The online versions of legislation provided on this website are not official. Enrolled bills are the final version passed by the Ohio General Assembly and presented to the Governor for signature. The official version of acts signed by the Governor are available from the Secretary of State's Office in the Continental Plaza, 180 East Broad St., Columbus.
|
H. B. No. 123 As Passed by the HouseAs Passed by the House
129th General Assembly | Regular Session | 2011-2012 |
| |
Cosponsors:
Representatives Amstutz, Sears, Anielski, Baker, Blair, Bubp, Combs, Garland, Goyal, Hackett, Johnson, Letson, McClain, Milkovich, Newbold, O'Brien, Peterson, Slaby, Uecker Speaker Batchelder
A BILL
To amend sections 4121.12, 4121.123, 4121.125,
4121.32, 4121.41, 4121.44, 4121.68, 4123.35,
4123.512, and 4123.52 and to repeal sections
4121.124 and 4121.99 of the Revised Code to allow
the Administrator of Workers' Compensation to
waive criteria certain public employers must
satisfy to become self-insuring employers; to
require bills for medical and vocational
rehabilitation services in claims that are
ultimately denied to be paid from the Surplus Fund
Account under specified circumstances; to make
other changes to the Workers' Compensation Law; to
make appropriations for the Bureau of Workers'
Compensation and for the Workers' Compensation
Council for the biennium beginning July 1, 2011,
and ending June 30, 2013; and to provide
authorization and conditions for the operation of
the Bureau's and the Council's programs.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 101. That sections 4121.12, 4121.123, 4121.125,
4121.32, 4121.41, 4121.44, 4121.68, 4123.35, 4123.512, and 4123.52
of the Revised Code be amended to read as follows:
Sec. 4121.12. (A) There is hereby created the bureau of
workers' compensation board of directors consisting of eleven
members to be appointed by the governor with the advice and
consent of the senate. One member shall be an individual who, on
account of the individual's previous vocation, employment, or
affiliations, can be classed as a representative of employees; two
members shall be individuals who, on account of their previous
vocation, employment, or affiliations, can be classed as
representatives of employee organizations and at least one of
these two individuals shall be a member of the executive committee
of the largest statewide labor federation; three members shall be
individuals who, on account of their previous vocation,
employment, or affiliations, can be classed as representatives of
employers, one of whom represents self-insuring employers, one of
whom is a state fund employer who employs one hundred or more
employees, and one of whom is a state fund employer who employs
less than one hundred employees; two members shall be individuals
who, on account of their vocation, employment, or affiliations,
can be classed as investment and securities experts who have
direct experience in the management, analysis, supervision, or
investment of assets and are residents of this state; one member
who shall be a certified public accountant; one member who shall
be an actuary who is a member in good standing with the American
academy of actuaries or who is an associate or fellow with the
casualty actuarial society of actuaries; and one member shall
represent the public and also be an individual who, on account of
the individual's previous vocation, employment, or affiliations,
cannot be classed as either predominantly representative of
employees or of employers. The governor shall select the
chairperson of the board who shall serve as chairperson at the
pleasure of the governor.
None of the members of the board, within one year immediately
preceding the member's appointment, shall have been employed by
the bureau of workers' compensation or by any person, partnership,
or corporation that has provided to the bureau services of a
financial or investment nature, including the management,
analysis, supervision, or investment of assets.
(B) Of the initial appointments made to the board, the
governor shall appoint the member who represents employees, one
member who represents employers, and the member who represents the
public to a term ending one year after June 11, 2007; one member
who represents employers, one member who represents employee
organizations, one member who is an investment and securities
expert, and the member who is a certified public accountant to a
term ending two years after June 11, 2007; and one member who
represents employers, one member who represents employee
organizations, one member who is an investment and securities
expert, and the member who is an actuary to a term ending three
years after June 11, 2007. Thereafter, terms of office shall be
for three years, with each term ending on the same day of the same
month as did the term that it succeeds. Each member shall hold
office from the date of the member's appointment until the end of
the term for which the member was appointed.
Members may be reappointed. Any member appointed to fill a
vacancy occurring prior to the expiration date of the term for
which the member's predecessor was appointed shall hold office as
a member for the remainder of that term. A member shall continue
in office subsequent to the expiration date of the member's term
until a successor takes office or until a period of sixty days has
elapsed, whichever occurs first.
(C) In making appointments to the board, the governor shall
select the members from the list of names submitted by the
workers' compensation board of directors nominating committee
pursuant to this division. The nominating committee shall submit
to the governor a list containing four separate names for each of
the members on the board. Within fourteen days after the
submission of the list, the governor shall appoint individuals
from the list.
