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Am. Sub. S. B. No. 7 As Passed by the Senate
As Passed by the Senate
126th General Assembly | Regular Session | 2005-2006 |
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Senators Cates, Spada, Austria, Mumper, Wachtmann, Schuler, Padgett, Clancy, Niehaus, Coughlin, Hottinger, Armbruster, Jacobson, Harris
A BILL
To amend sections 2913.48, 3121.034, 3121.037, 4121.10, 4121.44, 4121.441, 4123.01, 4123.32, 4123.35, 4123.512, 4123.52, 4123.54, 4123.56, 4123.57, 4123.58, 4123.61, 4123.65, 4123.88, 5703.21, and 5747.18, to enact sections 3121.0311, 4121.131, 4121.444, 4123.271, and 4123.311 of the Revised Code to make various changes to the Workers' Compensation Law.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That sections 2913.48, 3121.034, 3121.037, 4121.10, 4121.44, 4121.441, 4123.01, 4123.32, 4123.35, 4123.512, 4123.52, 4123.54, 4123.56, 4123.57, 4123.58, 4123.61, 4123.65, 4123.88, 5703.21, and 5747.18 be amended and sections 3121.0311, 4121.131, 4121.444, 4123.271, and 4123.311 of the Revised Code be enacted to read as follows:
Sec. 2913.48. (A) No person, with purpose to defraud or
knowing that the person is facilitating a fraud, shall do any of the
following: (1) Receive workers' compensation benefits to which the person is
not entitled; (2) Make or present or cause to be made or presented a
false or misleading statement with the purpose to secure payment
for goods or services rendered under Chapter 4121., 4123., 4127.,
or 4131. of the Revised Code or to secure workers' compensation
benefits; (3) Alter, falsify, destroy, conceal, or remove any record
or document that is necessary to fully establish the validity of
any claim filed with, or necessary to establish the nature and
validity of all goods and services for which reimbursement or
payment was received or is requested from, the bureau of workers'
compensation, or a self-insuring employer under Chapter 4121.,
4123., 4127., or 4131. of the Revised Code; (4) Enter into an agreement or conspiracy to defraud the
bureau or a self-insuring employer by making or presenting or
causing to be made or presented a false claim for workers'
compensation benefits; (5) Make or present or cause to be made or presented a false statement concerning manual codes,
classification of employees, payroll, paid compensation, or number of personnel, when information
of that nature is necessary to determine the actual workers' compensation
premium or
assessment owed to the bureau by an employer; (6) Alter, forge, or create a workers' compensation certificate to falsely
show current or
correct workers' compensation coverage; (7) Fail to secure or maintain workers' compensation coverage as
required by Chapter 4123. of the Revised Code with the intent to defraud the bureau of workers' compensation. (B) Whoever violates this section is guilty of workers'
compensation fraud. Except as
otherwise provided in this division, a
violation of this section is a misdemeanor of the
first degree. If the value of the
premiums and assessments unpaid
pursuant to actions described in division (A)(5), (6), or (7) of this
section, or of
goods, services, property, or
money stolen is five hundred dollars or more and is less than
five thousand dollars, a violation of
this section is a felony of the fifth degree. If
the value of the
premiums and assessments unpaid
pursuant to actions described in division (A)(5), (6), or (7) of this
section, or of
goods, services, property, or money stolen is five thousand
dollars or more and is less than one hundred thousand dollars, a violation of
this section is a felony of the fourth degree. If
the value of the
premiums and assessments unpaid
pursuant to actions described in division (A)(5), (6), or (7) of this
section, or of
goods, services, property, or money stolen is one hundred
thousand dollars or more, a violation of this section is a felony of the third
degree. (C) Upon application of the governmental body that
conducted the investigation and prosecution of a violation of
this section, the court shall order the person who is convicted
of the violation to pay the governmental body its costs of
investigating and prosecuting the case. These costs are in
addition to any other costs or penalty provided in the Revised
Code or any other section of law. (D) The remedies and penalties provided in this section
are not exclusive remedies and penalties and do not preclude the
use of any other criminal or civil remedy or penalty for any act
that is in violation of this section. (E) As used in this section: (1) "False" means wholly or partially untrue or deceptive. (2) "Goods" includes, but is not limited to, medical
supplies, appliances, rehabilitative equipment, and any other
apparatus or furnishing provided or used in the care, treatment,
or rehabilitation of a claimant for workers' compensation
benefits. (3) "Services" includes, but is not limited to, any
service provided by any health care provider to a claimant for
workers' compensation benefits and any and all services provided by the
bureau
as part of workers' compensation insurance coverage. (4) "Claim" means any attempt to cause the bureau, an
independent third party with whom the administrator or an
employer contracts under section 4121.44 of the Revised Code, or
a self-insuring employer to make payment or reimbursement for
workers' compensation benefits. (5) "Employment" means participating in any trade,
occupation, business, service, or profession for substantial
gainful remuneration. (6) "Employer," "employee," and "self-insuring employer"
have the same meanings as in section 4123.01 of the Revised Code. (7) "Remuneration" includes, but is not limited to, wages,
commissions, rebates, and any other reward or consideration. (8) "Statement" includes, but is not limited to, any oral,
written, electronic, electronic impulse, or magnetic
communication notice, letter, memorandum, receipt for payment,
invoice, account, financial statement, or bill for services;
a diagnosis, prognosis, prescription, hospital, medical, or dental
chart or other record; and a computer generated document. (9) "Records" means any medical, professional, financial,
or business record relating to the treatment or care of any
person, to goods or services provided to any person, or to rates
paid for goods or services provided to any person, or any record
that the administrator of workers' compensation requires pursuant
to rule. (10) "Workers' compensation benefits" means any
compensation or benefits payable under Chapter 4121., 4123.,
4127., or 4131. of the Revised Code.
Sec. 3121.034. (A) A Except for deductions from lump sum payments made in accordance with section 3121.0311 of the Revised Code, a withholding or deduction requirement
contained in a withholding or deduction notice described in section 3121.03 of
the Revised Code has
priority over any order of attachment, any order in aid of
execution, and any other legal process issued under state law
against the same earnings, payments, or account. (B) When two or more withholding notices
are received by a payor, the payor shall comply with all
of the
requirements contained in the notices to the extent that the
total amount withheld from the obligor's
income does not exceed the maximum amount
permitted under section 303(b) of the "Consumer
Credit Protection
Act," 15 U.S.C. 1673(b), withhold amounts in
accordance
with the allocation set forth in divisions (B)(1)
and (2) of
this section, notify each court or child support enforcement
agency that issued one of the notices of the allocation, and give
priority to amounts designated in each notice as current support
in the following manner: (1) If the total of the amounts designated in the notices
as current support exceeds the amount available for withholding
under section 303(b) of the "Consumer Credit
Protection Act," 15
U.S.C. 1673(b), the
payor shall allocate to each notice an amount
for
current support equal to the amount designated in that notice as
current support multiplied by a fraction in which the numerator
is the amount of
income
available for withholding and the denominator is the
total amount designated in all of the notices as current support. (2) If the total of the amounts designated in the notices
as current support does not exceed the amount available for
withholding under section 303(b) of the "Consumer
Credit
Protection Act," 15 U.S.C. 1673(b), the payor
shall pay all of the
amounts designated as current support in the notices and shall
allocate to each notice an amount for past-due support equal to
the amount designated in that notice as past-due support
multiplied by a fraction in which the numerator is the amount of
income remaining available
for withholding after the payment of current support and the
denominator is the total amount designated in all of the notices
as past-due support. Sec. 3121.037. (A) A withholding notice sent under section
3121.03 of the Revised Code
shall contain all of the following: (1) Notice of the amount to be withheld from the obligor's
income and a statement that, notwithstanding that amount, the
payor may not
withhold an amount for support and
other purposes,
including the fee described in division
(A)(11) of this section,
that exceeds the
maximum amounts permitted under section 303(b) of
the
"Consumer
Credit Protection Act," 15 U.S.C.
1673(b); (2) A statement that the payor is required to send
the
amount withheld to the office of child support
immediately, but
not later than seven business days, after
the obligor is paid and
is required to report to the
agency the date the amount was
withheld; (3) A statement that the withholding is binding on the
payor
until further notice from the court or agency; (4) A statement that if the payor is an employer,
the payor
is subject to a fine to
be determined under the law of this state
for discharging the
obligor from employment, refusing to employ
the obligor, or
taking any disciplinary action against the obligor
because of the
withholding requirement; (5) A statement that, if the payor fails to withhold
in
accordance with the notice, the
payor is liable for the
accumulated amount the
payor should
have withheld from the
obligor's income; (6) A statement that, except for deductions from lump sum payments made in accordance with section 3121.0311 of the Revised Code, the withholding in accordance with
the
notice has priority
over any other legal process under the law of
this state against
the same income; (7) The date on which the notice was mailed and a
statement
that the payor is required to implement the
withholding no later
than
fourteen business days following the date the notice was
mailed or, if the
payor is an employer, no later than the first
pay period that occurs after
fourteen business days following the
date the notice was mailed, and is
required to continue the
withholding at the intervals
specified in the notice. (8) A requirement that the payor do the following: (a) Promptly notify the
child support enforcement agency
administering the support order, in writing,
within ten business
days after the date of any situation that occurs
in which the
payor ceases to pay
income to the obligor in an amount sufficient
to comply with the order,
including termination of employment,
layoff of the obligor from employment,
any leave of absence of the
obligor from employment without pay, termination
of workers'
compensation benefits, or termination of any pension, annuity,
allowance, or retirement benefit; (b) Provide the agency with
the obligor's last known address
and, with respect to a court support order
and if known, notify
the agency of
any new employer or income source and the
name,
address, and telephone number of the new employer or income
source. (9) A requirement that, if the payor is an
employer, the
payor do both of the following: (a) Identify in the
notice given under division
(A)(8) of
this section
any types of benefits other than personal earnings
the
obligor is receiving or is eligible to receive as a benefit of
employment or as a result of the obligor's termination of
employment, including, but not limited to, unemployment
compensation, workers' compensation benefits, severance pay, sick
leave, lump sum payments of retirement benefits or contributions,
and bonuses or profit-sharing payments or distributions, and the
amount of the benefits; (b) Include in the notice the
obligor's last known address
and telephone number, date of birth,
social security number, and
case number and, if known, the
name and business address of any
new employer of the obligor. (10) A Subject to section 3121.0311 of the Revised Code, a requirement that, no later than the earlier of
forty-five days before a lump sum payment is to be made or, if
the
obligor's right to the lump sum payment is determined less
than
forty-five days before it is to be made, the date on which
that
determination is made, the payor notify the child
support
enforcement agency administering the support order of any lump sum
payment of
any kind of
one hundred fifty dollars or more that is
to be paid to the
obligor, hold
each lump sum payment of one
hundred fifty dollars
or more for thirty
days after the date on
which it
would otherwise be paid to the obligor and, on
order of
the court or agency that issued the support order, pay all or a
specified
amount of the lump sum
payment to the office of child
support; (11) A statement that, in addition to the amount withheld
for support, the payor may withhold a fee from the
obligor's
income as a charge for its services in complying with
the
notice
and a specification of the amount that may be withheld. (B) A deduction notice sent under section 3121.03 of the
Revised Code shall contain all of the following: (1) Notice of the amount to be deducted from the obligor's
account; (2) A statement that the financial institution is
required
to send the amount deducted to the office of child support
immediately, but not later than
seven business
days, after the
date the last deduction was made and
to report to the child
support enforcement agency the date on which the
amount was
deducted; (3) A statement that the deduction is binding on the
financial institution until further notice from the court or
agency; (4) A statement that the deduction in accordance with
the
notice has priority
over any other legal process under the law of
this state against
the same account; (5) The date on which the notice was mailed and a
statement
that the financial institution is required to implement
the
deduction no later than fourteen business days following that
date
and to continue the
deduction at the intervals specified in the
notice; (6) A requirement that the financial institution promptly
notify the child support enforcement agency administering the
support order,
in writing, within
ten days after the date of any
termination of the account from
which the deduction is being made
and notify the agency, in
writing, of the opening of a new account
at that financial
institution, the account number of the new
account, the name of
any other known financial institutions in
which the obligor has
any accounts, and the numbers of those
accounts; (7) A requirement that the financial institution include
in
all notices the obligor's last known mailing address, last
known
residence address, and social security number; (8) A statement that, in addition to the amount
deducted for
support, the financial institution may deduct a fee
from the
obligor's account as a charge for its services in
complying with
the notice and a specification of the amount that
may be deducted.
Sec. 3121.0311. (A) If a lump sum payment referred to in division (A)(10) of section 3121.037 of the Revised Code consists of workers' compensation benefits and the obligor is represented by an attorney with respect to the obligor's workers' compensation claim, prior to issuing the notice to the child support enforcement agency required by that division, the administrator of workers' compensation, for claims involving state fund employers, or a self-insuring employer, for that employer's claims, shall notify the obligor and the obligor's attorney in writing that the obligor is subject to a support order and that the administrator or self-insuring employer, as appropriate, shall hold the lump sum payment for a period of thirty days after the administrator or self-insuring employer sends this written notice, pending receipt of the information referred to in division (B) of this section.
(B) The administrator or self-insuring employer, as appropriate, shall instruct the obligor's attorney in writing to file a copy of the fee agreement signed by the obligor, along with an affidavit signed by the attorney setting forth the amount of the attorney's fee with respect to the lump sum payment award to the obligor and the amount of all necessary expenses, along with documentation of those expenses, incurred by the attorney with respect to obtaining the lump sum award. The obligor's attorney shall file the fee agreement and attorney affidavit with the administrator or self-insuring employer, as appropriate, within thirty days after the date the administrator or self-insuring employer sends the notice required by division (A) of this section.
(C) Upon receipt of the fee agreement and attorney affidavit, the administrator or self-insuring employer, as appropriate, shall deduct from the lump sum payment the amount of the attorney's fee and necessary expenses and pay that amount directly to and solely in the name of the attorney within fourteen days after the fee agreement and attorney affidavit have been filed with the administrator or self-insuring employer.
(D) After deducting any attorney's fee and necessary expenses, if the lump sum payment is one hundred fifty dollars or more, the administrator or self-insuring employer, as appropriate, shall hold the balance of the lump sum award in accordance with division (A)(10) of section 3121.037 of the Revised Code.
Sec. 4121.10. The industrial commission shall be in continuous session and
open for the transaction of business during all business hours of every day
excepting Sundays and legal holidays. The sessions of the commission shall be
open to the public and shall stand and be adjourned without further notice
thereof on its record. All of the proceedings of the commission shall be
shown on its record, which shall be a public record except as provided in section 4123.88 of the Revised Code, and all voting shall be
had by calling the name of each member of the industrial commission by the
executive director, and each member's vote shall be
recorded on the record of
proceedings as cast. The commission shall keep a separate record of its
proceedings relative to claims coming before it for compensation for injured
and the dependents of killed employees, which record shall contain its
findings and the award in each such claim for compensation considered by it,
and in all such claims the reasons for the allowance or rejection thereof
shall be stated in said record.
Sec. 4121.131. The bureau of workers' compensation special investigation department is a criminal justice agency in investigating reported violations of law relating to workers' compensation, and as such may apply for access to the computerized databases administered by the national crime information center or the law enforcement automated data system in Ohio and to other computerized databases administered for the purpose of making criminal justice information accessible to state and criminal justice agencies.
Sec. 4121.44. (A) The administrator of workers'
compensation shall oversee
the implementation of the Ohio workers'
compensation qualified health
plan system as established under
section 4121.442 of the Revised
Code. (B) The administrator shall direct the
implementation of the
health partnership program administered by
the bureau as set forth
in section 4121.441 of the Revised Code.
