sports | 627 |
facility as defined in section 307.696 of the Revised Code, | 628 |
provided that the electors of the county in which the sports | 629 |
facility is to be built have approved construction of a sports | 630 |
facility by ballot election no later than November 6, 1997. | 631 |
(I) "Sexual conduct" means vaginal intercourse between a male | 634 |
and female; anal intercourse, fellatio, and cunnilingus between | 635 |
persons regardless of gender; and, without privilege to do so, the | 636 |
insertion, however slight, of any part of the body or any | 637 |
instrument, apparatus, or other object into the vaginal or anal | 638 |
cavity of another. Penetration, however slight, is sufficient to | 639 |
complete vaginal or anal intercourse. | 640 |
Sec. 4123.511. (A) Within seven days after receipt of any | 665 |
claim under this chapter, the bureau of workers' compensation | 666 |
shall notify the claimant and the employer of the claimant of the | 667 |
receipt of the claim and of the facts alleged therein. If the | 668 |
bureau receives from a person other than the claimant written or | 669 |
facsimile information or information communicated verbally over | 670 |
the telephone indicating that an injury or occupational disease | 671 |
has occurred or been contracted which may be compensable under | 672 |
this chapter, the bureau shall notify the employee and the | 673 |
employer of the information. If the information is provided | 674 |
verbally over the telephone, the person providing the information | 675 |
shall provide written verification of the information to the | 676 |
bureau according to division (E) of section 4123.84 of the Revised | 677 |
Code. The receipt of the information in writing or facsimile, or | 678 |
if initially by telephone, the subsequent written verification, | 679 |
and the notice by the bureau shall be considered an application | 680 |
for compensation under section 4123.84 or 4123.85 of the Revised | 681 |
Code, provided that the conditions of division (E) of section | 682 |
4123.84 of the Revised Code apply to information provided verbally | 683 |
over the telephone. Upon receipt of a claim, the bureau shall | 684 |
advise the claimant of the claim number assigned and the | 685 |
claimant's right to representation in the processing of a claim or | 686 |
to elect no representation. If | 687 |
To be considered eligible for compensation or benefits paid | 688 |
under this chapter or Chapter 4121., 4127., or 4131. of the | 689 |
Revised Code other than medical benefits as described in section | 690 |
4123.66 of the Revised Code, the claimant shall submit to the | 691 |
administrator of workers' compensation a signed attestation that | 692 |
the claimant is an eligible "employee" as that term is defined in | 693 |
section 4123.01 of the Revised Code or, if the claimant is a | 694 |
dependent of an individual who died as a result of suffering an | 695 |
injury or contracting an occupational disease, that the individual | 696 |
who is the subject of the claim was such an employee. The | 697 |
administrator shall not pay compensation or benefits, other than | 698 |
medical benefits described in section 4123.66 of the Revised Code, | 699 |
unless the administrator receives the signed attestation. The | 700 |
administrator, if the administrator has reason to believe that a | 701 |
submitted attestation is not valid, may request the claimant to | 702 |
submit proof to the administrator that the attestation is valid. | 703 |
The administrator shall make the request in writing and shall | 704 |
state in the request the type of proof necessary to determine | 705 |
validity and the date by which the claimant shall submit the | 706 |
proof. If a claimant fails to comply with the request, the | 707 |
administrator shall deny the claim for compensation or benefits | 708 |
other than medical benefits and the claimant is barred from | 709 |
refiling that claim for compensation or benefits. A denial of a | 710 |
claim for compensation or benefits for failing to comply with the | 711 |
written request may be appealed under this section and section | 712 |
4123.512 of the Revised Code. In the event a claimant provides a | 713 |
signed attestation required under this division and it is later | 714 |
determined that the claimant is or the deceased individual who is | 715 |
the subject of the claim was an illegal or unauthorized alien, the | 716 |
claimant shall be subject to prosecution for a violation of | 717 |
section 2913.48 of the Revised Code. | 718 |
If the bureau determines that a claim is determined to be a | 719 |
compensable lost-time claim, the bureau shall notify the claimant | 720 |