At least thirty days prior to a vacancy occurring as a result
of the expiration of a term and within thirty days after other
vacancies occurring on the board, the nominating committee shall
submit an initial list containing four names for each vacancy.
Within fourteen days after the submission of the initial list, the
governor either shall appoint individuals from that list or
request the nominating committee to submit another list of four
names for each member the governor has not appointed from the
initial list, which list the nominating committee shall submit to
the governor within fourteen days after the governor's request.
The governor then shall appoint, within seven days after the
submission of the second list, one of the individuals from either
list to fill the vacancy for which the governor has not made an
appointment from the initial list. If the governor appoints an
individual to fill a vacancy occurring as a result of the
expiration of a term, the individual appointed shall begin serving
as a member of the board when the term for which the individual's
predecessor was appointed expires or immediately upon appointment
by the governor, whichever occurs later. With respect to the
filling of vacancies, the nominating committee shall provide the
governor with a list of four individuals who are, in the judgment
of the nominating committee, the most fully qualified to accede to
membership on the board.
In order for the name of an individual to be submitted to the
governor under this division, the nominating committee shall
approve the individual by an affirmative vote of a majority of its
members.
(D) All members of the board shall receive their reasonable
and necessary expenses pursuant to section 126.31 of the Revised
Code while engaged in the performance of their duties as members
and also shall receive an annual salary not to exceed sixty
thousand dollars in total, payable on the following basis:
(1) Except as provided in division (D)(2) of this section, a
member shall receive two thousand five hundred dollars during a
month in which the member attends one or more meetings of the
board and shall receive no payment during a month in which the
member attends no meeting of the board.
(2) A member may receive no more than thirty thousand dollars
per year to compensate the member for attending meetings of the
board, regardless of the number of meetings held by the board
during a year or the number of meetings in excess of twelve within
a year that the member attends.
(3) Except as provided in division (D)(4) of this section, if
a member serves on the workers' compensation audit committee,
workers' compensation actuarial committee, or the workers'
compensation investment committee, the member shall receive two
thousand five hundred dollars during a month in which the member
attends one or more meetings of the committee on which the member
serves and shall receive no payment during any month in which the
member attends no meeting of that committee.
(4) A member may receive no more than thirty thousand dollars
per year to compensate the member for attending meetings of any of
the committees specified in division (D)(3) of this section,
regardless of the number of meetings held by a committee during a
year or the number of committees on which a member serves.
The chairperson of the board shall set the meeting dates of
the board as necessary to perform the duties of the board under
this chapter and Chapters 4123., 4125., 4127., 4131., and 4167. of
the Revised Code. The board shall meet at least twelve times a
year. The administrator of workers' compensation shall provide
professional and clerical assistance to the board, as the board
considers appropriate.
(E) Before entering upon the duties of office, each appointed
member of the board shall take an oath of office as required by
sections 3.22 and 3.23 of the Revised Code and file in the office
of the secretary of state the bond required under section 4121.127
of the Revised Code.
(1) Establish the overall administrative policy for the
bureau for the purposes of this chapter and Chapters 4123., 4125.,
4127., 4131., and 4167. of the Revised Code;
(2) Review progress of the bureau in meeting its cost and
quality objectives and in complying with this chapter and Chapters
4123., 4125., 4127., 4131., and 4167. of the Revised Code;
(3) Submit an annual report to the president of the senate,
the speaker of the house of representatives, the governor, and the
workers' compensation council and include all of the following in
that report:
(a) An evaluation of the cost and quality objectives of the
bureau;
(b) A statement of the net assets available for the provision
of compensation and benefits under this chapter and Chapters
4123., 4127., and 4131. of the Revised Code as of the last day of
the fiscal year;
(c) A statement of any changes that occurred in the net
assets available, including employer premiums and net investment
income, for the provision of compensation and benefits and payment
of administrative expenses, between the first and last day of the
fiscal year immediately preceding the date of the report;
(d) The following information for each of the six consecutive
fiscal years occurring previous to the report:
(i) A schedule of the net assets available for compensation
and benefits;
(ii) The annual cost of the payment of compensation and
benefits;
(iii) Annual administrative expenses incurred;
(iv) Annual employer premiums allocated for the provision of
compensation and benefits.
(e) A description of any significant changes that occurred
during the six years for which the board provided the information
required under division (F)(3)(d) of this section that affect the
ability of the board to compare that information from year to
year.
(4) Review all independent financial audits of the bureau.