To implement the health
partnership program, the bureau: (1) Shall certify one or more external vendors, which shall
be
known as
"managed care organizations," to provide
medical
management and cost containment services in the health
partnership
program for a period of two years beginning on
the date of
certification, consistent with the
standards established under
this section; (2) May recertify external vendors for
additional periods of
two years; and (3) May integrate the certified vendors with bureau
staff
and existing bureau services for purposes of operation and
training to allow the bureau to assume operation of the health
partnership program at the conclusion of the
certification periods
set
forth in division (B)(1) or (2) of this section. (C) Any vendor selected shall demonstrate all of the
following: (1) Arrangements and reimbursement agreements with a
substantial number of the medical, professional and pharmacy
providers currently being utilized by claimants. (2) Ability to accept a common format of medical bill data
in an electronic fashion from any provider who wishes to submit
medical bill data in that form. (3) A computer system able to handle the volume of medical
bills and
willingness to customize that system
to the bureau's
needs and to be operated by the vendor's staff,
bureau staff, or
some combination of both staffs. (4) A prescription drug system where pharmacies on a
statewide basis have access to the eligibility and pricing, at a
discounted rate, of all prescription drugs. (5) A tracking system to record all telephone calls from
claimants and providers regarding the status of
submitted medical
bills so as to be able to track each inquiry. (6) Data processing capacity to absorb all of the bureau's
medical bill processing or at least that part of the processing
which the bureau arranges to delegate. (7) Capacity to store, retrieve, array, simulate, and
model
in a relational mode all of the detailed medical bill data
so that
analysis can be performed in a variety of ways and so
that the
bureau and its governing authority can make informed
decisions. (8) Wide variety of software programs which translate
medical terminology into standard codes, and which reveal if a
provider is manipulating the procedures codes, commonly
called
"unbundling." (9) Necessary professional staff to conduct, at a minimum,
authorizations for treatment, medical necessity, utilization
review, concurrent review, post-utilization review, and have the
attendant computer system which supports such activity and
measures the outcomes and the savings. (10) Management experience and flexibility to be able to
react quickly to the needs of the bureau in the case of required
change in federal or state requirements. (D)(1) Information contained in a
vendor's application for
certification in the health partnership program, and
other
information
furnished to the bureau by a vendor for purposes of
obtaining certification or
to comply with performance and
financial auditing requirements established by
the
administrator,
is for the exclusive use and information
of the bureau in the
discharge of its official duties, and shall not be open to the
public or be used in any court in any proceeding pending therein,
unless the bureau is a party to the action or proceeding, but the
information may be tabulated and published by the bureau in
statistical form for the use and information of other state
departments and the public. No employee of the bureau, except as
otherwise authorized by the administrator, shall divulge any
information secured by the employee while in the employ of the
bureau in respect to a vendor's application for certification or
in respect to the business or other trade processes of any vendor
to any person other than the administrator or to the employee's
superior. (2) Notwithstanding the restrictions imposed by division
(D)(1)
of this section, the governor, members of select or
standing committees of the
senate or house of representatives, the
auditor
of state, the attorney general, or their designees,
pursuant to the
authority granted in this chapter and Chapter
4123. of the
Revised Code, may examine any vendor application
or
other information furnished to the bureau by the vendor. None
of
those individuals shall divulge any information secured in the
exercise of that authority in respect to a vendor's application
for certification or in respect to the business or other trade
processes of any vendor to any person. (E) On and after January 1, 2001, a vendor shall
not be any
insurance company holding a certificate of authority issued
pursuant to
Title XXXIX of the Revised Code or any
health insuring
corporation holding a certificate of authority under Chapter 1751.
of the Revised Code. (F) The administrator may
limit freedom of choice of health
care provider or supplier by
requiring, beginning with the period
set forth in division
(B)(1) or (2) of this section, that
claimants shall pay an
appropriate
out-of-plan copayment for
selecting a medical provider
not within
the health partnership
program as provided for in this section. (G) The administrator, six
months prior to the expiration of
the bureau's
certification or recertification of the vendor or
vendors as set forth
in division (B)(1) or (2) of this
section,
may certify and provide evidence to the governor, the
speaker of
the house of representatives, and the president of the
senate that
the existing bureau staff is able to match or exceed
the
performance and outcomes of the external vendor or vendors
and
that the bureau should be permitted to internally administer
the
health partnership program upon the expiration of
the
certification or recertification as set forth in
division (B)(1)
or (2) of this section. (H) The administrator shall establish and operate a bureau
of workers'
compensation health care
data program.
The
administrator shall develop reporting
requirements from all
employees, employers and medical providers,
medical vendors, and
plans that participate in the workers'
compensation system. The
administrator shall do all of the
following: (1) Utilize the collected data to measure and perform
comparison analyses of costs, quality, appropriateness of medical
care, and effectiveness of medical care delivered by
all
components of the workers' compensation system. (2) Compile data to support activities of the selected
vendor or vendors and to measure the outcomes and savings of the
health partnership program. (3) Publish and report compiled data to the governor, the
speaker of the house of representatives, and the president of the
senate on the first day of
each January and July, the measures of
outcomes and savings of the health partnership program and the
qualified health plan system. The administrator shall protect
the
confidentiality of all proprietary pricing data. (I) Any rehabilitation facility the bureau operates is
eligible for inclusion in the Ohio workers' compensation
qualified
health plan system or the health partnership program
under the
same terms as other providers within health care plans
or the
program. (J) In areas outside the state or within the state where
no
qualified health plan or an inadequate number of providers
within
the health partnership program exist, the administrator
shall
permit employees to use a nonplan or nonprogram health care
provider and shall pay the provider for the services or supplies
provided to or on behalf of an employee for an injury or
occupational disease that is compensable under this chapter or
Chapter 4123., 4127., or 4131. of the Revised Code on a fee
schedule the administrator adopts. (K) No health care provider, whether certified or not, shall charge,
assess,
or otherwise attempt to collect from an employee, employer, a
managed
care organization, or the bureau any amount for covered
services or supplies that is in excess of the allowed
amount paid
by a managed care organization, the bureau, or a qualified
health
plan. (L) The administrator shall permit any employer or group
of
employers who agree to abide by the rules adopted under this
section and sections 4121.441 and 4121.442 of the Revised Code to
provide services or supplies to or on behalf of an employee for
an
injury or occupational disease that is compensable under this
chapter or Chapter 4123., 4127., or 4131. of the Revised Code
through qualified health plans of the Ohio workers' compensation
qualified health plan system pursuant to section 4121.442 of the
Revised Code or through the health partnership program pursuant
to
section 4121.441 of the Revised Code. No amount paid under
the
qualified health plan system pursuant to section 4121.442 of
the
Revised Code by an employer who is a state fund employer
shall be
charged to the employer's experience or otherwise be
used in
merit-rating or determining the risk of that employer for
the
purpose of the payment of premiums under this chapter, and if
the
employer is a self-insuring employer, the employer shall not
include that amount in the paid compensation the employer
reports
under section 4123.35 of the Revised Code.
Sec. 4121.441. (A) The administrator of workers' compensation, with the
advice and consent of the workers' compensation oversight commission, shall
adopt rules under Chapter 119. of the Revised Code for the health care
partnership program administered by the bureau of workers' compensation to
provide medical, surgical, nursing, drug, hospital, and rehabilitation
services and supplies to an employee for an injury or occupational disease
that is compensable under this chapter or Chapter 4123., 4127., or 4131. of
the Revised Code. The rules shall include, but are not limited to, the
following: (1) Procedures for the resolution of medical disputes
between an employer and an employee, an employee and a provider,
or an employer and a provider, prior to an appeal under section
4123.511 of the Revised Code;. Rules the administrator adopts pursuant to division (A)(1) of this section may specify that the resolution procedures shall not be used to resolve disputes concerning medical services rendered that have been approved through standard treatment guidelines, pathways, or presumptive authorization guidelines. (2) Prohibitions against discrimination against any
category of health care providers; (3) Procedures for reporting injuries to employers and the
bureau by providers; (4) Appropriate financial incentives to reduce service
cost and insure proper system utilization without sacrificing the
quality of service; (5) Adequate methods of peer review, utilization review,
quality assurance, and dispute resolution to prevent, and provide
sanctions for, inappropriate, excessive or not medically
necessary treatment; (6) A timely and accurate method of collection of
necessary information regarding medical and health care service
and supply costs, quality, and utilization to enable the
administrator to determine the effectiveness of the program; (7) Provisions for necessary emergency medical treatment
for an injury or occupational disease provided by a health
care
provider who is not part of the program; (8) Discounted pricing for all in-patient and out-patient
medical services, all professional services, and all
pharmaceutical services; (9) Provisions for provider referrals, pre-admission and
post-admission approvals, second surgical opinions, and other
cost management techniques; (10) Antifraud mechanisms; (11) Standards and criteria for the bureau to utilize in certifying or
recertifying a health care provider or a vendor for participation in the
health
partnership program; (12) Standards and criteria for the bureau to utilize in penalizing or
decertifying a health care provider or a vendor from participation in the
health partnership program. (B) The administrator shall
implement the health partnership program according to the rules
the administrator adopts under this section for the provision and payment
of medical, surgical, nursing, drug, hospital, and rehabilitation
services and supplies to an employee for an injury or
occupational disease that is compensable under this chapter or
Chapter 4123., 4127., or 4131. of the Revised Code.
Sec. 4121.444. (A) No person, health care provider, managed care
organization, or owner of a health care provider or managed care organization
shall obtain or attempt to obtain payments by deception under
Chapter 4121., 4123., 4127., or 4131. of the Revised Code to which the person, health care
provider, managed care organization, or owner is not
entitled under rules of the bureau of workers' compensation adopted pursuant
to sections 4121.441 and 4121.442 of the Revised
Code. (B) Any person, health care provider, managed care organization, or owner
that violates division (A) of this section is
liable, in addition to any other penalties provided by law, for all of the
following penalties: (1) Payment of interest on the amount of the excess payments at the
maximum interest rate allowable for real estate mortgages under section
1343.01 of the Revised Code. The interest shall be calculated from
the date the payment was made to the person, owner, health care provider, or managed
care
organization through the date upon which repayment is made to the bureau or
the
self-insuring employer. (2) Payment of an amount equal to three times the amount of any excess
payments; (3) Payment of a sum of not less than five thousand
dollars and not more
than ten thousand dollars for each act of deception; (4) All reasonable and necessary expenses that the court determines have
been incurred by the bureau or the self-insuring employer in the enforcement
of
this section. All moneys collected by the bureau pursuant to this section shall be
deposited into the state insurance fund created in section 4123.30 of
the Revised
Code. All moneys collected by a self-insuring
employer pursuant to this section shall be awarded to the self-insuring
employer. (C)(1) In addition to the monetary
penalties provided in division (B) of this
section and except as provided in division (C)(3) of this section,
the administrator may terminate any
agreement between the bureau and a person or a health care provider or managed care
organization or its owner and cease reimbursement to that person, provider,
organization, or owner for services rendered if any of the following
apply: (a) The person, health care provider, managed care
organization, or its owner, or an officer, authorized agent, associate,
manager, or employee of a person, provider, or organization is convicted of or
pleads
guilty to a violation of sections 2913.48 or 2923.31 to 2923.36 of the Revised Code or any other criminal offense related to the delivery of or billing for health care benefits. (b) There exists an entry of judgment against the person,
health care provider, managed care organization, or its owner, or an officer,
authorized agent, associate, manager, or employee of a person, provider, or
organization and proof of the specific intent of
the person, health care provider, managed care organization, or owner to defraud, in a
civil action brought pursuant to this section. (c) There exists an entry of judgment against the person, health care
provider, managed care organization, or its owner, or an officer, authorized
agent, associate, manager, or employee of a person, provider, or organization in a
civil
action brought pursuant to sections
2923.31 to 2923.36 of the Revised Code. (2) No person, health care provider, or managed care organization that has had its
agreement with and reimbursement from the bureau terminated by the
administrator pursuant to division (C)(1) of this section, or an
owner,
officer, authorized agent, associate, manager, or employee of that person, health care
provider, or managed care organization shall do either of the following: (a) Directly provide services to any other bureau
provider or have an ownership interest in a provider of services that
furnishes
services to any other bureau provider; (b) Arrange for, render, or order services for
claimants during the period that the agreement of the person, health care provider,
managed care organization, or its owner is terminated as described in division
(C)(1) of this section; (3) The administrator shall not terminate the agreement or reimbursement
if the person, health care provider, managed care organization, or owner
demonstrates that the person, provider, organization, or owner did not directly or
indirectly sanction the action of the authorized agent, associate, manager, or
employee that resulted
in the conviction, plea of guilty, or entry of judgment as described in
division (C)(1) of this section. (4) Nothing in division (C) of this
section prohibits an owner, officer, authorized agent, associate, manager, or
employee of a person, health care provider, or managed care organization from entering
into an agreement with the bureau if the provider, organization, owner,
officer, authorized agent, associate, manager, or employee demonstrates
absence
of knowledge of the action of the person, health care provider, or managed care
organization with which that individual or organization was formerly
associated that resulted in
a conviction, plea of guilty, or entry of judgment as described in division
(C)(1) of this section. (D) The attorney general may bring an
action on behalf of the state and a self-insuring employer may bring an action
on its own behalf to enforce this section in any court of competent
jurisdiction. The attorney general may settle or compromise any action
brought
under this section with the approval of the administrator. Notwithstanding any other law providing a shorter period of
limitations, the attorney general or a self-insuring employer may bring an
action to enforce this section at any time within six years after the conduct
in violation of this section terminates. (E) The availability of remedies under
this section and sections 2913.48 and 2923.31 to 2923.36 of the Revised Code
for recovering benefits paid on behalf of claimants for medical assistance
does not limit the authority of the bureau or a self-insuring employer to
recover excess payments made to an owner, health care provider, managed
care organization, or person
under state and federal law. (F) As used in this section: (1) "Deception" means acting with actual knowledge in order to deceive another or cause another to
be deceived by means of any of the following: (a) A false or misleading representation; (b) The withholding of information; (c) The preventing of another from acquiring
information; (d) Any other conduct, act, or omission that
creates, confirms, or perpetuates a false impression as to a fact, the law,
the
value of something, or a person's state of mind. (2) "Owner" means any person having at least a five per cent ownership
interest in a health care provider or managed care organization.