and the employer of the availability of rehabilitation services. | 721 |
No bureau or industrial commission employee shall directly or | 722 |
indirectly convey any information in derogation of this right. | 723 |
This section shall in no way abrogate the bureau's responsibility | 724 |
to aid and assist a claimant in the filing of a claim and to | 725 |
advise the claimant of the claimant's rights under the law. | 726 |
The administrator, with the advice and consent of the bureau | 735 |
of workers' compensation board of directors, may adopt rules that | 736 |
identify specified medical conditions that have a historical | 737 |
record of being allowed whenever included in a claim. The | 738 |
administrator may grant immediate allowance of any medical | 739 |
condition identified in those rules upon the filing of a claim | 740 |
involving that medical condition and may make immediate payment of | 741 |
medical bills for any medical condition identified in those rules | 742 |
that is included in a claim. If an employer contests the allowance | 743 |
of a claim involving any medical condition identified in those | 744 |
rules, and the claim is disallowed, payment for the medical | 745 |
condition included in that claim shall be charged to and paid from | 746 |
the surplus fund account created under section 4123.34 of the | 747 |
Revised Code. | 748 |
(B)(1) Except as provided in division (B)(2) of this section, | 749 |
in claims other than those in which the employer is a | 750 |
self-insuring employer, if the administrator determines under | 751 |
division (A) of this section that a claimant is or is not entitled | 752 |
to an award of compensation or benefits, the administrator shall | 753 |
issue an order no later than twenty-eight days after the sending | 754 |
of the notice under division (A) of this section, granting or | 755 |
denying the payment of the compensation or benefits, or both as is | 756 |
appropriate to the claimant. Notwithstanding the time limitation | 757 |
specified in this division for the issuance of an order, if a | 758 |
medical examination of the claimant is required by statute, the | 759 |
administrator promptly shall schedule the claimant for that | 760 |
examination and shall issue an order no later than twenty-eight | 761 |
days after receipt of the report of the examination. The | 762 |
administrator shall notify the claimant and the employer of the | 763 |
claimant and their respective representatives in writing of the | 764 |
nature of the order and the amounts of compensation and benefit | 765 |
payments involved. The employer or claimant may appeal the order | 766 |
pursuant to division (C) of this section within fourteen days | 767 |
after the date of the receipt of the order. The employer and | 768 |
claimant may waive, in writing, their rights to an appeal under | 769 |
this division. | 770 |
(2) Notwithstanding the time limitation specified in division | 771 |
(B)(1) of this section for the issuance of an order, if the | 772 |
employer certifies a claim for payment of compensation or | 773 |
benefits, or both, to a claimant, and the administrator has | 774 |
completed the investigation of the claim, the payment of benefits | 775 |
or compensation, or both, as is appropriate, shall commence upon | 776 |
the later of the date of the certification or completion of the | 777 |
investigation and issuance of the order by the administrator, | 778 |
provided that the administrator shall issue the order no later | 779 |
than the time limitation specified in division (B)(1) of this | 780 |
section. | 781 |
(3) If an appeal is made under division (B)(1) or (2) of this | 782 |
section, the administrator shall forward the claim file to the | 783 |
appropriate district hearing officer within seven days of the | 784 |
appeal. In contested claims other than state fund claims, the | 785 |
administrator shall forward the claim within seven days of the | 786 |
administrator's receipt of the claim to the industrial commission, | 787 |
which shall refer the claim to an appropriate district hearing | 788 |
officer for a hearing in accordance with division (C) of this | 789 |
section. | 790 |
(C) If an employer or claimant timely appeals the order of | 791 |
the administrator issued under division (B) of this section or in | 792 |
the case of other contested claims other than state fund claims, | 793 |
the commission shall refer the claim to an appropriate district | 794 |
hearing officer according to rules the commission adopts under | 795 |
section 4121.36 of the Revised Code. The district hearing officer | 796 |
shall notify the parties and their respective representatives of | 797 |
the time and place of the hearing. | 798 |