The administrator shall provide access to records of the bureau to
facilitate the review required under this division.
(5) Study issues as requested by the administrator or the
governor;
(6) Contract with all of the following:
(a) An independent actuarial firm to assist the board in
making recommendations to the administrator regarding premium
rates;
(b) An outside investment counsel to assist the workers'
compensation investment committee in fulfilling its duties;
(c) An independent fiduciary counsel to assist the board in
the performance of its duties.
(7) Approve the investment policy developed by the workers'
compensation investment committee pursuant to section 4121.129 of
the Revised Code if the policy satisfies the requirements
specified in section 4123.442 of the Revised Code.
(8) Review and publish the investment policy no less than
annually and make copies available to interested parties.
(9) Prohibit, on a prospective basis, any specific investment
it finds to be contrary to the investment policy approved by the
board.
(10) Vote to open each investment class and allow the
administrator to invest in an investment class only if the board,
by a majority vote, opens that class;
(11) After opening a class but prior to the administrator
investing in that class, adopt rules establishing due diligence
standards for employees of the bureau to follow when investing in
that class and establish policies and procedures to review and
monitor the performance and value of each investment class;
(12) Submit a report annually on the performance and value of
each investment class to the governor, the president and minority
leader of the senate, the speaker and minority leader of the house
of representatives, and the workers' compensation council.
(13) Advise and consent on all of the following:
(a) Administrative rules the administrator submits to it
pursuant to division (B)(5) of section 4121.121 of the Revised
Code for the classification of occupations or industries, for
premium rates and contributions, for the amount to be credited to
the surplus fund, for rules and systems of rating, rate revisions,
and merit rating;
(b) The duties and authority conferred upon the administrator
pursuant to section 4121.37 of the Revised Code;
(c) Rules the administrator adopts for the health partnership
program and the qualified health plan system, as provided in
sections 4121.44, 4121.441, and 4121.442 of the Revised Code;
(d) Rules the administrator submits to it pursuant to Chapter
4167. of the Revised Code regarding the public employment risk
reduction program and the protection of public health care workers
from exposure incidents.
As used in this division, "public health care worker" and
"exposure incident" have the same meanings as in section 4167.25
of the Revised Code.
(14) Perform all duties required under this chapter and
Chapters 4123., 4125., 4127., 4131., and 4167. of the Revised
Code;
(15) Meet with the governor on an annual basis to discuss the
administrator's performance of the duties specified in this
chapter and Chapters 4123., 4125., 4127., 4131., and 4167. of the
Revised Code;
(16) Develop and participate in a bureau of workers'
compensation board of directors education program that consists of
all of the following:
(a) An orientation component for newly appointed members;
(b) A continuing education component for board members who
have served for at least one year;
(c) A curriculum that includes education about each of the
following topics:
(i) Board member duties and responsibilities;
(ii) Compensation and benefits paid pursuant to this chapter
and Chapters 4123., 4127., and 4131. of the Revised Code;
(iv) Governance processes and procedures;
(vii) Any other subject matter the board believes is
reasonably related to the duties of a board member.
(17) Submit the program developed pursuant to division
(F)(16) of this section to the workers' compensation council for
approval;
(18) Hold all sessions, classes, and other events for the
program developed pursuant to division (F)(16) of this section in
this state.
(G) The board may do both of the following:
(1) Vote to close any investment class;
(2) Create any committees in addition to the workers'
compensation audit committee, the workers' compensation actuarial
committee, and the workers' compensation investment committee that
the board determines are necessary to assist the board in
performing its duties.
(H) The office of a member of the board who is convicted of
or pleads guilty to a felony, a theft offense as defined in
section 2913.01 of the Revised Code, or a violation of section
102.02, 102.03, 102.04, 2921.02, 2921.11, 2921.13, 2921.31,
2921.41, 2921.42, 2921.43, or 2921.44 of the Revised Code shall be
deemed vacant. The vacancy shall be filled in the same manner as
the original appointment. A person who has pleaded guilty to or
been convicted of an offense of that nature is ineligible to be a
member of the board. A member who receives a bill of indictment
for any of the offenses specified in this section shall be
automatically suspended from the board pending resolution of the
criminal matter.
(I) For the purposes of division (G)(1) of section 121.22 of
the Revised Code, the meeting between the governor and the board
to review the administrator's performance as required under
division (F)(15) of this section shall be considered a meeting
regarding the employment of the administrator.