Sec. 4123.01. As used in this chapter: (a) Every person in the service of the state, or of any
county, municipal corporation, township, or school district
therein, including regular members of lawfully constituted police
and fire departments of municipal corporations and townships,
whether paid or volunteer, and wherever serving within the state
or on temporary assignment outside thereof, and executive officers
of boards of education, under any appointment or contract of hire,
express or implied, oral or written, including any elected
official of the state, or of any county, municipal corporation, or
township, or members of boards of education. As used in division (A)(1)(a) of this section, the term "employee" includes the following persons when
responding to an inherently dangerous situation
that calls for an
immediate response on the part of the person,
regardless of
whether the person is within the limits of the
jurisdiction of the
person's regular employment or voluntary
service when responding,
on the condition that the person responds
to the situation as the
person otherwise would if the person were
on duty in the person's
jurisdiction: (i) Off-duty peace officers. As used in division
(A)(1)(a)(i) of this section, "peace officer"
has the same meaning as in
section
2935.01 of the Revised
Code. (ii) Off-duty firefighters, whether paid or volunteer, of a
lawfully constituted fire department. (iii) Off-duty first responders, emergency medical
technicians-basic, emergency medical technicians-intermediate, or
emergency medical technicians-paramedic, whether paid or
volunteer, of an ambulance service organization or emergency
medical service organization pursuant to Chapter 4765. of the
Revised Code. (b) Every person in the service of any person, firm, or
private corporation, including any public service corporation,
that (i) employs one or more persons regularly in the same
business or in or about the same establishment under any contract
of hire, express or implied, oral or written, including aliens and
minors, household workers who earn one hundred sixty dollars or
more in cash in any calendar quarter from a single household and
casual workers who earn one hundred sixty dollars or more in cash
in any calendar quarter from a single employer, or (ii) is bound
by any such contract of hire or by any other written contract, to
pay into the state insurance fund the premiums provided by this
chapter. (c) Every person who performs labor or provides services
pursuant to a construction contract, as defined in section 4123.79
of the Revised Code, if at least ten of the following criteria
apply: (i) The person is required to comply with instructions from
the other contracting party regarding the manner or method of
performing services; (ii) The person is required by the other contracting party
to have particular training; (iii) The person's services are integrated into the regular
functioning of the other contracting party; (iv) The person is required to perform the work personally; (v) The person is hired, supervised, or paid by the other
contracting party; (vi) A continuing relationship exists between the person and
the other contracting party that contemplates continuing or
recurring work even if the work is not full time; (vii) The person's hours of work are established by the
other contracting party; (viii) The person is required to devote full time to the
business of the other contracting party; (ix) The person is required to perform the work on the
premises of the other contracting party; (x) The person is required to follow the order of work set
by the other contracting party; (xi) The person is required to make oral or written reports
of progress to the other contracting party; (xii) The person is paid for services on a regular basis
such as hourly, weekly, or monthly; (xiii) The person's expenses are paid for by the other
contracting party; (xiv) The person's tools and materials are furnished by the
other contracting party; (xv) The person is provided with the facilities used to
perform services; (xvi) The person does not realize a profit or suffer a loss
as a result of the services provided; (xvii) The person is not performing services for a number of
employers at the same time; (xviii) The person does not make the same services available
to the general public; (xix) The other contracting party has a right to discharge
the person; (xx) The person has the right to end the relationship with
the other contracting party without incurring liability pursuant
to an employment contract or agreement. Every person in the service of any independent contractor or
subcontractor who has failed to pay into the state insurance fund
the amount of premium determined and fixed by the administrator of
workers' compensation for the person's employment or occupation or
if a self-insuring employer has failed to pay compensation and
benefits directly to the employer's injured and to the dependents
of the employer's killed employees as required by section 4123.35
of the Revised Code, shall be considered as the employee of the
person who has entered into a contract, whether written or verbal,
with such independent contractor unless such employees or their
legal representatives or beneficiaries elect, after injury or
death, to regard such independent contractor as the employer. (2) "Employee" does not mean: (a) A duly ordained, commissioned, or licensed minister or
assistant or associate minister of a church in the exercise of
ministry; (b) Any officer of a family farm corporation; (c) An individual incorporated as a corporation; or
(d) An individual who otherwise is an employee of an employer but who signs the waiver and affidavit specified in section 4123.15 of the Revised Code on the condition that the administrator has granted a waiver and exception to the individual's employer under section 4123.15 of the Revised Code. Any employer may elect to include as an "employee" within
this chapter, any person excluded from the definition of
"employee" pursuant to division (A)(2) of this section. If an
employer is a partnership, sole proprietorship, individual incorporated as a corporation, or family farm
corporation, such employer may elect to include as an "employee"
within this chapter, any member of such partnership, the owner of
the sole proprietorship, the individual incorporated as a corporation, or the officers of the family farm
corporation. In the event of an election, the employer shall
serve upon the bureau of workers' compensation written notice
naming the persons to be covered, include such employee's
remuneration for premium purposes in all future payroll reports,
and no person excluded from the definition of "employee" pursuant
to division (A)(2) of this section, proprietor, individual incorporated as a corporation, or partner shall
be deemed an employee within this division until the employer has
served such notice. For informational purposes only, the bureau shall prescribe
such language as it considers appropriate, on such of its forms as
it considers appropriate, to advise employers of their right to
elect to include as an "employee" within this chapter a sole
proprietor, any member of a partnership, an individual incorporated as a corporation, the officers of a family
farm corporation, or a person excluded from the definition of
"employee" under division (A)(2) of this section, that they
should check any health and disability insurance policy, or other
form of health and disability plan or contract, presently covering
them, or the purchase of which they may be considering, to
determine whether such policy, plan, or contract excludes benefits
for illness or injury that they might have elected to have covered
by workers' compensation. (1) The state, including state hospitals, each county,
municipal corporation, township, school district, and hospital
owned by a political subdivision or subdivisions other than the
state; (2) Every person, firm, professional employer organization as defined in section 4125.01 of the Revised Code, and private corporation, including
any public service corporation, that (a) has in service one or
more employees or shared employees regularly in the same business or in or about the
same establishment under any contract of hire, express or implied,
oral or written, or (b) is bound by any such contract of hire or
by any other written contract, to pay into the insurance fund the
premiums provided by this chapter. All such employers are subject to this chapter. Any member
of a firm or association, who regularly performs manual labor in
or about a mine, factory, or other establishment, including a
household establishment, shall be considered an employee in
determining whether such person, firm, or private corporation, or
public service corporation, has in its service, one or more
employees and the employer shall report the income derived from
such labor to the bureau as part of the payroll of such employer,
and such member shall thereupon be entitled to all the benefits of
an employee. (C) "Injury" includes
any injury, whether caused by external
accidental means
or accidental in character and result, received
in the course of,
and arising out of, the injured employee's
employment. "Injury" does not include: (1) Psychiatric conditions except where the claimant's psychiatric conditions
have
arisen from an injury or occupational disease sustained by that claimant or where the claimant's psychiatric conditions have arisen from sexual conduct in which the claimant was forced by threat of physical harm to engage or participate; (2) Injury or disability caused primarily by the natural
deterioration of tissue, an organ, or part of the body; (3) Injury or disability incurred in voluntary
participation
in an employer-sponsored recreation or fitness
activity if the
employee signs a waiver of the employee's right to
compensation or
benefits under this chapter prior to engaging in
the recreation or
fitness activity; (4) A condition that pre-existed an injury unless that pre-existing condition is substantially aggravated by the injury. Such a substantial aggravation must be documented by objective diagnostic findings, objective clinical findings, or objective test results. Subjective complaints may be evidence of such a substantial aggravation. However, subjective complaints without objective diagnostic findings, objective clinical findings, or objective test results are insufficient to substantiate a substantial aggravation. (D) "Child" includes a posthumous child and a child legally
adopted prior to the injury. (E) "Family farm corporation" means a corporation founded
for the purpose of farming agricultural land in which the majority
of the voting stock is held by and the majority of the
stockholders are persons or the spouse of persons related to each
other within the fourth degree of kinship, according to the rules
of the civil law, and at least one of the related persons is
residing on or actively operating the farm, and none of whose
stockholders are a corporation. A family farm corporation does
not cease to qualify under this division where, by reason of any
devise, bequest, or the operation of the laws of descent or
distribution, the ownership of shares of voting stock is
transferred to another person, as long as that person is within
the degree of kinship stipulated in this division. (F) "Occupational disease" means a disease contracted in the
course of employment, which by its causes and the characteristics
of its manifestation or the condition of the employment results in
a hazard which distinguishes the employment in character from
employment generally, and the employment creates a risk of
contracting the disease in greater degree and in a different
manner from the public in general. (G) "Self-insuring employer" means an employer who is
granted the privilege of paying compensation and benefits directly
under section 4123.35 of the Revised Code, including a board of
county commissioners for the sole purpose of constructing a sports
facility as defined in section 307.696 of the Revised Code,
provided that the electors of the county in which the sports
facility is to be built have approved construction of a sports
facility by ballot election no later than November 6, 1997. (H) "Public employer" means an employer as defined in
division (B)(1) of this section. (I) "Sexual conduct" means vaginal intercourse between a male and female; anal intercourse, fellatio, and cunnilingus between persons regardless of gender; and, without privilege to do so, the insertion, however slight, of any part of the body or any instrument, apparatus, or other object into the vaginal or anal cavity of another. Penetration, however slight, is sufficient to complete vaginal or anal intercourse.
Sec. 4123.271. The administrator of workers' compensation may furnish to the tax commissioner, on a quarterly basis, a list in a format approved by the tax commissioner containing the name and social security number or employer identification number of any employer, and may request that the tax commissioner, on a quarterly basis, report the total amount of compensation paid that the employer reported for the period for which the annual return is made pursuant to division (F)(3) of section 5747.07 of the Revised Code, for each employer contained on the administrator's list. Upon receipt of this list and request, the tax commissioner shall provide to the administrator, in a format designed by the tax commissioner, information identifying any employer listed by the administrator who reported compensation paid to employees on the most recent return filed by the person pursuant to section 5747.07 of the Revised Code and the total amount of compensation paid that the employer reported for the period for which the annual return is made pursuant to division (F)(3) of section 5747.07 of the Revised Code.
Sec. 4123.311. (A) The administrator of workers' compensation may do all of the following:
(1) Utilize direct deposit of funds by electronic transfer for all disbursements the administrator is authorized to pay under this chapter and Chapters 4121., 4127., and 4131. of the Revised Code;
(2) Require any payee to provide a written authorization designating a financial institution and an account number to which a payment made according to division (A)(1) of this section is to be credited, notwithstanding division (B) of section 9.37 of the Revised Code;
(3) Contract with an agent to do both of the following:
(a) Supply debit cards for claimants to access payments made to them pursuant to this chapter and Chapters 4121., 4127., and 4131. of the Revised Code;
(b) Credit the debit cards described in division (A)(3)(a) of this section with the amounts specified by the administrator pursuant to this chapter and Chapters 4121., 4127., and 4131. of the Revised Code by utilizing direct deposit of funds by electronic transfer.
(4) Enter into agreements with financial institutions to credit the debit cards described in division (A)(3)(a) of this section with the amounts specified by the administrator pursuant to this chapter and Chapters 4121., 4127., and 4131. of the Revised Code by utilizing direct deposit of funds by electronic transfer.
(B) The administrator shall inform claimants about the administrator's utilization of direct deposit of funds by electronic transfer under this section and section 9.37 of the Revised Code, furnish debit cards to claimants as appropriate, and provide claimants with instructions regarding use of those debit cards.
(C) The administrator, with the advice and consent of the workers' compensation oversight commission, shall adopt rules in accordance with Chapter 119. of the Revised Code regarding utilization of the direct deposit of funds by electronic transfer under this section and section 9.37 of the Revised Code.
Sec. 4123.32. The administrator of workers' compensation,
with the advice and
consent of the workers' compensation
oversight
commission, shall adopt rules with respect to the collection,
maintenance,
and disbursements of the state insurance fund
including all of
the following: (A) A rule providing that in the event there is developed
as
of any given rate revision date a surplus of earned premium
over
all losses which, in the judgment of the administrator, is
larger
than is necessary adequately to safeguard the solvency of
the
fund, the administrator may return such excess surplus to the
subscriber to the fund in either the form of cash refunds or a
reduction of
premiums, regardless of when the premium
obligations have accrued; (B) A rule providing that the premium security deposit
collected from
any employer entitles the employer to the benefits
of
this chapter for the remainder of
the six months and also for
an additional adjustment period of two months,
and,
thereafter, if
the employer pays the premium due at the close of any six-month
period, coverage shall be extended for an additional eight-month
period
beginning from the end of the six-month period for which
the employer pays the
premium due; (C) A rule providing for ascertaining the correctness of any
employer's
report of
estimated or actual expenditure of wages and
the determination and adjustment
of proper premiums and the
payment of those premiums by the employer
for or during any period
less than eight months and notwithstanding any
payment or
determination of premium made when exceptional conditions or
circumstances in the judgment of the administrator justify the
action; (D) Such special rules as the administrator considers
necessary to safeguard the fund and that are just in the
circumstances, covering the rates to be applied where one
employer
takes over the occupation or industry of another or
where an
employer first makes application for state insurance,
and the
administrator may require that if any employer transfers
a
business in whole or in part or otherwise reorganizes the
business, the successor in interest shall assume, in proportion
to
the extent of the transfer, as determined by the
administrator,
the employer's account and shall continue the
payment of all
contributions due under this chapter; (E) A rule providing for all of the
following: (1) If, within two months immediately after the expiration
of the
six-month period, an employer fails to file a report of the
employer's
actual payroll
expenditures for the period, the premium
found to be due from the
employer for the period
shall be
increased in an amount equal to one per cent of the premium, but
the
increase shall not be less than three nor more than fifteen
dollars; (2) The premium determined by the administrator to be due
from an employer
shall be payable on or before the end of the
coverage period established by
the premium security deposit, or
within the time specified by the
administrator if
the period for
which the advance premium has been paid is less than eight
months.
If an employer fails to pay the premium when due, an amount equal
to
three per cent of the premium shall be added to the premium.
If
the failure
to pay continues for more than one month, the
premium
shall be increased
further
in an amount equal to two per
cent of
the premium for each additional month or
part of a month,
but the
total of all additional amounts shall not exceed
twelve
per cent
of the premium. If the administrator may add a thirty dollar late fee penalty to the premium plus an additional penalty amount as follows:
(a) For a premium from eleven to thirty days past due, three per cent of the premium due;
(b) For a premium from thirty-one to sixty days past due, the prime interest rate multiplied by the premium due;
(c) For a premium from sixty-one to ninety days past due, the prime interest rate plus two per cent, multiplied by the premium due;
(d) For a premium from ninety-one to one hundred twenty days past due, the prime interest rate plus four per cent, multiplied by the premium due;
(e) For a premium from one hundred twenty-one to one hundred fifty days past due, the prime interest rate plus six per cent, multiplied by the premium due;
(f) For a premium from one hundred fifty-one to one hundred eighty days past due, the prime interest rate plus eight per cent, multiplied by the premium due;
(g) For a premium from one hundred eighty-one to two hundred ten days past due, the prime interest rate plus ten per cent, multiplied by the premium due;
(h) For each additional thirty-day period or portion thereof that a premium remains past due after it has remained past due for more than two hundred ten days, the prime interest rate plus ten per cent, multiplied by the premium due.
(3) An employer may appeal a late fee penalty or additional penalty to an adjudicating committee pursuant to section 4123.291 of the Revised Code.
For purposes of this division, "prime interest rate" means the average bank prime rate, and the administrator shall determine the prime interest rate in the same manner as a county auditor determines the average bank prime rate under section 929.02 of the Revised Code. (4) If the employer files an appropriate
payroll
report, within the time provided by law or within the time
specified by the
administrator if the period for which the
employer paid an estimated premium is
less than eight months, the
employer shall not be in default and division
(E)(2) of this section
4123.32 of the Revised Code shall not apply if the employer
pays
the premiums within fifteen days after being first notified by the
administrator of the amount due. (3)(5) Any deficiencies in the amounts of the premium security
deposit paid by
an employer for any period shall be subject to an
interest charge of six per
cent per annum from the date the
premium obligation is incurred. In
determining the interest due
on deficiencies in premium security deposit
payments, a charge in
each case shall be made against the employer in an
amount
equal to
interest at the rate of six per cent per annum on the premium
security
deposit due but remaining unpaid sixty days after notice
by the administrator.
(4)(6) Any interest charges or penalties provided for in
divisions
(E)(2) and (3)(5) of this section shall be credited to the
employer's
account for rating purposes in the same manner as
premiums.
(F) A rule providing that each employer, on the occasion
of
instituting coverage under this chapter, shall submit a
premium
security deposit. The deposit shall be calculated
equivalent to
thirty per cent of the semiannual premium
obligation of the
employer based upon the employer's estimated
expenditure for wages
for the ensuing six-month period plus
thirty per cent of an
additional adjustment period of two months
but only up to a
maximum of one thousand dollars and not less
than ten dollars.
The
administrator shall review the security
deposit of every
employer
who has submitted a deposit which is
less than the
one-thousand-dollar maximum. The administrator may
require any
such employer to submit additional money up to the
maximum of one
thousand dollars that, in the administrator's
opinion, reflects
the employer's current payroll expenditure for
an eight-month
period.
Sec. 4123.35. (A) Except as provided in this section,
every employer mentioned in division (B)(2) of section 4123.01 of
the Revised Code, and every publicly owned utility shall pay
semiannually in the months of January and July into the state
insurance fund the amount of annual premium the administrator of
workers' compensation fixes for the employment or occupation of
the employer, the amount of which premium to be paid by each
employer to be determined by the classifications, rules, and rates
made and published by the administrator. The employer shall pay
semiannually a further sum of money into the state insurance fund
as may be ascertained to be due from the employer by applying the
rules of the administrator, and a receipt or certificate
certifying that payment has been made, along with a written notice as is required in section 4123.54 of the Revised Code, shall be mailed immediately
to the employer by the bureau of workers' compensation. The
receipt or certificate is prima-facie evidence of the payment of
the premium, and the proper posting of the notice constitutes the employer's compliance with the notice requirement mandated in section 4123.54 of the Revised Code.
The bureau of workers' compensation shall verify with the
secretary of state the existence of all corporations and
organizations making application for workers' compensation
coverage and shall require every such application to include the
employer's federal identification number.
An employer as defined in division (B)(2) of section 4123.01
of the Revised Code who has contracted with a subcontractor is
liable for the unpaid premium due from any subcontractor with
respect to that part of the payroll of the subcontractor that is
for work performed pursuant to the contract with the employer.
Division (A) of this section providing for the payment of
premiums semiannually does not apply to any employer who was a
subscriber to the state insurance fund prior to January 1, 1914,
or who may first become a subscriber to the fund in any month
other than January or July. Instead, the semiannual premiums
shall be paid by those employers from time to time upon the
expiration of the respective periods for which payments into the
fund have been made by them. The administrator shall adopt rules to permit employers to
make periodic payments of the semiannual premium due under this
division. The rules shall include provisions for the assessment
of interest charges, where appropriate, and for the assessment of
penalties when an employer fails to make timely premium payments.
An employer who timely pays the amounts due under this division is
entitled to all of the benefits and protections of this chapter.