The district hearing officer shall hold a hearing on a | 799 |
disputed issue or claim within forty-five days after the filing of | 800 |
the appeal under this division and issue a decision within seven | 801 |
days after holding the hearing. The district hearing officer shall | 802 |
notify the parties and their respective representatives in writing | 803 |
of the order. Any party may appeal an order issued under this | 804 |
division pursuant to division (D) of this section within fourteen | 805 |
days after receipt of the order under this division. | 806 |
(D) Upon the timely filing of an appeal of the order of the | 807 |
district hearing officer issued under division (C) of this | 808 |
section, the commission shall refer the claim file to an | 809 |
appropriate staff hearing officer according to its rules adopted | 810 |
under section 4121.36 of the Revised Code. The staff hearing | 811 |
officer shall hold a hearing within forty-five days after the | 812 |
filing of an appeal under this division and issue a decision | 813 |
within seven days after holding the hearing under this division. | 814 |
The staff hearing officer shall notify the parties and their | 815 |
respective representatives in writing of the staff hearing | 816 |
officer's order. Any party may appeal an order issued under this | 817 |
division pursuant to division (E) of this section within fourteen | 818 |
days after receipt of the order under this division. | 819 |
(E) Upon the filing of a timely appeal of the order of the | 820 |
staff hearing officer issued under division (D) of this section, | 821 |
the commission or a designated staff hearing officer, on behalf of | 822 |
the commission, shall determine whether the commission will hear | 823 |
the appeal. If the commission or the designated staff hearing | 824 |
officer decides to hear the appeal, the commission or the | 825 |
designated staff hearing officer shall notify the parties and | 826 |
their respective representatives in writing of the time and place | 827 |
of the hearing. The commission shall hold the hearing within | 828 |
forty-five days after the filing of the notice of appeal and, | 829 |
within seven days after the conclusion of the hearing, the | 830 |
commission shall issue its order affirming, modifying, or | 831 |
reversing the order issued under division (D) of this section. The | 832 |
commission shall notify the parties and their respective | 833 |
representatives in writing of the order. If the commission or the | 834 |
designated staff hearing officer determines not to hear the | 835 |
appeal, within fourteen days after the expiration of the period in | 836 |
which an appeal of the order of the staff hearing officer may be | 837 |
filed as provided in division (D) of this section, the commission | 838 |
or the designated staff hearing officer shall issue an order to | 839 |
that effect and notify the parties and their respective | 840 |
representatives in writing of that order. | 841 |
(3) The administrator is a party and may appear and | 861 |
participate at all administrative proceedings on behalf of the | 862 |
state insurance fund. However, in cases in which the employer is | 863 |
represented, the administrator shall neither present arguments nor | 864 |
introduce testimony that is cumulative to that presented or | 865 |
introduced by the employer or the employer's representative. The | 866 |
administrator may file an appeal under this section on behalf of | 867 |
the state insurance fund; however, except in cases arising under | 868 |
section 4123.343 of the Revised Code, the administrator only may | 869 |
appeal questions of law or issues of fraud when the employer | 870 |
appears in person or by representative. | 871 |
(J) The administrator shall charge the compensation payments | 897 |
made in accordance with division (H) of this section or medical | 898 |
benefits payments made in accordance with division (I) of this | 899 |
section to an employer's experience immediately after the employer | 900 |
has exhausted the employer's administrative appeals as provided in | 901 |
this section or has waived the employer's right to an | 902 |
administrative appeal under division (B) of this section, subject | 903 |
to the adjustment specified in division (H) of section 4123.512 of | 904 |
the Revised Code. | 905 |
(K) Upon the final administrative or judicial determination | 906 |
under this section or section 4123.512 of the Revised Code of an | 907 |
appeal of an order to pay compensation, if a claimant is found to | 908 |
have received compensation pursuant to a prior order which is | 909 |
reversed upon subsequent appeal, the claimant's employer, if a | 910 |