Sec. 4121.123. (A) There is hereby created the workers'
compensation board of directors nominating committee consisting of
the following:
(1) Three individuals who are members of affiliated employee
organizations of the Ohio chapter of the American federation of
labor-congress of industrial organizations, who are selected by
the Ohio chapter of the American federation of labor-congress of
industrial organizations and who, on account of their previous
vocation, employment, or affiliations, can be classed as
representative of employees who are members of an employee
organization. Terms of office shall be for one year, with each
term ending on the same day of the same month as did the term that
it succeeds.
(2) Two individuals who, on account of their previous
vocation, employment, or affiliations, can be classed as
representative of employees, one of whom shall be an injured
worker with a valid, open, and active workers' compensation claim
and at least one of these two representatives also shall represent
employees who are not members of an employee organization. The
president of the senate and the speaker of the house of
representatives each shall appoint annually one of these members.
The member who is an injured worker shall serve for a full term
even if the member's workers' compensation claim is invalidated,
closed, or inactivated during the member's term.
(3) The chief executive officer, or the equivalent of the
chief executive officer, of the Ohio chamber of commerce, the Ohio
manufacturers' association, the Ohio self-insurers' association,
the Ohio council of retail merchants, and of either the national
federation of independent business or, and the Ohio farm bureau as
jointly selected by the national federation of independent
business and the Ohio farm bureau;
(4) The director of development;
(5) The president of the Ohio municipal league, the Ohio
township association, and the president of the Ohio county
commissioners association, or, in the event of a vacancy in the
presidency, a designee appointed by the governing body authorized
to appoint the president. A designee so appointed shall serve on
the nominating committee only until the vacancy in the presidency
is filled.
(B) Each member appointed under divisions (A)(1) and (2) of
this section shall hold office from the date of the member's
appointment until the end of the term for which the member was
appointed. Such members may be reappointed. Vacancies shall be
filled in the manner provided for original appointments. Any such
member appointed to fill a vacancy occurring prior to the
expiration date of the term for which the member's predecessor was
appointed shall hold office as a member for the remainder of that
term. Such a member shall continue in office subsequent to the
expiration date of the member's term until the member's successor
takes office or until a period of sixty days has elapsed,
whichever occurs first.
(C) The nominating committee shall meet at the request of the
governor or as the nominating committee determines appropriate in
order to make recommendations to the governor for the appointment
of members of the bureau of workers' compensation board of
directors under section 4121.12 of the Revised Code.
(D) The director of development shall serve as chairperson of
the nominating committee and have no voting rights on matters
coming before the nominating committee, except that the director
may vote in the event of a tie vote of the nominating committee.
Annually, the nominating committee shall select a secretary from
among its members. The nominating committee may adopt by-laws
governing its proceedings.
(E) Members of the nominating committee shall be paid their
reasonable and necessary expenses pursuant to section 126.31 of
the Revised Code while engaged in the performance of their duties
as members of the nominating committee.
(F) The nominating committee shall:
(1) Review and evaluate possible appointees for the board. In
reviewing and evaluating possible appointees for the board, the
nominating committee may accept comments from, cooperate with, and
request information from any person.
(2) Make recommendations to the governor for the appointment
of members to the board as provided in division (C) of section
4121.12 of the Revised Code.
(G) The nominating committee may make recommendations to the
general assembly concerning changes in legislation that will
assist the nominating committee in the performance of its duties.
Sec. 4121.125. (A) The bureau of workers' compensation board
of directors, based upon recommendations of the workers'
compensation actuarial committee, may contract with one or more
outside actuarial firms and other professional persons, as the
board determines necessary, to assist the board in measuring the
performance of Ohio's workers' compensation system and in
comparing Ohio's workers' compensation system to other state and
private workers' compensation systems. The board, actuarial firm
or firms, and professional persons shall make such measurements
and comparisons using accepted insurance industry standards,
including, but not limited to, standards promulgated by the
National Council on Compensation Insurance.
(B) The board may contract with one or more outside firms to
conduct management and financial audits of the workers'
compensation system, including audits of the reserve fund
belonging to the state insurance fund, and to establish objective
quality management principles and methods by which to review the
performance of the workers' compensation system.