Upon receipt of payment, the bureau immediately shall mail a
receipt or certificate to the employer certifying that payment has
been made, which receipt is prima-facie evidence of payment.
Workers' compensation coverage under this chapter continues
uninterrupted upon timely receipt of payment under this division.
Every public employer, except public employers that are
self-insuring employers under this section, shall comply with
sections 4123.38 to 4123.41, and 4123.48 of the Revised Code in
regard to the contribution of moneys to the public insurance fund. (B) Employers who will abide by the rules of the
administrator and who may be of sufficient financial ability to
render certain the payment of compensation to injured employees or
the dependents of killed employees, and the furnishing of medical,
surgical, nursing, and hospital attention and services and
medicines, and funeral expenses, equal to or greater than is
provided for in sections 4123.52, 4123.55 to 4123.62, and 4123.64
to 4123.67 of the Revised Code, and who do not desire to insure
the payment thereof or indemnify themselves against loss sustained
by the direct payment thereof, upon a finding of such facts by the
administrator, may be granted the privilege to pay individually
compensation, and furnish medical, surgical, nursing, and hospital
services and attention and funeral expenses directly to injured
employees or the dependents of killed employees, thereby being
granted status as a self-insuring employer. The administrator may
charge employers who apply for the status as a self-insuring
employer a reasonable application fee to cover the bureau's costs
in connection with processing and making a determination with
respect to an application. All employers granted
status
as self-insuring employers
shall demonstrate
sufficient financial and administrative ability
to assure that all
obligations under this section are promptly
met. The
administrator shall deny the privilege where the
employer is
unable to demonstrate the employer's ability to
promptly meet all
the obligations imposed on the employer by this
section.
(1) The administrator shall consider, but is not limited to,
the following factors, where applicable, in determining the
employer's ability to meet all of the obligations imposed on the
employer by this section:
(a) The employer employs a minimum of five hundred employees
in this state;
(b) The employer has operated in this state for a minimum of
two years, provided that an employer who has purchased, acquired,
or otherwise succeeded to the operation of a business, or any part
thereof, situated in this state that has operated for at least two
years in this state, also shall qualify;
(c) Where the employer previously contributed to the state
insurance fund or is a successor employer as defined by bureau
rules, the amount of the buyout, as defined by bureau rules; (d) The sufficiency of the employer's assets located in this
state to insure the employer's solvency in paying compensation
directly; (e) The financial records, documents, and data, certified by
a certified public accountant, necessary to provide the employer's
full financial disclosure. The records, documents, and data
include, but are not limited to, balance sheets and profit and
loss history for the current year and previous four years.
(f) The employer's organizational plan for the
administration of the workers' compensation law; (g) The employer's proposed plan to inform employees of the
change from a state fund insurer to a self-insuring employer, the
procedures the employer will follow as a self-insuring employer,
and the employees' rights to compensation and benefits; and
(h) The employer has either an account in a financial
institution in this state, or if the employer maintains an account
with a financial institution outside this state, ensures that
workers' compensation checks are drawn from the same account as
payroll checks or the employer clearly indicates that payment will
be honored by a financial institution in this state.
The administrator may waive the requirements of divisions
(B)(1)(a) and (b) of this section and the requirement of division
(B)(1)(e) of this section that the financial records, documents,
and data be certified by a certified public accountant. The
administrator shall adopt rules establishing the criteria that an
employer shall meet in order for the administrator to waive the
requirement of division (B)(1)(e) of this section. Such rules may
require additional security of that employer pursuant to division
(E) of section 4123.351 of the Revised Code. The administrator shall not grant the status of self-insuring
employer to the state, except that the administrator may grant the
status of self-insuring employer to a state institution of higher
education, excluding its hospitals, that meets the requirements of
division (B)(2) of this section.
(2) When considering the application of a public employer,
except for a board of county commissioners described in division
(G) of section 4123.01 of the Revised Code, a board of a county
hospital, or a publicly owned utility, the administrator shall
verify that the public employer satisfies all of the following
requirements as the requirements apply to that public employer:
(a) For the two-year period preceding application under this
section, the public employer has maintained an unvoted debt
capacity equal to at least two times the amount of the current
annual premium established by the administrator under this chapter
for that public employer for the year immediately preceding the
year in which the public employer makes application under this
section.
(b) For each of the two fiscal years preceding application
under this section, the unreserved and undesignated year-end fund
balance in the public employer's general fund is equal to at least
five per cent of the public employer's general fund revenues for
the fiscal year computed in accordance with generally accepted
accounting principles. (c) For the five-year period preceding application under
this section, the public employer, to the extent applicable, has
complied fully with the continuing disclosure requirements
established in rules adopted by the United States securities and
exchange commission under 17 C.F.R. 240.15c 2-12. (d) For the five-year period preceding application under
this section, the public employer has not had its local government
fund distribution withheld on account of the public employer being
indebted or otherwise obligated to the state.
(e) For the five-year period preceding application under
this section, the public employer has not been under a fiscal
watch or fiscal emergency pursuant to section 118.023, 118.04, or
3316.03 of the Revised Code.
(f) For the public employer's fiscal year preceding
application under this section, the public employer has obtained
an annual financial audit as required under section 117.10 of the
Revised Code, which has been released by the auditor of state
within seven months after the end of the public employer's fiscal
year. (g) On the date of application, the public employer holds a
debt rating of Aa3 or higher according to Moody's investors
service, inc., or a comparable rating by an independent rating
agency similar to Moody's investors service, inc.
(h) The public employer agrees to generate an annual
accumulating book reserve in its financial statements reflecting
an actuarially generated reserve adequate to pay projected claims
under this chapter for the applicable period of time, as
determined by the administrator.
(i) For a public employer that is a hospital, the public
employer shall submit audited financial statements showing the
hospital's overall liquidity characteristics, and the
administrator shall determine, on an individual basis, whether the
public employer satisfies liquidity standards equivalent to the
liquidity standards of other public employers.
(j) Any additional criteria that the administrator adopts by
rule pursuant to division (E) of this section. The administrator shall not approve the application of a
public employer, except for a board of county commissioners
described in division (G) of section 4123.01 of the Revised Code,
a board of a county hospital, or publicly owned utility, who does
not satisfy all of the requirements listed in division (B)(2) of
this section.
(C) A board of county commissioners described in division
(G) of section 4123.01 of the Revised Code, as an employer, that
will abide by the rules of the administrator and that may be of
sufficient financial ability to render certain the payment of
compensation to injured employees or the dependents of killed
employees, and the furnishing of medical, surgical, nursing, and
hospital attention and services and medicines, and funeral
expenses, equal to or greater than is provided for in sections
4123.52, 4123.55 to 4123.62, and 4123.64 to 4123.67 of the Revised
Code, and that does not desire to insure the payment thereof or
indemnify itself against loss sustained by the direct payment
thereof, upon a finding of such facts by the administrator, may be
granted the privilege to pay individually compensation, and
furnish medical, surgical, nursing, and hospital services and
attention and funeral expenses directly to injured employees or
the dependents of killed employees, thereby being granted status
as a self-insuring employer. The administrator may charge a board
of county commissioners described in division (G) of section
4123.01 of the Revised Code that applies for the status as a
self-insuring employer a reasonable application fee to cover the
bureau's costs in connection with processing and making a
determination with respect to an application. All employers
granted such status shall demonstrate sufficient financial and
administrative ability to assure that all obligations under this
section are promptly met. The administrator shall deny the
privilege where the employer is unable to demonstrate the
employer's ability to promptly meet all the obligations imposed on
the employer by this section. The administrator shall consider,
but is not limited to, the following factors, where applicable, in
determining the employer's ability to meet all of the obligations
imposed on the board as an employer by this section: (1) The board as an employer employs a minimum of five
hundred employees in this state;
(2) The board has operated in this state for a minimum of
two years;
(3) Where the board previously contributed to the state
insurance fund or is a successor employer as defined by bureau
rules, the amount of the buyout, as defined by bureau rules; (4) The sufficiency of the board's assets located in this
state to insure the board's solvency in paying compensation
directly;
(5) The financial records, documents, and data, certified by
a certified public accountant, necessary to provide the board's
full financial disclosure. The records, documents, and data
include, but are not limited to, balance sheets and profit and
loss history for the current year and previous four years. (6) The board's organizational plan for the administration
of the workers' compensation law;
(7) The board's proposed plan to inform employees of the
proposed self-insurance, the procedures the board will follow as a
self-insuring employer, and the employees' rights to compensation
and benefits;
(8) The board has either an account in a financial
institution in this state, or if the board maintains an account
with a financial institution outside this state, ensures that
workers' compensation checks are drawn from the same account as
payroll checks or the board clearly indicates that payment will be
honored by a financial institution in this state;
(9) The board shall provide the administrator a surety bond
in an amount equal to one hundred twenty-five per cent of the
projected losses as determined by the administrator.
(D) The administrator shall require a surety bond from all
self-insuring employers, issued pursuant to section 4123.351 of
the Revised Code, that is sufficient to compel, or secure to
injured employees, or to the dependents of employees killed, the
payment of compensation and expenses, which shall in no event be
less than that paid or furnished out of the state insurance fund
in similar cases to injured employees or to dependents of killed
employees whose employers contribute to the fund, except when an
employee of the employer, who has suffered the loss of a hand,
arm, foot, leg, or eye prior to the injury for which compensation
is to be paid, and thereafter suffers the loss of any other of the
members as the result of any injury sustained in the course of and
arising out of the employee's employment, the compensation to be
paid by the self-insuring employer is limited to the disability suffered in the subsequent injury, additional compensation, if
any, to be paid by the bureau out of the surplus created by
section 4123.34 of the Revised Code.
(E) In addition to the requirements of this section, the
administrator shall make and publish rules governing the manner of
making application and the nature and extent of the proof required
to justify a finding of fact by the administrator as to granting
the status of a self-insuring employer, which rules shall be
general in their application, one of which rules shall provide
that all self-insuring employers shall pay into the state
insurance fund such amounts as are required to be credited to the
surplus fund in division (B) of section 4123.34 of the Revised
Code. The administrator may adopt rules establishing requirements
in addition to the requirements described in division (B)(2) of
this section that a public employer shall meet in order to qualify
for self-insuring status. Employers shall secure directly from the bureau central
offices application forms upon which the bureau shall stamp a
designating number. Prior to submission of an application, an
employer shall make available to the bureau, and the bureau shall
review, the information described in division (B)(1) of this
section, and public employers shall make available, and the bureau
shall review, the information necessary to verify whether the
public employer meets the requirements listed in division (B)(2)
of this section. An employer shall file the completed application
forms with an application fee, which shall cover the costs of
processing the application, as established by the administrator,
by rule, with the bureau at least ninety days prior to the
effective date of the employer's new status as a self-insuring
employer. The application form is not deemed complete until all
the required information is attached thereto. The bureau shall
only accept applications that contain the required information.
(F) The bureau shall review completed applications within a
reasonable time. If the bureau determines to grant an employer
the status as a self-insuring employer, the bureau shall issue a
statement, containing its findings of fact, that is prepared by
the bureau and signed by the administrator. If the bureau
determines not to grant the status as a self-insuring employer,
the bureau shall notify the employer of the determination and
require the employer to continue to pay its full premium into the
state insurance fund. The administrator also shall adopt rules
establishing a minimum level of performance as a criterion for
granting and maintaining the status as a self-insuring employer
and fixing time limits beyond which failure of the self-insuring
employer to provide for the necessary medical examinations and
evaluations may not delay a decision on a claim.
(G) The administrator shall adopt rules setting forth
procedures for auditing the program of self-insuring employers.
The bureau shall conduct the audit upon a random basis or whenever
the bureau has grounds for believing that a self-insuring employer
is not in full compliance with bureau rules or this chapter.
The administrator shall monitor the programs conducted by
self-insuring employers, to ensure compliance with bureau
requirements and for that purpose, shall develop and issue to
self-insuring employers standardized forms for use by the
self-insuring employer in all aspects of the self-insuring
employers' direct compensation program and for reporting of
information to the bureau.
The bureau shall receive and transmit to the self-insuring
employer all complaints concerning any self-insuring employer. In
the case of a complaint against a self-insuring employer, the
administrator shall handle the complaint through the
self-insurance division of the bureau. The bureau shall maintain
a file by employer of all complaints received that relate to the
employer. The bureau shall evaluate each complaint and take
appropriate action.
The administrator shall adopt as a rule a prohibition against
any self-insuring employer from harassing, dismissing, or
otherwise disciplining any employee making a complaint, which rule
shall provide for a financial penalty to be levied by the
administrator payable by the offending self-insuring employer.
(H) For the purpose of making determinations as to whether
to grant status as a self-insuring employer, the administrator may
subscribe to and pay for a credit reporting service that offers
financial and other business information about individual
employers. The costs in connection with the bureau's subscription
or individual reports from the service about an applicant may be
included in the application fee charged employers under this
section.
(I) The administrator, notwithstanding other provisions of
this chapter, may permit a self-insuring employer to resume
payment of premiums to the state insurance fund with appropriate
credit modifications to the employer's basic premium rate as such
rate is determined pursuant to section 4123.29 of the Revised
Code. (J) On the first day of July of each year, the administrator
shall calculate separately each self-insuring employer's
assessments for the safety and hygiene fund, administrative costs
pursuant to section 4123.342 of the Revised Code, and for the
portion of the surplus fund under division (B) of section 4123.34
of the Revised Code that is not used for handicapped
reimbursement, on the basis of the paid compensation attributable
to the individual self-insuring employer according to the
following calculation:
(1) The total assessment against all self-insuring employers
as a class for each fund and for the administrative costs for the
year that the assessment is being made, as determined by the
administrator, divided by the total amount of paid compensation
for the previous calendar year attributable to all amenable
self-insuring employers;
(2) Multiply the quotient in division (J)(1) of this section
by the total amount of paid compensation for the previous calendar
year that is attributable to the individual self-insuring employer
for whom the assessment is being determined. Each self-insuring
employer shall pay the assessment that results from this
calculation, unless the assessment resulting from this calculation
falls below a minimum assessment, which minimum assessment the
administrator shall determine on the first day of July of each
year with the advice and consent of the workers' compensation
oversight commission, in which event, the self-insuring employer
shall pay the minimum assessment. In determining the total amount due for the total assessment
against all self-insuring employers as a class for each fund and
the administrative assessment, the administrator shall reduce
proportionately the total for each fund and assessment by the
amount of money in the self-insurance assessment fund as of the
date of the computation of the assessment.
The administrator shall calculate the assessment for the
portion of the surplus fund under division (B) of section 4123.34
of the Revised Code that is used for handicapped reimbursement in
the same manner as set forth in divisions (J)(1) and (2) of this
section except that the administrator shall calculate the total
assessment for this portion of the surplus fund only on the basis
of those self-insuring employers that retain participation in the
handicapped reimbursement program and the individual self-insuring
employer's proportion of paid compensation shall be calculated
only for those self-insuring employers who retain participation in
the handicapped reimbursement program. The administrator, as the
administrator determines appropriate, may determine the total
assessment for the handicapped portion of the surplus fund in
accordance with sound actuarial principles. The administrator shall calculate the assessment for the
portion of the surplus fund under division (B) of section 4123.34
of the Revised Code that under division (D) of section 4121.66 of
the Revised Code is used for rehabilitation costs in the same
manner as set forth in divisions (J)(1) and (2) of this section,
except that the administrator shall calculate the total assessment
for this portion of the surplus fund only on the basis of those
self-insuring employers who have not made the election to make
payments directly under division (D) of section 4121.66 of the
Revised Code and an individual self-insuring employer's proportion
of paid compensation only for those self-insuring employers who
have not made that election.
The administrator shall calculate the assessment for the portion of the surplus fund under division (B) of section 4123.34 of the Revised Code that is used for reimbursement to a self-insuring employer under division (H) of section 4123.512 of the Revised Code in the same manner as set forth in divisions (J)(1) and (2) of this section except that the administrator shall calculate the total assessment for this portion of the surplus fund only on the basis of those self-insuring employers that retain participation in reimbursement to the self-insuring employer under division (H) of section 4123.512 of the Revised Code and the individual self-insuring employer's proportion of paid compensation shall be calculated only for those self-insuring employers who retain participation in reimbursement to the self-insuring employer under division (H) of section 4123.512 of the Revised Code. An employer who no longer is a self-insuring employer in this
state or who no longer is operating in this state, shall continue
to pay assessments for administrative costs and for the portion of
the surplus fund under division (B) of section 4123.34 of the
Revised Code that is not used for handicapped reimbursement, based
upon paid compensation attributable to claims that occurred while
the employer was a self-insuring employer within this state. (K) There is hereby created in the state treasury the
self-insurance assessment fund. All investment earnings of the
fund shall be deposited in the fund. The administrator shall use
the money in the self-insurance assessment fund only for
administrative costs as specified in section 4123.341 of the
Revised Code.