self-insuring employer, or the bureau, shall withhold from any | 911 |
amount to which the claimant becomes entitled pursuant to any | 912 |
claim, past, present, or future, under Chapter 4121., 4123., | 913 |
4127., or 4131. of the Revised Code, the amount of previously paid | 914 |
compensation to the claimant which, due to reversal upon appeal, | 915 |
the claimant is not entitled, pursuant to the following criteria: | 916 |
The administrator and self-insuring employers, as | 930 |
appropriate, are subject to the repayment schedule of this | 931 |
division only with respect to an order to pay compensation that | 932 |
was properly paid under a previous order, but which is | 933 |
subsequently reversed upon an administrative or judicial appeal. | 934 |
The administrator and self-insuring employers are not subject to, | 935 |
but may utilize, the repayment schedule of this division, or any | 936 |
other lawful means, to collect payment of compensation made to a | 937 |
person who was not entitled to the compensation due to fraud as | 938 |
determined by the administrator or the industrial commission. | 939 |
(L) If a staff hearing officer or the commission fails to | 940 |
issue a decision or the commission fails to refuse to hear an | 941 |
appeal within the time periods required by this section, payments | 942 |
to a claimant shall cease until the staff hearing officer or | 943 |
commission issues a decision or hears the appeal, unless the | 944 |
failure was due to the fault or neglect of the employer or the | 945 |
employer agrees that the payments should continue for a longer | 946 |
period of time. | 947 |
(2) "Disaster" means any natural catastrophe or fire, flood, | 968 |
or explosion, regardless of the cause, that causes damage of | 969 |
sufficient magnitude that the governor of Ohio or the president of | 970 |
the United States, through a public declaration, orders state or | 971 |
federal assistance to alleviate damage, loss, hardship, or | 972 |
suffering that results from the occurrence. | 973 |
Sec. 4123.513. (A) Except as otherwise provided in divisions | 974 |
(B) and (C) of this section, if a claim is denied because the | 975 |
claimant is, or if the claimant is a dependent of an individual | 976 |
who died as a result of suffering an injury or contracting an | 977 |
occupational disease, that individual was an unauthorized alien, | 978 |
the claimant's employer or the individual's employer is not liable | 979 |
to that claimant for damages suffered by reason of personal injury | 980 |
sustained or occupational disease contracted in the course of | 981 |
employment caused by the wrongful act or omission or neglect of | 982 |
the employer. For such a claimant, filing a claim under Chapter | 983 |
4121., 4123., 4127., or 4131. of the Revised Code is the exclusive | 984 |
remedy against the employer on account of injury, disease, or | 985 |
death in the course of and arising out of the claimant's or | 986 |
deceased employee's employment. Notwithstanding section 4123.77 of | 987 |
the Revised Code and except as provided in division (B) of this | 988 |
section, an irrebuttable presumption exists that the individual | 989 |
assumed the risk of incurring an injury or contracting an | 990 |
occupational disease at the workplace, or dying as a result of | 991 |
such an injury or occupational disease, when performing services | 992 |
or providing labor for that employer. | 993 |
(B) An employer is liable to a claimant whose claim is denied | 994 |
because the claimant is or the deceased individual who is the | 995 |
subject of the claim was an unauthorized alien for damages | 996 |
suffered by reason of personal injury sustained or occupational | 997 |
disease contracted in the course of employment caused by the | 998 |
wrongful act or omission or neglect of the employer if the | 999 |
claimant establishes, by clear and convincing evidence, that the | 1000 |
employer employed the claimant or the deceased individual knowing | 1001 |
that the claimant or deceased individual was not authorized to | 1002 |
work under section 101(a) of the "Immigration Reform and Control | 1003 |
Act of 1986," 100 Stat. 3360, 8 U.S.C. 1324a, on the date the | 1004 |
claimant or deceased individual suffered the injury or contracted | 1005 |
the occupational disease and that such knowledge was not solely | 1006 |
the result of communications made by the claimant or the deceased | 1007 |
individual to the employer. An employer may not assert any of the | 1008 |
common law defenses listed in section 4123.77 of the Revised Code | 1009 |
in an action brought against the employer pursuant to this | 1010 |
section. | 1011 |