(C) The board shall do all of the following:
(1) Contract to have prepared annually by or under the
supervision of an actuary a report that meets the requirements
specified under division (E) of this section and that consists of
an actuarial valuation of the assets, liabilities, and funding
requirements of the state insurance fund and all other funds
specified in this chapter and Chapters 4123., 4127., and 4131. of
the Revised Code;
(2) Require that the actuary or person supervised by an
actuary referred to in division (C)(1) of this section complete
the valuation in accordance with the actuarial standards of
practice promulgated by the actuarial standards board of the
American academy of actuaries;
(3) Submit the report referred to in division (C)(1) of this
section to the workers' compensation council and the standing
committees of the house of representatives and the senate with
primary responsibility for workers' compensation legislation on or
before the first day of November following the year for which the
valuation was made;
(4) Have an actuary or a person who provides actuarial
services under the supervision of an actuary, at such time as the
board determines, and at least once during the five-year period
that commences on September 10, 2007, and once within each
five-year period thereafter, conduct an actuarial investigation of
the experience of employers, the mortality, service, and injury
rate of employees, and the payment of temporary total disability,
permanent partial disability, and permanent total disability under
sections 4123.56 to 4123.58 of the Revised Code to update the
actuarial assumptions used in the report required by division
(C)(1) of this section;
(5) Submit the report required under division (F) of this
section to the council and the standing committees of the house of
representatives and the senate with primary responsibility for
workers' compensation legislation not later than the first day of
November following the fifth year of the period that the report
covers;
(6) Have prepared by or under the supervision of an actuary
an actuarial analysis of any introduced legislation expected to
have a measurable financial impact on the workers' compensation
system;
(7) Submit the report required under division (G) of this
section to the legislative service commission, the standing
committees of the house of representatives and the senate with
primary responsibility for workers' compensation legislation, and
the council not later than sixty days after the date of
introduction of the legislation.
(D) The administrator of workers' compensation and the
industrial commission shall compile information and provide access
to records of the bureau and the industrial commission to the
board to the extent necessary for fulfillment of both of the
following requirements:
(1) Conduct of the measurements and comparisons described in
division (A) of this section;
(2) Conduct of the management and financial audits and
establishment of the principles and methods described in division
(B) of this section.
(E) The firm or person with whom the board contracts pursuant
to division (C)(1) of this section shall prepare a report of the
valuation and submit the report to the board. The firm or person
shall include all of the following information in the report that
is required under division (C)(1) of this section:
(1) A summary of the compensation and benefit provisions
evaluated;
(2) A summary of the census data and financial information
used in the valuation;
(3) A description of the actuarial assumptions, and actuarial
cost method, and asset valuation method used in the valuation;
(4) A summary of findings that includes a statement of the
actuarial accrued compensation and benefit liabilities and
unfunded actuarial accrued compensation and benefit liabilities;
(5)(3) A schedule showing the effect of any changes in the
compensation and benefit provisions, actuarial assumptions, or
cost methods since the previous annual actuarial valuation report
was submitted to the board.
(F) The actuary or person whom the board designates to
conduct an actuarial investigation under division (C)(4) of this
section shall prepare a report of the actuarial investigation and
shall submit the report to the board. The actuary or person shall
prepare the report and make any recommended changes in actuarial
assumptions in accordance with the actuarial standards of practice
promulgated by the actuarial standards board of the American
academy of actuaries. The actuary or person shall include all of
the following information in the report:
(1) A summary of relevant decrement and economic assumption
experience;
(2) Recommended changes in actuarial assumptions to be used
in subsequent actuarial valuations required by division (C)(1) of
this section;
(3) A measurement of the financial effect of the recommended
changes in actuarial assumptions.
(G) The actuary or person whom the board designates to
conduct the actuarial analysis under division (C)(6) of this
section shall prepare a report of the actuarial analysis and shall
submit that report to the board. The actuary or person shall
complete the analysis in accordance with the actuarial standards
of practice promulgated by the actuarial standards board of the
American academy of actuaries. The actuary or person shall include
all of the following information in the report:
(1) A summary of the statutory changes being evaluated;
(2) A description of or reference to the actuarial
assumptions and actuarial cost method used in the report;
(3) A description of the participant group or groups included
in the report;
(4) A statement of the financial impact of the legislation,
including the resulting increase, if any, in employer premiums, in
actuarial accrued liabilities, and, if an increase in actuarial
accrued liabilities is predicted, the per cent of premium increase
that would be required to amortize the increase in those
liabilities as a level per cent of employer premiums over a period
not to exceed thirty years.
(5) A statement of whether the employer premiums paid to the
bureau of workers' compensation after the proposed change is
enacted are expected to be sufficient to satisfy the funding
objectives established by the board.
(H) The board may, at any time, request an actuary to make
any studies or actuarial valuations to determine the adequacy of
the premium rates established by the administrator in accordance
with sections 4123.29 and 4123.34 of the Revised Code, and may
adjust those rates as recommended by the actuary.