(L) Every self-insuring employer shall certify, in affidavit
form subject to the penalty for perjury, to the bureau the amount
of the self-insuring employer's paid compensation for the previous
calendar year. In reporting paid compensation paid for the
previous year, a self-insuring employer shall exclude from the
total amount of paid compensation any reimbursement the
self-insuring employer receives in the previous calendar year from
the surplus fund pursuant to section 4123.512 of the Revised Code
for any paid compensation. The self-insuring employer also shall
exclude from the paid compensation reported any amount recovered
under section 4123.931 of the Revised Code and any amount that is
determined not to have been payable to or on behalf of a claimant
in any final administrative or judicial proceeding. The
self-insuring employer shall exclude such amounts from the paid
compensation reported in the reporting period subsequent to the
date the determination is made. The administrator shall adopt
rules, in accordance with Chapter 119. of the Revised Code,
establishing that provide for all of the following: (1) Establishing the date by which self-insuring employers must submit
such information and the amount of the assessments provided for in
division (J) of this section for employers who have been granted
self-insuring status within the last calendar year; (2) If an employer fails to pay the assessment when due, the administrator may add a late fee penalty of not more than five hundred dollars to the assessment plus an additional penalty amount as follows:
(a) For an assessment from sixty-one to ninety days past due, the prime interest rate, multiplied by the assessment due;
(b) For an assessment from ninety-one to one hundred twenty days past due, the prime interest rate plus two per cent, multiplied by the assessment due;
(c) For an assessment from one hundred twenty-one to one hundred fifty days past due, the prime interest rate plus four per cent, multiplied by the assessment due;
(d) For an assessment from one hundred fifty-one to one hundred eighty days past due, the prime interest rate plus six per cent, multiplied by the assessment due;
(e) For an assessment from one hundred eighty-one to two hundred ten days past due, the prime interest rate plus eight per cent, multiplied by the assessment due;
(f) For each additional thirty-day period or portion thereof that an assessment remains past due after it has remained past due for more than two hundred ten days, the prime interest rate plus eight per cent, multiplied by the assessment due.
(3) An employer may appeal a late fee penalty and penalty assessment to the administrator.
For purposes of this division, "prime interest rate" means the average bank prime rate, and the administrator shall determine the prime interest rate in the same manner as a county auditor determines the average bank prime rate under section 929.02 of the Revised Code.
The administrator shall include any assessment and penalties that remains
remain unpaid for previous assessment periods in the calculation and
collection of any assessments due under this division or division
(J) of this section. (M) As used in this section, "paid compensation" means all
amounts paid by a self-insuring employer for living maintenance
benefits, all amounts for compensation paid pursuant to sections
4121.63, 4121.67, 4123.56, 4123.57, 4123.58, 4123.59, 4123.60, and
4123.64 of the Revised Code, all amounts paid as wages in lieu of
such compensation, all amounts paid in lieu of such compensation
under a nonoccupational accident and sickness program fully funded
by the self-insuring employer, and all amounts paid by a
self-insuring employer for a violation of a specific safety
standard pursuant to Section 35 of Article II, Ohio Constitution
and section 4121.47 of the Revised Code. (N) Should any section of this chapter or Chapter 4121. of
the Revised Code providing for self-insuring employers'
assessments based upon compensation paid be declared
unconstitutional by a final decision of any court, then that
section of the Revised Code declared unconstitutional shall revert
back to the section in existence prior to November 3, 1989,
providing for assessments based upon payroll.
(O) The administrator may grant a self-insuring employer the
privilege to self-insure a construction project entered into by
the self-insuring employer that is scheduled for completion within
six years after the date the project begins, and the total cost of
which is estimated to exceed one hundred million dollars
or, for
employers described in division (R) of this section, if the
construction project is estimated to exceed twenty-five million
dollars. The
administrator may waive such cost and time criteria
and grant a
self-insuring employer the privilege to self-insure a
construction
project regardless of the time needed to complete the
construction
project and provided that the cost of the
construction project is
estimated to exceed fifty million dollars.
A self-insuring
employer who desires to self-insure a construction
project shall
submit to the administrator an application listing
the dates the
construction project is scheduled to begin and end,
the estimated
cost of the construction project, the contractors
and
subcontractors whose employees are to be self-insured by the
self-insuring employer, the provisions of a safety program that is
specifically designed for the construction project, and a
statement as to whether a collective bargaining agreement
governing the rights, duties, and obligations of each of the
parties to the agreement with respect to the construction project
exists between the self-insuring employer and a labor
organization.
A self-insuring employer may apply to self-insure the
employees of either of the following:
(1) All contractors and subcontractors who perform labor or
work or provide materials for the construction project;
(2) All contractors and, at the administrator's discretion,
a substantial number of all the subcontractors who perform labor
or work or provide materials for the construction project.
Upon approval of the application, the administrator shall
mail a certificate granting the privilege to self-insure the
construction project to the self-insuring employer. The
certificate shall contain the name of the self-insuring employer
and the name, address, and telephone number of the self-insuring
employer's representatives who are responsible for administering
workers' compensation claims for the construction project. The
self-insuring employer shall post the certificate in a conspicuous
place at the site of the construction project.
The administrator shall maintain a record of the contractors
and subcontractors whose employees are covered under the
certificate issued to the self-insured employer. A self-insuring
employer immediately shall notify the administrator when any
contractor or subcontractor is added or eliminated from inclusion
under the certificate.
Upon approval of the application, the self-insuring employer
is responsible for the administration and payment of all claims
under this chapter and Chapter 4121. of the Revised Code for the
employees of the contractor and subcontractors covered under the
certificate who receive injuries or are killed in the course of
and arising out of employment on the construction project, or who
contract an occupational disease in the course of employment on
the construction project. For purposes of this chapter and
Chapter 4121. of the Revised Code, a claim that is administered
and paid in accordance with this division is considered a claim
against the self-insuring employer listed in the certificate. A
contractor or subcontractor included under the certificate shall
report to the self-insuring employer listed in the certificate,
all claims that arise under this chapter and Chapter 4121. of the
Revised Code in connection with the construction project for which
the certificate is issued.
A self-insuring employer who complies with this division is
entitled to the protections provided under this chapter and
Chapter 4121. of the Revised Code with respect to the employees of
the contractors and subcontractors covered under a certificate
issued under this division for death or injuries that arise out
of, or death, injuries, or occupational diseases that arise in the
course of, those employees' employment on that construction
project, as if the employees were employees of the self-insuring
employer, provided that the self-insuring employer also complies
with this section. No employee of the contractors and
subcontractors covered under a certificate issued under this
division shall be considered the employee of the self-insuring
employer listed in that certificate for any purposes other than
this chapter and Chapter 4121. of the Revised Code. Nothing in
this division gives a self-insuring employer authority to control
the means, manner, or method of employment of the employees of the
contractors and subcontractors covered under a certificate issued
under this division. The contractors and subcontractors included under a
certificate issued under this division are entitled to the
protections provided under this chapter and Chapter 4121. of the
Revised Code with respect to the contractor's or subcontractor's
employees who are employed on the construction project which is
the subject of the certificate, for death or injuries that arise
out of, or death, injuries, or occupational diseases that arise in
the course of, those employees' employment on that construction
project.
The contractors and subcontractors included under a
certificate issued under this division shall identify in their
payroll records the employees who are considered the employees of
the self-insuring employer listed in that certificate for purposes
of this chapter and Chapter 4121. of the Revised Code, and the
amount that those employees earned for employment on the
construction project that is the subject of that certificate.
Notwithstanding any provision to the contrary under this chapter
and Chapter 4121. of the Revised Code, the administrator shall
exclude the payroll that is reported for employees who are
considered the employees of the self-insuring employer listed in
that certificate, and that the employees earned for employment on
the construction project that is the subject of that certificate,
when determining those contractors' or subcontractors' premiums or
assessments required under this chapter and Chapter 4121. of the
Revised Code. A self-insuring employer issued a certificate under
this division shall include in the amount of paid compensation it
reports pursuant to division (L) of this section, the amount of
paid compensation the self-insuring employer paid pursuant to this
division for the previous calendar year. Nothing in this division shall be construed as altering the
rights of employees under this chapter and Chapter 4121. of the
Revised Code as those rights existed prior to September 17, 1996.
Nothing in this division shall be construed as altering the rights
devolved under sections 2305.31 and 4123.82 of the Revised Code as
those rights existed prior to September 17, 1996.
As used in this division, "privilege to self-insure a
construction project" means privilege to pay individually
compensation, and to furnish medical, surgical, nursing, and
hospital services and attention and funeral expenses directly to
injured employees or the dependents of killed employees.
(P) A self-insuring employer whose application is granted
under division (O) of this section shall designate a safety
professional to be responsible for the administration and
enforcement of the safety program that is specifically designed
for the construction project that is the subject of the
application.
A self-insuring employer whose application is granted under
division (O) of this section shall employ an ombudsperson for the
construction project that is the subject of the application. The
ombudsperson shall have experience in workers' compensation or the
construction industry, or both. The ombudsperson shall perform
all of the following duties:
(1) Communicate with and provide information to employees
who are injured in the course of, or whose injury arises out of
employment on the construction project, or who contract an
occupational disease in the course of employment on the
construction project; (2) Investigate the status of a claim upon the request of an
employee to do so;
(3) Provide information to claimants, third party
administrators, employers, and other persons to assist those
persons in protecting their rights under this chapter and Chapter
4121. of the Revised Code.
A self-insuring employer whose application is granted under
division (O) of this section shall post the name of the safety
professional and the ombudsperson and instructions for contacting
the safety professional and the ombudsperson in a conspicuous
place at the site of the construction project. (Q) The administrator may consider all of the following when
deciding whether to grant a self-insuring employer the privilege
to self-insure a construction project as provided under division
(O) of this section:
(1) Whether the self-insuring employer has an organizational
plan for the administration of the workers' compensation law;
(2) Whether the safety program that is specifically designed
for the construction project provides for the safety of employees
employed on the construction project, is applicable to all
contractors and subcontractors who perform labor or work or
provide materials for the construction project, and has
as a
component, a safety training program that complies with standards
adopted pursuant to the "Occupational Safety and Health Act of
1970," 84 Stat. 1590, 29 U.S.C.A. 651, and provides for continuing
management and employee involvement;
(3) Whether granting the privilege to self-insure the
construction project will reduce the costs of the construction
project; (4) Whether the self-insuring employer has employed an
ombudsperson as required under division (P) of this section; (5) Whether the self-insuring employer has sufficient surety
to secure the payment of claims for which the self-insuring
employer would be responsible pursuant to the granting of the
privilege to self-insure a construction project under division (O)
of this section. (R)
As used in divisions (O), (P), and (Q), "self-insuring
employer" includes the following employers, whether or not they
have been granted the status of being a self-insuring employer
under division (B) of this section:
(1) A state institution of higher education;
(3) A county school financing district;
(4) An educational service center;
(5) A community school established under Chapter 3314. of
the Revised Code.
(S) As used in this section: (1) "Unvoted debt capacity" means the amount of money that a
public employer may borrow without voter approval of a tax levy;
(2) "State institution of higher education" means the state
universities listed in section 3345.011 of the Revised Code,
community colleges created pursuant to Chapter 3354. of the
Revised Code, university branches created pursuant to Chapter
3355. of the Revised Code, technical colleges created pursuant to
Chapter 3357. of the Revised Code, and state community colleges
created pursuant to Chapter 3358. of the Revised Code.
Sec. 4123.512. (A) The claimant or the employer may
appeal an order of the industrial commission made under division
(E) of section 4123.511 of the Revised Code in any injury or
occupational disease case, other than a decision as to the extent
of disability to the court of common pleas of the county in
which the injury was inflicted or in which the contract of
employment was made if the injury occurred outside the state, or
in which the contract of employment was made if the exposure
occurred outside the state. If no common pleas court has
jurisdiction for the purposes of an appeal by the use of the
jurisdictional requirements described in this division, the
appellant may use the venue provisions in the Rules of Civil
Procedure to vest jurisdiction in a court. If the claim is for
an occupational disease, the appeal shall be to the court of
common pleas of the county in which the exposure which caused the
disease occurred. Like appeal may be taken from an order of a
staff hearing officer made under division (D) of section 4123.511
of the Revised Code from which the commission has refused to hear
an appeal. The appellant shall file the notice of appeal with a
court of common pleas within sixty days after the date of the
receipt of the order appealed from or the date of receipt of the
order of the commission refusing to hear an appeal of a staff
hearing officer's decision under division (D) of section 4123.511
of the Revised Code. The filing of the notice of the appeal with
the court is the only act required to perfect the appeal. If an action has been commenced in a court of a county
other than a court of a county having jurisdiction over the
action, the court, upon notice by any party or upon its own
motion, shall transfer the action to a court of a county having
jurisdiction. Notwithstanding anything to the contrary in this section,
if the commission determines under section 4123.522 of the
Revised Code that an employee, employer, or their respective
representatives have not received written notice of an order or
decision which is appealable to a court under this section and
which grants relief pursuant to section 4123.522 of the Revised
Code, the party granted the relief has sixty days from receipt of
the order under section 4123.522 of the Revised Code to file a
notice of appeal under this section. (B) The notice of appeal shall state the names of the
claimant and the employer, the number of the claim, the date of
the order appealed from, and the fact that the appellant appeals
therefrom. The administrator of workers' compensation, the claimant, and the employer shall be
parties to the appeal and the court, upon the application of the
commission, shall make the commission a party. The party filing the appeal
shall serve a copy of the notice of appeal on the admnistrator
of workers' compensation administrator at the central office of the
bureau of workers' compensation in Columbus. The administrator
shall notify the employer that if the employer fails to
become an active
party to the appeal, then the administrator may act on behalf of
the employer and the results of the appeal could have an adverse
effect upon the employer's premium rates. (C) The attorney general or one or more of the attorney
general's assistants
or special counsel designated by the attorney general shall
represent the administrator and the commission. In the event the attorney
general or the attorney general's designated assistants or
special counsel are
absent, the administrator or the commission shall select one or
more of the attorneys in the employ of the administrator or the
commission as the administrator's attorney or
the commission's attorney in the appeal. Any attorney so
employed shall continue the representation during the entire
period of the appeal and in all hearings thereof except where the
continued representation becomes impractical. (D) Upon receipt of notice of appeal, the clerk of courts
shall provide notice to all parties who are appellees and to the
commission. The claimant shall, within thirty days after the filing of
the notice of appeal, file a petition containing a statement of
facts in ordinary and concise language showing a cause of action
to participate or to continue to participate in the fund and
setting forth the basis for the jurisdiction of the court over
the action. Further pleadings shall be had in accordance with
the Rules of Civil Procedure, provided that service of summons on
such petition shall not be required and provided that the claimant may not dismiss the complaint without the employer's consent if the employer is the party that filed the notice of appeal to court pursuant to this section. The clerk of the court shall,
upon receipt thereof, transmit by certified mail a copy
thereof to each party named in the notice of appeal other than
the claimant. Any party may file with the clerk prior to the
trial of the action a deposition of any physician taken in
accordance with the provisions of the Revised Code, which
deposition may be read in the trial of the action even though the
physician is a resident of or subject to service in the county in
which the trial is had. The bureau of workers' compensation
shall pay the cost of the stenographic deposition filed in court and of
copies
of the stenographic deposition for each party from the surplus fund and
charge
the costs thereof against the unsuccessful party if the
claimant's right to participate or continue to participate is
finally sustained or established in the appeal. In the event the
deposition is taken and filed, the physician whose deposition is
taken is not required to respond to any subpoena issued in the
trial of the action. The court, or the jury under the
instructions of the court, if a jury is demanded, shall determine
the right of the claimant to participate or to continue to
participate in the fund upon the evidence adduced at the hearing
of the action. (E) The court shall certify its decision to the commission
and the certificate shall be entered in the records of the court.