(I) The board shall have an independent auditor, at least
once every ten years, conduct a fiduciary performance audit of the
investment program of the bureau of workers' compensation. That
audit shall include an audit of the investment policies approved
by the board and investment procedures of the bureau. The board
shall submit a copy of that audit to the auditor of state.
(J) The administrator, with the advice and consent of the
board, shall employ an internal auditor who shall report findings
directly to the board, workers' compensation audit committee, and
administrator, except that the internal auditor shall not report
findings directly to the administrator when those findings involve
malfeasance, misfeasance, or nonfeasance on the part of the
administrator. The board and the workers' compensation audit
committee may request and review internal audits conducted by the
internal auditor.
(K) The administrator shall pay the expenses incurred by the
board to effectively fulfill its duties and exercise its powers
under this section as the administrator pays other operating
expenses of the bureau.
Sec. 4121.32. (A) The rules covering operating procedure and
criteria for decision-making that the administrator of workers'
compensation and the industrial commission are required to adopt
pursuant to section 4121.31 of the Revised Code shall be
supplemented with operating manuals setting forth the procedural
steps in detail for performing each of the assigned tasks of each
section of the bureau of workers' compensation and commission. The
administrator and commission jointly shall adopt such manuals. No
employee may deviate from manual procedures without authorization
of the section chief.
(B) Manuals shall set forth the procedure for the assignment
and transfer of claims within sections and be designed to provide
performance objectives and may require employees to record
sufficient data to reasonably measure the efficiency of functions
in all sections. The bureau's division of research and statistics
bureau shall perform periodic cost-effectiveness analyses
which
that shall be made available to the general assembly, the
governor, and to the public during normal working hours.
(C) The bureau and commission jointly shall develop, adopt,
and use a policy manual setting forth the guidelines and bases for
decision-making for any decision which is the responsibility of
the bureau, district hearing officers, staff hearing officers, or
the commission. Guidelines shall be set forth in the policy manual
by the bureau and commission to the extent of their respective
jurisdictions for deciding at least the following specific
matters:
(1) Reasonable ambulance services;
(2) Relationship of drugs to injury;
(3) Awarding lump-sum advances for creditors;
(4) Awarding lump-sum advances for attorney's fees;
(5) Placing a claimant into rehabilitation;
(6) Transferring costs of a claim from employer costs to the
statutory surplus fund pursuant to section 4123.343 of the Revised
Code;
(7) Utilization of physician specialist reports;
(8) Determining the percentage of permanent partial
disability, temporary partial disability, temporary total
disability, violations of specific safety requirements, an award
under division (B) of section 4123.57 of the Revised Code, and
permanent total disability.
(D) The bureau shall establish, adopt, and implement policy
guidelines and bases for decisions involving reimbursement issues
including, but not limited to, the adjustment of invoices, the
reduction of payments for future services when an internal audit
concludes that a health care provider was overpaid or improperly
paid for past services, reimbursement fees, or other adjustments
to payments. These policy guidelines and bases for decisions, and
any changes to the guidelines and bases, shall be set forth in a
reimbursement manual and provider bulletins.
Neither the policy guidelines nor the bases set forth in the
reimbursement manual or provider bulletins referred to in this
division is a rule as defined in section 119.01 of the Revised
Code.
(E) With respect to any determination of disability under
Chapter 4123. of the Revised Code, when the physician makes a
determination based upon statements or information furnished by
the claimant or upon subjective evidence, he the physician shall
clearly indicate this fact in his the physician's report.
(F) The administrator shall publish the manuals and make
copies of all manuals available to interested parties at cost.
Sec. 4121.41. (A) The administrator of workers' compensation
shall operate a program designed to inform employees and employers
of their rights and responsibilities under Chapter 4123. of the
Revised Code and as part of that program prepare and distribute
pamphlets, which clearly and simply explain at least all of the
following:
(1) The rights and responsibilities of claimants and
employers;
(2) The procedures for processing claims;
(3) The procedure for fulfilling employer responsibility;
(4) All applicable statutes of limitation;
(5) The availability of services and benefits;
(6) The claimant's right to representation in the processing
of a claim or to elect no representation.
The administrator shall ensure that the provisions of this
section are faithfully and speedily implemented.
(B) The bureau of workers' compensation shall maintain an
ongoing program to identify employers subject to Chapter 4123. of
the Revised Code and to audit employers to ensure an optimum level
of premium payment. The bureau shall coordinate such efforts with
other governmental agencies which have information as to employers
who are subject to Chapter 4123. of the Revised Code.
(C) The administrator of the bureau shall handle complaints
through the service offices, the claims section, and the ombudsman
ombudsperson program. The administrator shall provide toll free
telephone lines for employers and claimants in order to expedite
the handling of complaints. The bureau shall monitor complaint
traffic to ensure an adequacy of telephone service to bureau
offices. The division of research and statistics in the bureau
shall compile statistics on complaint subjects. Based upon those
compilations, the bureau shall revise procedures and rules to
correct major problem areas and submit data and recommendations
annually to the appropriate committees of the general assembly.
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, on the measures
of outcomes and savings of the health partnership program and
submit the report to the president of the senate, the speaker of
the house of representatives, the governor, and the workers'
compensation council with the annual report prepared under
division (F)(3) of section 4121.12 of the Revised Code. 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. 4121.68. In the event a claimant sustains an injury or
occupational disease or dies as a result of any injury or disease
received in the course of and arising out of his the claimant's
participation in a rehabilitation program, the claimant or, in the
case of death, a dependent of the claimant, may file a claim for
compensation and benefits as if the claimant's employer were the
bureau of workers' compensation. All compensation and benefit
awards made as a result of the injury, disease, or death shall be
charged to the surplus fund account, created pursuant to section
4123.34 of the Revised Code, and not charged through the state
insurance fund to the employer against which the claim was allowed
so long as the employer pays assessments into the surplus fund
account for the payment of such compensation and benefits.
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 may
waive any of the requirements listed in divisions (B)(2)(a) to (j)
of this section for 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 those requirements
listed in division (B)(2) of this section. The administrator may
adopt rules establishing the criteria that a public employer shall
satisfy in order for the administrator to waive any of the
requirements listed in divisions (B)(2)(a) to (j) of this section.
The rules may require additional security from that employer
pursuant to division (E) of section 4123.351 of the Revised Code.
(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 bureau of workers'
compensation board of directors, 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) The administrator shall deposit any moneys received from
a self-insuring employer for the self-insuring employer's
assessment to pay the costs solely attributable to the workers'
compensation council into the administrative assessment account
described in division (B) of section 4123.342 of the Revised Code
for the administrative cost assessment collected by the
administrator for the council. 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, 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 division (L)(2) of this section, "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 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;
(6) A municipal power agency as defined in section 3734.058
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 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 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)(1) 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 or medical benefits
has been made shall not stay the payment of compensation or
medical benefits under the award, or payment for subsequent
periods of total disability or medical benefits 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 account under division (A)(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, and the
administrator shall adjust the employer's account accordingly. 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.
(2)(a) Notwithstanding a final determination that payments of
benefits made to or on behalf of a claimant should not have been
made, the administrator or self-insuring employer shall award
payment of medical or vocational rehabilitation services submitted
for payment after the date of the final determination if all of
the following apply:
(i) The services were approved and were rendered by the
provider in good faith prior to the date of the final
determination.
(ii) The services were payable under division (I) of section
4123.511 of the Revised Code prior to the date of the final
determination.
(iii) The request for payment is submitted within the time
limit set forth in section 4123.52 of the Revised Code.
(b) Payments made under division (H)(1) of this section shall
be charged to the surplus fund account under division (B) of
section 4123.34 of the Revised Code. If the employer of the
employee who is the subject of a claim described in division
(H)(2)(a) of this section is a state fund employer, the payments
made under that division shall not be charged to the employer's
experience. If that 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.
(c) Division (H)(2) of this section shall apply only to a
claim under this chapter or Chapter 4121., 4127., or 4131. of the
Revised Code arising on or after the effective date of this
amendment.
(3) 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 account 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 account on
account of those payments and shall not be required to pay any
amounts into the surplus fund account on account of this section.
The election made under this division is irrevocable.
(I) 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. (A) 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 five years from the date of injury
in the absence of the payment of medical benefits under this
chapter 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 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. 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
(B) Notwithstanding division (A) of this section, neither the
administrator nor the commission shall make any finding or award
for payment of medical or vocational rehabilitation services
submitted for payment more than one year after the date the
services were rendered or more than one year after the date the
services became payable under division (I) of section 4123.511 of
the Revised Code, whichever is later. No medical or vocational
rehabilitation provider shall bill a claimant for services
rendered if the administrator or commission is prohibited from
making that payment under this division.
(C) 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.
(D) 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.
(E) The commission may, by general rules, provide for the
destruction of files of cases in which no further action may be
taken.
(F) 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.
Section 102. That existing sections 4121.12, 4121.123,
4121.125, 4121.32, 4121.41, 4121.44, 4121.68, 4123.35, 4123.512,
and 4123.52 and sections 4121.124 and 4121.99 of the Revised Code
are hereby repealed.