Appeals from the judgment are governed by the law applicable to
the appeal of civil actions. (F) The cost of any legal proceedings authorized by this
section, including an attorney's fee to the claimant's attorney
to be fixed by the trial judge, based upon the effort expended,
in the event the claimant's right to participate or to continue
to participate in the fund is established upon the final
determination of an appeal, shall be taxed against the employer
or the commission if the commission or the administrator rather
than the employer contested the right of the claimant to
participate in the fund. The attorney's fee shall not exceed
twenty-five forty-two hundred dollars. (G) If the finding of the court or the verdict of the jury
is in favor of the claimant's right to participate in the fund,
the commission and the administrator shall thereafter proceed in
the matter of the claim as if the judgment were the decision of
the commission, subject to the power of modification provided by
section 4123.52 of the Revised Code. (H) An appeal from an order issued under division (E) of
section 4123.511 of the Revised Code or any action filed in court
in a case in which an award of compensation has been made shall
not stay the payment of compensation under the award or payment
of compensation for subsequent periods of total disability during
the pendency of the appeal. If, in a final administrative or
judicial action, it is determined that payments of compensation
or benefits, or both, made to or on behalf of a claimant should
not have been made, the amount thereof shall be charged to the
surplus fund under division (B) of section 4123.34 of the Revised
Code. In the event the employer is a state risk, the amount
shall not be charged to the employer's experience. In the event
the employer is a self-insuring employer, the self-insuring
employer shall deduct the amount from the paid compensation the
self-insuring employer
reports to the administrator under division (L) of section
4123.35 of the Revised Code. All A self-insuring employer may elect to pay compensation and benefits under this section directly to an employee or an employee's dependents by filing an application with the bureau of workers' compensation not more than one hundred eighty days and not less than ninety days before the first day of the employer's next six-month coverage period. If the self-insuring employer timely files the application, the application is effective on the first day of the employer's next six-month coverage period, provided that the administrator shall compute the employer's assessment for the surplus fund due with respect to the period during which that application was filed without regard to the filing of the application. On and after the effective date of the employer's election, the self-insuring employer shall pay directly to an employee or to an employee's dependents compensation and benefits under this section regardless of the date of the injury or occupational disease, and the employer shall receive no money or credits from the surplus fund on account of those payments and shall not be required to pay any amounts into the surplus fund on account of this section. The election made under this division is irrevocable.
All actions and proceedings under
this section which are the subject of an appeal to the court of
common pleas or the court of appeals shall be preferred over all
other civil actions except election causes, irrespective of
position on the calendar. This section applies to all decisions of the commission or
the administrator on November 2, 1959, and all claims filed
thereafter are governed by sections 4123.511 and 4123.512 of the
Revised Code. Any action pending in common pleas court or any other court
on January 1, 1986, under this section is governed by former
sections 4123.514, 4123.515, 4123.516, and 4123.519 and section
4123.522 of the Revised Code.
Sec. 4123.52. The jurisdiction of the industrial
commission and the authority of the administrator of workers'
compensation over each case is continuing, and the commission may
make such modification or change with respect to former findings
or orders with respect thereto, as, in its opinion is justified. No modification or change nor any finding or award in respect of
any claim shall be made with respect to disability, compensation,
dependency, or benefits, after six five years from the date of
injury in the absence of the payment of medical benefits under this
chapter, in which event the modification, change, finding, or
award shall be made within six years after the payment of
medical benefits, or in the absence of payment of compensation under
section 4123.57, 4123.58, or division (A) or
(B) of section 4123.56 of the Revised Code or wages in lieu of compensation in
a manner so as to satisfy the requirements of section 4123.84 of
the Revised Code, in which event the modification, change,
finding, or award shall be made within ten five years from the date of
the last payment of compensation or from the date of death, nor
unless written notice of claim for the specific part or parts of
the body injured or disabled has been given as provided in
section 4123.84 or 4123.85 of the Revised Code, and the. The
commission shall not make any modification, change, finding, or
award which shall award compensation for a back period in excess
of two years prior to the date of filing application therefor. This section
does not affect the right of a claimant to compensation accruing subsequent to
the filing of any such application, provided the application is filed within
the time limit provided in this section. This section does not deprive the commission of its
continuing jurisdiction to determine the questions raised by any
application for modification of award which has been filed with
the commission after June 1, 1932, and prior to the expiration of
the applicable period but in respect to which no award has been
granted or denied during the applicable period. The commission may, by general rules, provide for the
destruction of files of cases in which no further action may be
taken. The commission and administrator of workers' compensation
each may, by general rules, provide for the retention and
destruction of all other records in their possession or under
their control pursuant to section 121.211 and sections 149.34 to
149.36 of the Revised Code. The bureau of workers' compensation
may purchase or rent required equipment for the document
retention media, as determined necessary to preserve the records.
Photographs, microphotographs, microfilm, films, or other direct
document retention media, when properly identified, have the same
effect as the original record and may be offered in like manner
and may be received as evidence in proceedings before the industrial
commission, staff hearing officers, and district hearing officers, and in
any court where the original
record could have been introduced.
Sec. 4123.54. (A) Every employee, who is injured or who
contracts an occupational disease, and the dependents of each
employee who is killed, or dies as the result of an occupational
disease contracted in the course of employment, wherever such
injury has occurred or occupational disease has been contracted,
provided the same were not: (1) Purposely self-inflicted; or (2) Caused by the employee being intoxicated or under the
influence of a controlled substance not prescribed by a physician
where the intoxication or being under the influence of the
controlled substance not prescribed by a physician was the
proximate cause of the injury, is entitled to receive, either
directly from the employee's self-insuring employer as
provided in
section
4123.35 of the Revised Code, or from the state insurance
fund,
the compensation for loss sustained on account of the
injury,
occupational disease, or death, and the medical, nurse,
and
hospital services and medicines, and the amount of funeral
expenses in case of death, as are provided by this chapter.
(B) For the purpose of this section, provided that an
employer has posted written notice to employees that the results of, or
the employee's refusal
to submit to, any chemical test described
under this division may affect the
employee's eligibility for
compensation and benefits pursuant to this chapter
and Chapter
4121. of the Revised Code,
there is a rebuttable presumption that
an employee is intoxicated
or under the influence of a controlled
substance not prescribed by the employee's
physician and that being intoxicated
or under the influence of a
controlled substance not prescribed by
the employee's physician is the
proximate cause of an injury under either of the following conditions: (1) When any one or
more of the following
is true: (a) The employee, through a qualifying chemical test administered
within
eight hours of an injury, is determined to have an alcohol
concentration
level equal to or in excess of the levels
established in divisions
(A)(1)(b) to (i) of section 4511.19 of the
Revised
Code; (b) The employee, through a qualifying chemical test administered
within
thirty-two hours of an injury, is determined to have one of
the
following controlled substances not prescribed by the
employee's
physician in the employee's system that tests above the
following
levels in an enzyme multiplied immunoassay technique
screening test and above
the levels established in division (B)(3)(1)(c)
of this section in a gas
chromatography mass spectrometry test: (i) For amphetamines, one thousand nanograms per milliliter
of
urine; (ii) For cannabinoids, fifty nanograms per milliliter of
urine; (iii) For cocaine, including crack cocaine, three hundred
nanograms
per milliliter of urine; (iv) For opiates, two thousand nanograms per milliliter of
urine; (v) For phencyclidine, twenty-five nanograms per milliliter
of
urine. (c) The employee, through a qualifying chemical test administered
within
thirty-two hours of an injury, is determined to have one of
the
following controlled substances not prescribed by the
employee's
physician in the employee's system that tests above the
following
levels by a gas chromatography mass spectrometry test: (i) For amphetamines, five hundred nanograms per milliliter
of
urine; (ii) For cannabinoids, fifteen nanograms per milliliter of
urine; (iii) For cocaine, including crack cocaine, one hundred fifty
nanograms per milliliter of urine; (iv) For opiates, two thousand nanograms per milliliter of
urine; (v) For phencyclidine, twenty-five nanograms per milliliter
of
urine. (d) The employee, through a qualifying chemical test administered
within
thirty-two hours of an injury, is determined to have
barbiturates,
benzodiazepines, methadone, or propoxyphene in the
employee's system
that tests above levels established by
laboratories certified by the
United States department of health
and human services. (2) When the employee refuses to submit to a requested chemical
test, on the condition that that employee is or was given notice that the refusal to submit to any chemical test described in division (B)(1) of this section may affect the employee's eligibility for compensation and benefits under this chapter and Chapter 4121. of the Revised Code. (C)(1) For purposes of division (B) of this section, a chemical test is a qualifying chemical test if it is administered to an employee after an injury under at least one of the following conditions:
(a) When the employee's employer had reasonable cause to suspect that the employee may be intoxicated or under the influence of a controlled substance not prescribed by the employee's physician;
(b) At the request of a police officer pursuant to section 4511.191 of the Revised Code, and not at the request of the employee's employer;
(c) At the request of a licensed physician who is not employed by the employee's employer, and not at the request of the employee's employer.
(2) As used in division (C)(1)(a) of this section, "reasonable cause" means, but is not limited to, evidence that an employee is or was using alcohol or a controlled substance drawn from specific, objective facts and reasonable inferences drawn from these facts in light of experience and training. These facts and inferences may be based on, but are not limited to, any of the following:
(a) Observable phenomena, such as direct observation of use, possession, or distribution of alcohol or a controlled substance, or of the physical symptoms of being under the influence of alcohol or a controlled substance, such as but not limited to slurred speech, dilated pupils, odor of alcohol or a controlled substance, changes in affect, or dynamic mood swings;
(b) A pattern of abnormal conduct, erratic or aberrant behavior, or deteriorating work performance such as frequent absenteeism, excessive tardiness, or recurrent accidents, that appears to be related to the use of alcohol or a controlled substance, and does not appear to be attributable to other factors;
(c) The identification of an employee as the focus of a criminal investigation into unauthorized possession, use, or trafficking of a controlled substance;
(d) A report of use of alcohol or a controlled substance provided by a reliable and credible source;
(e) Repeated or flagrant violations of the safety or work rules of the employee's employer, that are determined by the employee's supervisor to pose a substantial risk of physical injury or property damage and that appear to be related to the use of alcohol or a controlled substance and that do not appear attributable to other factors.
(D) Nothing in this section shall be construed to affect the rights of an employer to test employees for alcohol or controlled substance abuse. (E) For the purpose of this section, laboratories certified by the United States department of health and human services or laboratories that meet or exceed the standards of that department for laboratory certification shall be used for processing the test results of a qualifying chemical test.
(F) The written notice required by division (B) of this section shall be the same size or larger then the certificate of premium payment notice furnished by the bureau of workers' compensation and shall be posted by the employer in the same location as the certificate of premium payment notice or the certificate of self-insurance.
(G) If a condition that pre-existed an injury is substantially aggravated by the injury, and that substantial aggravation is documented by objective diagnostic findings, objective clinical findings, or objective test results, no compensation or benefits are payable because of the pre-existing condition once that condition has returned to a level that would have existed without the injury. (H) Whenever, with respect to an employee of an employer who is
subject to and has complied with this chapter, there is
possibility of conflict with respect to the application of
workers' compensation laws because the contract of employment is
entered into and all or some portion of the work is or is to be
performed in a state or states other than Ohio, the employer and
the employee may agree to be bound by the laws of this state or
by
the laws of some other state in which all or some portion of
the
work of the employee is to be performed. The agreement shall
be
in writing and shall be filed with the bureau of workers'
compensation within ten days after it is executed and shall
remain
in force until terminated or modified by agreement of the
parties
similarly filed. If the agreement is to be bound by the
laws of
this state and the employer has complied with this
chapter, then
the employee is entitled to compensation and
benefits regardless
of where the injury occurs or the disease is
contracted and the
rights of the employee and the employee's
dependents
under the
laws of this state are the exclusive remedy against the
employer
on account of injury, disease, or death in the course of
and
arising out of the employee's employment. If the
agreement is to
be
bound by the laws of another state and the employer has
complied
with the laws of that state, the rights of the employee
and the
employee's
dependents under the laws of that state are the
exclusive remedy
against the employer on account of injury,
disease, or death in
the course of and arising out of the
employee's employment
without regard
to
the place where the injury
was sustained or the disease
contracted. If any employee or the employee's dependents are awarded
workers'
compensation benefits or recover damages from the
employer under
the laws of another state, the amount awarded or
recovered,
whether paid or to be paid in future installments,
shall be
credited on the amount of any award of compensation or
benefits
made to the employee or the employee's dependents by the
bureau. If an employee is a resident of a state other than this
state
and is insured under the workers' compensation law or
similar laws
of a state other than this state, the employee and the employee's
dependents are not entitled to receive
compensation or
benefits
under this chapter, on account of injury, disease, or
death
arising out of or in the course of employment while
temporarily
within this state, and the rights of the employee and the
employee's dependents under the laws of the other state
are the
exclusive remedy against the employer on account of the injury,
disease, or death. (H)(I) Compensation or benefits are not payable to a claimant
during
the period of confinement of the claimant in any state or
federal
correctional institution, or in any county jail in lieu of incarceration in a state or federal correctional institution, whether in this or any other state for
conviction of violation of any state or federal criminal law.
Sec. 4123.56. (A) Except as provided in division (D) of
this section, in the case of temporary disability, an employee
shall receive sixty-six and two-thirds per cent of the
employee's
average
weekly wage so long as such disability is total, not to
exceed a
maximum amount of weekly compensation which is equal to
the
statewide average weekly wage as defined in division (C) of
section 4123.62 of the Revised Code, and not less than a minimum
amount of compensation which is equal to thirty-three and
one-third per cent of the statewide average weekly wage as
defined
in division (C) of section 4123.62 of the Revised Code
unless the
employee's wage is less than thirty-three and
one-third per cent
of the minimum statewide average weekly wage,
in which event the
employee shall receive compensation equal
to the employee's full
wages; provided that for the first twelve weeks of total
disability the employee shall receive seventy-two per cent of
the
employee's full weekly wage, but not to exceed a maximum amount of
weekly compensation which is equal to the lesser of the statewide
average weekly wage as defined in division (C) of section 4123.62
of the Revised Code or one hundred per cent of the employee's net
take-home weekly wage. In the case of a self-insuring employer,
payments
shall be for a duration based upon the medical reports
of
the attending physician. If the employer disputes the
attending
physician's report, payments may be terminated only
upon
application and hearing by a district hearing officer
pursuant to
division (C) of section 4123.511 of the Revised Code.
Payments
shall continue pending the determination of the matter,
however
payment shall not be made for the period when any
employee has
returned to work, when an employee's treating
physician has made a
written statement that the employee is
capable of returning to the
employee's former position of
employment, when work within the
physical capabilities of the employee is made
available by the
employer or another employer, or when the
employee has reached the
maximum medical improvement. Where the
employee is capable of
work activity, but the employee's
employer is unable
to offer the
employee any employment, the employee shall
register with the
director of job
and family services,
who shall assist
the
employee
in finding suitable employment. The termination of temporary
total
disability, whether by order or otherwise, does not preclude
the
commencement of temporary total disability at another point in
time if the employee again becomes temporarily totally disabled. After two hundred weeks of temporary total disability
benefits, the medical section of the bureau of workers'
compensation shall schedule the claimant
for an examination for an
evaluation to determine whether or not
the temporary disability
has become permanent. A self-insuring
employer shall notify the
bureau
immediately after payment of two hundred weeks of temporary
total
disability and request that the bureau
schedule the claimant
for such an examination. When the employee is awarded compensation for temporary total
disability for a
period for which the employee has received
benefits
under Chapter 4141. of the Revised Code, the bureau shall
pay an amount equal to
the amount received
from the award to the
director of
job and
family services and the
director shall credit
the
amount to
the accounts of the employers to whose accounts the
payment of
benefits was charged or is chargeable to the extent it
was
charged or is chargeable. If any compensation under this section has been paid for
the
same period or periods for which temporary nonoccupational
accident and sickness insurance is or has been paid pursuant to
an
insurance policy or program to which the employer has made the
entire contribution or payment for providing insurance or under a
nonoccupational accident and sickness program fully funded by the
employer, compensation paid under this section for the period or
periods shall be paid only to the extent by which the payment or
payments exceeds the amount of the nonoccupational insurance or
program paid or payable. Offset of the compensation shall be
made
only upon the prior order of the bureau or industrial commission
or
agreement of the
claimant. As used in this division,
"net take-home weekly wage" means
the amount obtained by dividing an employee's total remuneration,
as defined in section 4141.01 of the Revised Code, paid to or
earned by the employee during the first four of the last five
completed calendar quarters which immediately precede the first
day of the employee's entitlement to benefits under this
division,
by the number of weeks during which the employee was
paid or
earned remuneration during those four quarters, less the
amount of
local, state, and federal income taxes deducted for
each such
week. (B) Where (1) If an employee in a claim allowed under this
chapter
suffers a wage loss as a result of returning to
employment other
than the employee's former position of
employment or as a result
of being unable to find employment consistent with the claimant's
physical capabilities
due to an injury or occupational disease, the employee shall
receive compensation at
sixty-six and two-thirds per cent of the difference between the
employee's average weekly wage
loss and the employee's present earnings not to exceed the statewide average weekly
wage for a period
not to exceed two hundred weeks.
The payments may continue for up to a
maximum of two hundred weeks, but the payments shall be reduced by the
corresponding number of weeks in which the employee receives payments pursuant
to division (B) of section 4121.67 Of the Revised Code. (2) If an employee in a claim allowed under this
chapter suffers a wage loss as a result of being unable
to find employment consistent with the employee's disability resulting from the employee's injury or occupational disease, the
employee shall receive
compensation at
sixty-six and two-thirds per cent of the difference between the
employee's average weekly wage
and
the
employee's present earnings, not to exceed the statewide average
weekly wage. The payments may continue for up to a maximum of
fifty-two weeks. The first twenty-six weeks of payments under division (B)(2) of this section shall be in addition to the maximum of two hundred weeks of payments allowed under division (B)(1) of this section. If an employee in a claim allowed under this chapter receives compensation under division (B)(2) of this section in excess of twenty-six weeks, the number of weeks of compensation allowable under division (B)(1) of this section shall be reduced by the corresponding number of weeks in excess of twenty-six, and up to fifty-two, that is allowable under division (B)(1) of this section. (3) The number of weeks of wage loss payable to an employee under
divisions (B)(1) and (2) of this section shall not exceed two hundred and twenty-six
weeks in the aggregate. (C) In the event an employee of a professional sports
franchise domiciled in this state is disabled as the result
of an
injury or occupational disease, the total amount of payments made
under a contract of hire or collective bargaining agreement to
the
employee during a period of disability is deemed an advanced
payment of compensation payable under sections 4123.56 to 4123.58
of the Revised Code. The employer shall be reimbursed the total
amount of the advanced payments out of any award of compensation
made pursuant to sections 4123.56 to 4123.58 of the Revised Code. (D) If an employee receives temporary total disability
benefits pursuant to division (A) of this section and social
security retirement benefits pursuant to the
"Social Security
Act," the weekly benefit amount under division (A) of this
section
shall not exceed sixty-six and two-thirds per cent of the
statewide average weekly wage as defined in division (C) of
section 4123.62 of the Revised Code.
Sec. 4123.57. Partial disability compensation shall be paid as
follows. Except as provided in this section, not earlier than forty twenty-six
weeks after the date of termination of the latest period of
payments under section 4123.56 of the Revised Code, or not
earlier than forty twenty-six weeks after the date of the injury or
contraction of an occupational disease in the absence of payments
under section 4123.56 of the Revised Code, the employee may
file an application with the bureau of workers' compensation for
the determination of the percentage of the employee's
permanent partial disability resulting from an injury or occupational disease. Whenever the application is filed, the bureau shall send a
copy of the application to the employee's employer or the
employer's representative and shall schedule the employee for a
medical examination by the bureau medical section. The bureau
shall send a copy of the report of the medical examination to the
employee, the employer, and their representatives. Thereafter, the
administrator of
workers' compensation shall review the employee's claim file and make a
tentative order as the evidence before the administrator at
the time of the making of the order warrants. If the administrator determines
that there is a conflict of evidence, the administrator shall
send the application, along with the claimant's file, to the district hearing
officer who shall set the application for a hearing. The administrator shall notify the employee, the employer,
and their representatives, in writing, of the tentative order and
of the parties' right to request a hearing. Unless the employee,
the employer, or their representative notifies the administrator,
in writing, of an objection to the tentative order within twenty
days after receipt of the notice thereof, the tentative order
shall go into effect and the employee shall receive the
compensation provided in the order. In no event shall there be a
reconsideration of a tentative order issued under this division. If the employee, the employer, or their representatives
timely notify the administrator of an objection to the tentative
order, the matter shall be referred to a district hearing officer
who shall set the application for hearing with written notices to
all interested persons. Upon referral to a district hearing officer, the
employer may obtain a medical examination of the employee, pursuant to rules
of the industrial commission. (A) The district hearing officer, upon the
application, shall determine the percentage of the employee's permanent
disability, except as is subject to division (B) of this section,
based upon that condition of the employee resulting from the
injury or occupational disease and causing permanent impairment
evidenced by medical or clinical findings reasonably
demonstrable. The employee shall receive sixty-six and
two-thirds per cent of the employee's average weekly wage,
but not more than a maximum of thirty-three and one-third per cent of the
statewide average weekly wage as defined in division (C) of section 4123.62
of the Revised Code, per week regardless of the average weekly
wage, for the number of weeks which equals the percentage of two
hundred weeks. Except on application for reconsideration,
review, or modification, which is filed within ten days after the
date of receipt of the decision of the district hearing officer,
in no instance shall the former award be modified unless it is
found from medical or clinical findings that the condition of the
claimant resulting from the injury has so progressed as to have
increased the percentage of permanent partial disability. A
staff hearing officer shall hear an application for reconsideration filed and
the staff hearing officer's decision is final. An employee
may file an application for a subsequent determination of the
percentage of the employee's permanent
disability. If such an application is filed, the bureau shall
send a copy of the application to the
employer or the employer's representative. No sooner than sixty
days from the date of the mailing of the application to the
employer or the employer's representative, the administrator
shall review the application. The administrator may require a
medical examination or medical review of the employee. The
administrator shall issue a tentative order based upon the
evidence before the administrator, provided that if
the administrator requires a medical examination or medical
review, the administrator shall not issue the tentative order until the
completion of the examination or review. The employer may obtain a medical examination of the
employee and may submit medical evidence at any stage of the
process up to a hearing before the district hearing officer,
pursuant to rules of the commission. The administrator shall
notify the employee, the employer, and their representatives, in
writing, of the nature and amount of any tentative order issued
on an application requesting a subsequent determination of the
percentage of an employee's permanent disability. An employee,
employer, or their representatives may object to the tentative
order within twenty days after the receipt of the notice thereof.
If no timely objection is made, the tentative order shall go into
effect. In no event shall there be a reconsideration of a
tentative order issued under this division. If an objection is
timely made, the application for a subsequent determination shall
be referred to a district hearing officer who shall set the
application for a hearing with written notice to all interested
persons. No application for subsequent percentage determinations
on the same claim for injury or occupational disease shall be
accepted for review by the district hearing officer unless
supported by substantial evidence of new and changed
circumstances developing since the time of the hearing on the
original or last determination. No award shall be made under this division based upon a
percentage of disability which, when taken with
all other percentages of permanent disability, exceeds one
hundred per cent. If the percentage of the permanent disability
of the employee equals or exceeds ninety per cent, compensation for
permanent partial disability shall be paid for two
hundred weeks. Compensation payable under this division accrues and is
payable to the employee from the date of last payment of
compensation, or, in cases where no previous compensation has
been paid, from the date of the injury or the date of the diagnosis of the
occupational disease. When an award under this division has been made prior to
the death of an employee, all unpaid installments accrued or to
accrue under the provisions of the award are payable to the
surviving spouse, or if there is no surviving spouse, to the
dependent children of the employee, and if there are no children
surviving, then to other dependents as the administrator
determines. (B) In cases included in the following schedule the
compensation payable per week to the employee is the statewide
average weekly wage as defined in division (C) of section 4123.62
of the Revised Code per week and shall continue during the
periods provided in the following schedule: For the loss of a first finger, commonly known as a thumb, sixty weeks. For the loss of a first second finger, commonly called index
finger, thirty-five weeks. For the loss of a second third finger, thirty weeks. For the loss of a third fourth finger, twenty weeks. For the loss of a fourth fifth finger, commonly known as the
little finger, fifteen weeks. The loss of a second, or distal, phalange of the thumb is
considered equal to the loss of one half of such thumb; the loss
of more than one half of such thumb is considered equal to the
loss of the whole thumb. The loss of the third, or distal, phalange of any finger is
considered equal to the loss of one-third of the finger. The loss of the middle, or second, phalange of any finger
is considered equal to the loss of two-thirds of the finger. The loss of more than the middle and distal phalanges of
any finger is considered equal to the loss of the whole finger.
In no case shall the amount received for more than one finger
exceed the amount provided in this schedule for the loss of a
hand. For the loss of the metacarpal bone (bones of the palm) for
the corresponding thumb, or fingers, add ten weeks to the number
of weeks under this division. For ankylosis (total stiffness of) or contractures (due to
scars or injuries) which makes any of the fingers, thumbs, or
parts of either useless, the same number of weeks apply to the
members or parts thereof as given for the loss thereof. If the claimant has suffered the loss of two or more
fingers by amputation or ankylosis and the nature of the
claimant's employment in the course of which the claimant was working at
the time of the injury or occupational disease is such that the
handicap or disability resulting from the loss of
fingers, or loss of use of fingers, exceeds the normal handicap or disability
resulting from the loss of fingers, or loss of use of fingers,
the administrator may take that fact into consideration and
increase the award of compensation accordingly, but the award
made shall not exceed the amount of compensation for loss of a
hand. For the loss of a hand, one hundred seventy-five weeks. For the loss of an arm, two hundred twenty-five weeks. For the loss of a great toe, thirty weeks. For the loss of one of the toes other than the great toe,
ten weeks. The loss of more than two-thirds of any toe is considered
equal to the loss of the whole toe. The loss of less than two-thirds of any toe is considered
no loss, except as to the great toe; the loss of the great toe up
to the interphalangeal joint is co-equal to the loss of one-half
of the great toe; the loss of the great toe beyond the
interphalangeal joint is considered equal to the loss of the
whole great toe. For the loss of a foot, one hundred fifty weeks. For the loss of a leg, two hundred weeks. For the loss of the sight of an eye, one hundred
twenty-five weeks. For the permanent partial loss of sight of an eye, the
portion of one hundred twenty-five weeks as the administrator in
each case determines, based upon the percentage of vision
actually lost as a result of the injury or occupational disease,
but, in no case shall an award of compensation be made for less
than twenty-five per cent loss of uncorrected vision. "Loss of
uncorrected vision" means the percentage of vision actually lost
as the result of the injury or occupational disease. For the permanent and total loss of hearing of one ear,
twenty-five weeks; but in no case shall an award of compensation
be made for less than permanent and total loss of hearing of one
ear. For the permanent and total loss of hearing, one hundred
twenty-five weeks; but, except pursuant to the next preceding
paragraph, in no case shall an award of compensation be made for
less than permanent and total loss of hearing. In case an injury or occupational disease results in
serious facial or head disfigurement which either impairs or may
in the future impair the opportunities to secure or retain
employment, the administrator shall make an award of compensation
as it deems proper and equitable, in view of the nature of the
disfigurement, and not to exceed the sum of five ten thousand
dollars. For the purpose of making the award, it is not material
whether the employee is gainfully employed in any occupation or
trade at the time of the administrator's determination. When an award under this division has been made prior to
the death of an employee all unpaid installments accrued or to
accrue under the provisions of the award shall be payable to the
surviving spouse, or if there is no surviving spouse, to the
dependent children of the employee and if there are no such
children, then to such dependents as the administrator
determines. When an employee has sustained the loss of a member by
severance, but no award has been made on account thereof prior to
the employee's death, the administrator shall make an award
in accordance with this division for the loss which shall be payable to the
surviving spouse, or if there is no surviving spouse, to the
dependent children of the employee and if there are no such
children, then to such dependents as the administrator
determines. (C) Compensation for partial impairment under divisions
(A) and (B) of this section is in addition to the compensation
paid the employee pursuant to section 4123.56 of the Revised
Code. A claimant may receive compensation under divisions (A)
and (B) of this section. In all cases arising under division (B) of this section, if
it is determined by any one of the following: (1) the amputee
clinic at University hospital, Ohio state university; (2) the
rehabilitation services commission; (3) an amputee clinic or
prescribing physician approved by the administrator or the
administrator's designee, that an injured or disabled employee is in need
of an artificial appliance, or in need of a repair thereof, regardless
of whether the appliance or its repair will be serviceable in the
vocational rehabilitation of the injured employee, and regardless
of whether the employee has returned to or can ever again return
to any gainful employment, the bureau shall pay the cost of the
artificial appliance or its repair out of the surplus created by
division (B) of section 4123.34 of the Revised Code. In those cases where a rehabilitation services commission
recommendation that an injured or disabled employee is in need of
an artificial appliance would conflict with their state plan,
adopted pursuant to the "Rehabilitation Act of 1973," 87 Stat.
355, 29 U.S.C.A. 701, the administrator or the
administrator's designee or the
bureau may obtain a recommendation from an amputee clinic or
prescribing physician that they determine appropriate. (D) If an employee of a state fund employer makes
application for a finding and the administrator finds that the
employee has contracted silicosis as defined in division (X), or coal
miners' pneumoconiosis as defined in division (Y), or asbestosis as
defined in division (AA) of section 4123.68 of the Revised Code,
and that a change of such employee's occupation is medically
advisable in order to decrease substantially further exposure to
silica dust, asbestos, or coal dust and if the employee, after
the finding, has changed or shall change the employee's
occupation to an occupation in which the exposure to silica dust, asbestos, or
coal dust is substantially decreased, the administrator shall allow to the
employee an amount equal to fifty per cent of the
statewide average weekly wage per week for a period of thirty
weeks, commencing as of the date of the discontinuance or change,
and for a period of one hundred weeks immediately following the
expiration of the period of thirty weeks, the employee shall
receive sixty-six and two-thirds per cent of the loss
of wages resulting directly and solely from the change of
occupation but not to exceed a maximum of an amount equal to
fifty per cent of the statewide average weekly wage per week. No
such employee is entitled to receive more than one allowance on
account of discontinuance of employment or change of occupation
and benefits shall cease for any period during which the employee
is employed in an occupation in which the exposure to silica
dust, asbestos, or coal dust is not substantially less than the
exposure in the occupation in which the employee was formerly
employed or for any period during which the employee may be entitled to
receive compensation or benefits under section 4123.68 of the
Revised Code on account of disability from silicosis, asbestosis,
or coal miners' pneumoconiosis. An award for change of
occupation for a coal miner who has contracted coal miners'
pneumoconiosis may be granted under this division even though the
coal miner continues employment with the same employer, so long
as the coal miner's employment subsequent to the change is
such that the coal miner's exposure to
coal dust is substantially decreased and a change of occupation
is certified by the claimant as permanent. The administrator may accord to
the employee medical and other benefits in accordance with section 4123.66 of
the Revised Code. (E) If a firefighter or police officer makes
application for a finding and the administrator finds that the
firefighter or police officer has contracted
a cardiovascular and pulmonary disease as defined in division (W)
of section 4123.68 of the Revised Code, and that a change of the
firefighter's or police officer's occupation is
medically advisable in order to decrease substantially further exposure to
smoke, toxic gases, chemical fumes, and other toxic vapors, and
if the firefighter, or police officer, after the
finding, has changed or changes occupation to an occupation in
which the
exposure to smoke, toxic gases, chemical fumes, and other toxic
vapors is substantially decreased, the administrator shall allow
to the firefighter or police officer an amount
equal to fifty per cent of the statewide average weekly wage per week for a
period of thirty weeks, commencing as of the date of the
discontinuance or change, and for a period of seventy-five weeks
immediately following the expiration of the period of thirty
weeks the administrator shall allow the firefighter
or police officer sixty-six and two-thirds per cent of the loss of wages
resulting directly and solely from the change of occupation but
not to exceed a maximum of an amount equal to fifty per cent of
the statewide average weekly wage per week. No such
firefighter or police officer is entitled to
receive more than one allowance
on account of discontinuance of employment or change of
occupation and benefits shall cease for any period during which
the firefighter or police officer is employed in an
occupation in which the exposure to smoke, toxic gases, chemical fumes, and
other toxic vapors is not substantially less than the exposure in
the occupation in which the firefighter or police officer
was formerly employed or for any period during which the
firefighter or police officer may be entitled to receive compensation
or benefits under section
4123.68 of the Revised Code on account of disability from a
cardiovascular and pulmonary disease. The administrator may
accord to the firefighter or police officer medical
and other benefits in accordance with section 4123.66 of the Revised Code. (F) An order issued under this section is appealable
pursuant to section 4123.511 of the Revised Code but is not
appealable to court under section 4123.512 of the Revised Code.
Sec. 4123.58. (A) In cases of permanent total disability, the employee shall
receive an award to continue until his the employee's death
in the amount of sixty-six and two-thirds per cent of his the
employee's average
weekly wage, but, except as otherwise provided in division (B) of
this section, not more than a maximum amount of weekly
compensation which is equal to sixty-six and two-thirds per cent
of the statewide average weekly wage as defined in division (C)
of section 4123.62 of the Revised Code in effect on the date of injury or on the date the disability due to the occupational disease begins, nor not less than a
minimum amount of weekly compensation which is equal to fifty per
cent of the statewide average weekly wage as defined in division
(C) of section 4123.62 of the Revised Code in effect on the date of injury or on the date the disability due to the occupational disease begins, unless the employee's
average weekly wage is less than fifty per cent of the statewide
average weekly wage at the time of the injury, in which event he the
employee shall receive compensation in an amount equal to his
the employee's average weekly wage. (B) In the event the weekly workers' compensation amount
when combined with disability benefits received pursuant to the
Social Security Act is less than the statewide average weekly
wage as defined in division (C) of section 4123.62 of the Revised
Code, then the maximum amount of weekly compensation shall be the
statewide average weekly wage as defined in division (C) of
section 4123.62 of the Revised Code. At any time that social
security disability benefits terminate or are reduced, the
workers' compensation award shall be recomputed to pay the
maximum amount permitted under this division. (C) The loss or loss of Permanent total disability shall be compensated according to this section only when at least one of the following applies to the claimant:
(1) The claimant has lost, or lost the use of both hands or both arms, or
both feet or both legs, or both eyes, or of any two thereof,
constitutes total and permanent disability, to be compensated
according to this section. Compensation; however, the loss or loss of use of one limb does not constitute the loss or loss of use of two body parts;
(2) The impairment resulting from the employee's injury or occupational disease prevents the employee from engaging in sustained remunerative employment utilizing the employment skills that the employee has or may reasonably be expected to develop.
(D) Permanent total disability shall not be compensated when the reason the employee is unable to engage in sustained remunerative employment is due to any of the following reasons, whether individually or in combination:
(1) Impairments of the employee that are not the result of an allowed injury or occupational disease;
(2) Solely the employee's age or aging;
(3) The employee retired or otherwise voluntarily abandoned the workforce for reasons unrelated to the allowed injury or occupational disease.
(4) The employee has not engaged in educational or rehabilitative efforts to enhance the employee's employability, unless such efforts are determined to be in vain.
(E) Compensation payable under this
section for permanent total disability is in addition
to benefits payable under division (B) of section 4123.57 of the Revised Code. (F) If an employee is awarded compensation for permanent total disability under this section because the employee sustained a traumatic brain injury, the employee is entitled to that compensation regardless of the employee's employment in a sheltered workshop subsequent to the award, on the condition that the employee does not receive income, compensation, or remuneration from that employment in excess of two thousand dollars in any calendar quarter. As used in this division, "sheltered workshop" means a state agency or nonprofit organization established to carry out a program of rehabilitation for handicapped individuals or to provide these individuals with remunerative employment or other occupational rehabilitating activity.
Sec. 4123.61. The average weekly wage of an injured
employee at the time of the injury or at the time disability
due to the occupational disease begins is the basis upon which to
compute benefits. In cases of temporary total disability the compensation for
the first twelve weeks for which compensation is payable shall be
based on the full weekly wage of the claimant at the time of the
injury or at the time of the disability due to occupational
disease begins; when a factory, mine, or other place of employment is
working short time in order to divide work among the employees,
the bureau of workers' compensation shall take that fact into
consideration when determining the wage for the first twelve
weeks of temporary total disability. Compensation for all further temporary total disability
shall be based as provided for permanent disability claims. In death, permanent total disability claims,
permanent partial disability claims, and impairment of earnings claims, the
claimant's or the decedent's average weekly wage for the year
preceding the injury or the date the disability due to the
occupational disease begins is the weekly wage upon which
compensation shall be based. In ascertaining the average weekly
wage for the year previous to the injury, or the date the
disability due to the occupational disease begins any period of
unemployment due to sickness, industrial depression, strike,
lockout, or other cause beyond the employee's control shall be
eliminated. In cases where there are special circumstances under which
the average weekly wage cannot justly be determined by applying
this section, the administrator of workers' compensation, in
determining the average weekly wage in such cases, shall use such
method as will enable him the administrator to do substantial
justice to the claimants, provided that the administrator shall not recalculate the claimant's average weekly wage for awards for permanent total disability solely for the reason that the claimant continued working and the claimant's wages increased following the injury.
Sec. 4123.65. (A) A state fund employer or the employee
of such an employer may file an application with the
administrator of workers' compensation for approval of a final
settlement of a claim under this chapter. The application shall
include the settlement agreement, and except as otherwise specified in this
division, be signed by the claimant and
employer, and clearly set forth the circumstances by reason of
which the proposed settlement is deemed desirable and that the
parties agree to the terms of the settlement agreement provided
that the agreement need not be signed by the
employer if the. A claimant may file an application without an employer's signature in the following situations: (1) The
employer is no longer doing business in Ohio. If; (2) The claim no longer is in the employer's industrial accident or occupational disease experience as provided in division (B) of section 4123.34 of the Revised Code and the claimant no longer is employed with that employer;
(3) The employer has failed to comply with section 4123.35 of the Revised Code.
If a claimant files an application without an employer's signature, and the employer still is doing business in this state, the administrator shall send written notice of the application to the employer immediately upon receipt of the application. If the employer fails to respond to the notice within thirty days after the notice is sent, the application need not contain the employer's signature.
If a state fund
employer or an employee of such an employer has not filed an
application for a final settlement under this division, the
administrator may file an application on behalf of the employer
or the employee, provided that the administrator gives notice of
the filing to the employer and the employee and to the
representative of record of the employer and of the employee
immediately upon the filing. An application filed by the
administrator shall contain all of the information and signatures
required of an employer or an employee who files an application
under this division. Every self-insuring employer that enters
into a final settlement agreement with an employee shall mail,
within seven days of executing the agreement, a copy of the
agreement to the administrator and the employee's representative.
The administrator shall place the agreement into the claimant's
file. (B) Except as provided in divisions (C) and (D) of this
section, a settlement agreed to under this section is binding
upon all parties thereto and as to items, injuries, and
occupational diseases to which the settlement applies. (C) No settlement agreed to under division (A) of this
section or agreed to by a self-insuring employer and the
self-insuring employer's employee shall take effect until thirty days
after the administrator approves the settlement for state fund employees and
employers, or after the self-insuring employer and employee sign the final
settlement agreement. During the thirty-day period, the
employer, employee, or administrator, for state fund settlements,
and the employer or employee, for self-insuring settlements, may
withdraw consent to the settlement by an employer
providing
written notice to the employer's employee and the
administrator or by an
employee providing written notice to the employee's employer
and the administrator, or by the administrator providing written notice to the
state fund employer and employee. If an employee dies during the thirty-day waiting period following the approval of a settlement, the settlement can be voided by any party for good cause shown. (D) At the time of agreement to any final settlement
agreement under division (A) of this section or agreement between
a self-insuring employer and the self-insuring employer's
employee, the administrator, for state fund settlements, and
the self-insuring
employer, for self-insuring settlements, immediately shall send a copy of the
agreement to the industrial commission who shall assign the
matter to a staff hearing officer. The staff hearing officer
shall determine, within the time limitations specified in
division (C) of this section, whether the settlement agreement is
or is not a gross miscarriage of justice. If the
staff hearing
officer determines within that time period that the settlement
agreement is clearly unfair, the staff hearing officer shall issue an order
disapproving the settlement agreement. If
the staff hearing officer determines that the settlement agreement is not
clearly unfair or fails to act within those time limits, the settlement
agreement is approved. (E) A settlement entered into under this section may
pertain to one or more claims of a claimant, or one or more parts
of a claim, or the compensation or benefits pertaining to either,
or any combination thereof, provided that nothing in this section
shall be interpreted to require a claimant to enter into a
settlement agreement for every claim that has been filed with the
bureau of workers' compensation by that claimant under Chapter
4121., 4123., 4127., or 4131. of the Revised Code. (F) A settlement entered into under this section is not
appealable under section 4123.511 or 4123.512 of the Revised
Code.
Sec. 4123.88. (A) No person shall orally or in writing,
directly or indirectly, or through any agent or other person
fraudulently hold himself the person's self out or represent himself the person's
self or his any of the person's partners or associates as authorized by a
claimant or employer to
take charge of, or represent the claimant or employer in respect
of, any claim or matter in connection therewith before the bureau
of workers' compensation or the industrial commission or its
district or staff hearing officers. No person shall directly or indirectly
solicit
authority, or pay or give anything of value to another person to
solicit authority, or accept or receive pay or anything of value
from another person for soliciting authority, from a claimant or
employer to take charge of, or represent the claimant or employer
in respect of, any claim or appeal which is or may be filed with
the bureau or commission. No person shall, without prior
authority from the bureau, a member of the commission, the
claimant, or the employer, examine or directly or indirectly
cause or employ another person to examine any claim file or any
other file pertaining thereto. No person shall forge an
authorization for the purpose of examining or cause another
person to examine any such file. No district or staff hearing
officer or other employee of the bureau or commission,
notwithstanding the provisions of section 4123.27 of the Revised
Code, shall divulge any information in respect of any claim or
appeal which is or may be filed with a district or staff hearing
officer, the bureau, or commission to any person other than
members of the commission or to the superior of the employee
except upon authorization of the administrator of workers'
compensation or a member of the commission or upon authorization
of the claimant or employer. No (B) The records described or referred to in division (A) of this section are not public records as defined in division (A)(1) of section 149.43 of the Revised Code. Any information directly or indirectly identifying the address or telephone number of a claimant, regardless of whether the claimant's claim is active or closed, is not a public record. No person shall solicit or obtain
any such information from any such employee without first having
obtained an authorization therefor as provided in this section. (C) Except as otherwise specified in division (D) of this section, information kept by the commission or the bureau pursuant to this section is for the exclusive use and information of the commission and the bureau in the discharge of their official duties, and shall not be open to the public nor be used in any court in any action or proceeding pending therein, unless the commission or the bureau is a party to the action or proceeding. The information, however, may be tabulated and published by the commission or the bureau in statistical form for the use and information of other state agencies and the public.
(D)(1) Upon receiving a written request made and signed by a journalist, the commission or the bureau shall disclose to the journalist the address or addresses and telephone number or numbers of claimants, regardless of whether their claims are active or closed, and the dependents of those claimants. (2) A journalist is permitted to request the information described in division (D)(1) of this section for multiple workers or dependents in one written request. (3) A journalist shall include all of the following in the written request: (a) The journalist's name, title, and signature; (b) The name and title of the journalist's employer; (c) A statement that the disclosure of the information sought is in the public interest. (4) Neither the commission nor the bureau may inquire as to the specific public interest served by the disclosure of information requested by a journalist under division (D) of this section.
(E) As used in this section, "journalist" has the same meaning as in division (B)(5) of section 149.43 of the Revised Code.
Sec. 5703.21. (A) Except as provided in divisions (B) and
(C) of this section, no agent
of the department of taxation,
except in the agent's report to the department or when called on
to
testify in any court or proceeding, shall divulge any
information
acquired by the agent as to the transactions,
property, or business
of any person while acting or claiming to
act under orders of the
department. Whoever violates this
provision shall thereafter be
disqualified from acting as an
officer or employee or in any
other capacity under appointment or
employment of the department. (B)(1) For purposes of an audit pursuant to section 117.15
of the Revised Code, or an audit of the department pursuant to
Chapter 117. of the Revised Code, or an audit, pursuant to that
chapter, the objective of which is to express an opinion on a
financial report or statement prepared or issued pursuant to
division (A)(7) or (9) of section
126.21 of
the Revised Code, the
officers and employees of the auditor of state charged with
conducting the audit shall have access to and the right to
examine
any state tax returns and state tax return information in
the
possession of the department to the extent that the
access
and
examination are necessary for purposes of the audit. Any
information acquired as the result of that access and
examination
shall not be divulged for any purpose other than as required for
the audit or unless the officers and employees are required
to
testify in a court or proceeding under compulsion of legal
process. Whoever violates this provision shall thereafter be
disqualified from acting as an officer or employee or in any
other
capacity under appointment or employment of the auditor of
state. (2) As provided by section 6103(d)(2) of the Internal
Revenue Code, any federal tax returns or federal tax information
that the department has acquired from the internal revenue
service, through federal and state statutory authority, may be
disclosed to the auditor of state solely for purposes of an audit
of the department. (C) Division (A) of this section does not prohibit
any of
the following: (1) Divulging information contained in applications,
complaints, and
related documents filed with the department under
section 5715.27
of the Revised Code or in applications filed with
the department
under section 5715.39 of the Revised Code; (2) Providing
information to the office of child support
within the department of job and family services pursuant to
section 3125.43 of the Revised
Code; (3) Disclosing to the board of
motor vehicle collision
repair registration any information
in the possession of the
department that is necessary for the
board to
verify the existence
of an applicant's valid vendor's license and
current state tax
identification number under section 4775.07 of the
Revised Code; (4) Providing information to the administrator
of workers'
compensation pursuant
to section sections 4123.271 and 4123.591 of the Revised Code; (5) Providing to the attorney general
information the
department obtains
under division (J) of section 1346.01 of the
Revised Code; (6) Permitting properly authorized officers, employees, or
agents of a
municipal corporation from inspecting reports or
information pursuant to
rules adopted under section 5745.16 of the
Revised Code; (7) Providing information regarding the name, account
number, or business
address of a holder of a vendor's
license
issued pursuant to section 5739.17 of the Revised Code, a holder
of a
direct payment permit issued pursuant to section 5739.031 of
the
Revised Code, or a seller having a use tax account maintained
pursuant to
section 5741.17 of the Revised Code, or information
regarding the active or inactive status of a vendor's license,
direct payment permit, or seller's use tax account; (8) Releasing invoices or invoice information furnished under
section 4301.433 of
the Revised Code pursuant to
that section;
(9) Providing to a county auditor notices or documents concerning or affecting the taxable value of property in the county auditor's county. Unless authorized by law to disclose documents so provided, the county auditor shall not disclose such documents.
Sec. 5747.18. The tax commissioner shall enforce and
administer this chapter. In addition to any other powers
conferred upon the commissioner by law, the commissioner may: (A) Prescribe all forms required to be filed pursuant to
this chapter; (B) Adopt such rules as the commissioner finds necessary to carry
out this chapter; (C) Appoint and employ such personnel as are necessary to
carry out the duties imposed upon the commissioner by this chapter. Any information gained as the result of returns,
investigations, hearings, or verifications required or authorized
by this chapter is confidential, and no person shall disclose
such information, except for official purposes, or as provided by
section 3125.43, 4123.271, 4123.591, 4507.023, or 5101.182, division (B) of
section 5703.21 of the Revised Code, or in accordance with a
proper judicial order. The tax commissioner may furnish the
internal revenue service with copies of returns or reports filed and
may furnish the officer of a municipal corporation charged with the
duty of enforcing a tax subject to Chapter 718. of the Revised
Code with the names, addresses, and identification numbers of
taxpayers who may be subject to such tax. A municipal
corporation shall use this information for tax collection
purposes only. This section does not prohibit the publication of
statistics in a form which does not disclose information with
respect to individual taxpayers.
Section 2. That existing sections 2913.48, 3121.034, 3121.037, 4121.10, 4121.44, 4121.441, 4123.01, 4123.32, 4123.35, 4123.512, 4123.52, 4123.54, 4123.56, 4123.57, 4123.58, 4123.61, 4123.65, 4123.88, 5703.21, and 5747.18 of the Revised Code are hereby repealed.
Section 3. This act applies to all claims pursuant to Chapters 4121., 4123., 4127., and 4131. of the Revised Code arising on and after the effective date of this act, except that division (H) of section 4123.512 as amended by this act also applies to claims that are pending on the effective date of this act.
Section 4. Section 4123.54 of the Revised Code is presented in
this act as a composite of the section as amended by both Am. Sub. H.B. 163 and Sub. H.B. 223 of
the 125th General Assembly. The General Assembly, applying the
principle stated in division (B) of section 1.52 of the Revised
Code that amendments are to be harmonized if reasonably capable of
simultaneous operation, finds that the composite is the resulting
version of the section in effect prior to the effective date of
the section as presented in this act.
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