Section 201. All items in Sections 201 and 203 of this act
are hereby appropriated out of any moneys in the state treasury to
the credit of the designated fund. For all appropriations made in
this act, those in the first column are for fiscal year 2012, and
those in the second column are for fiscal year 2013.
FND |
AI |
|
AI TITLE |
|
|
|
Appropriations |
BWC BUREAU OF WORKERS' COMPENSATION
Workers' Compensation Fund Group
7023 |
855401 |
|
William Green Lease Payments to OBA |
|
$ |
18,291,365 |
|
$ |
17,533,370 |
7023 |
855407 |
|
Claims, Risk and Medical Management |
|
$ |
125,427,732 |
|
$ |
124,192,959 |
7023 |
855408 |
|
Fraud Prevention |
|
$ |
11,331,154 |
|
$ |
11,164,226 |
7023 |
855409 |
|
Administrative Services |
|
$ |
101,724,950 |
|
$ |
104,136,037 |
7023 |
855410 |
|
Attorney General Payments |
|
$ |
4,621,850 |
|
$ |
4,621,850 |
8220 |
855606 |
|
Coal Workers' Fund |
|
$ |
1,050,586 |
|
$ |
1,047,666 |
8230 |
855608 |
|
Marine Industry |
|
$ |
76,532 |
|
$ |
75,527 |
8250 |
855605 |
|
Disabled Workers Relief Fund |
|
$ |
322,266 |
|
$ |
319,718 |
8260 |
855609 |
|
Safety and Hygiene Operating |
|
$ |
20,382,567 |
|
$ |
20,161,132 |
8260 |
855610 |
|
Gear Program |
|
$ |
4,000,000 |
|
$ |
4,000,000 |
8290 |
855604 |
|
Long Term Care Loan Program |
|
$ |
1,000,000 |
|
$ |
1,000,000 |
TOTAL WCF Workers' Compensation |
|
|
|
|
|
|
Fund Group |
|
$ |
288,229,002 |
|
$ |
288,252,485 |
Federal Special Revenue Fund Group
3490 |
855601 |
|
OSHA Enforcement |
|
$ |
1,670,998 |
|
$ |
1,647,515 |
TOTAL FED Federal Special Revenue Fund Group |
|
$ |
1,670,998 |
|
$ |
1,647,515 |
TOTAL ALL BUDGET FUND GROUPS |
|
$ |
289,900,000 |
|
$ |
289,900,000 |
WILLIAM GREEN LEASE PAYMENTS
The foregoing appropriation item 855401, William Green Lease
Payments to OBA, shall be used for lease payments to the Ohio
Building Authority, and these appropriations shall be used to meet
all payments at the times they are required to be made during the
period from July 1, 2011, to June 30, 2013, by the Bureau of
Workers' Compensation to the Ohio Building Authority pursuant to
leases and agreements made under Chapter 152. of the Revised Code
and Section 6 of Am. Sub. H.B. 743 of the 118th General Assembly.
Of the amounts received in Fund 7023, appropriation item 855401,
William Green Lease Payments to OBA, up to $35,824,735 shall be
restricted for lease rental payments to the Ohio Building
Authority. If it is determined that additional appropriations are
necessary for such purpose, such amounts are hereby appropriated.
Notwithstanding any provision of law to the contrary, all
tenants of the William Green Building not funded by the Workers'
Compensation Fund (Fund 7023) shall pay their fair share of the
costs of lease payments to the Workers' Compensation Fund (Fund
7023) by intrastate transfer voucher.
WORKERS' COMPENSATION FRAUD UNIT
The Workers' Compensation Section Fund (Fund 1950)
administered by the Attorney General shall receive payments from
the Bureau of Workers' Compensation at the beginning of each
quarter of each fiscal year to fund expenses of the Workers'
Compensation Fraud Unit within the Attorney General's Office. Of
the foregoing appropriation item 855410, Attorney General
Payments, $828,200 in fiscal year 2012 and $828,200 in fiscal year
2013 shall be used to provide these payments.
Notwithstanding section 4121.37 of the Revised Code, the
Treasurer of State shall transfer $20,382,567 cash in fiscal year
2012 and $20,161,132 cash in fiscal year 2013 from the State
Insurance Fund to the Safety and Hygiene Fund (Fund 8260).
OSHA ON-SITE CONSULTATION PROGRAM
The Bureau of Workers' Compensation may designate a portion
of appropriation item 855609, Safety and Hygiene Operating, to be
used to match federal funding for the federal Occupational Safety
and Health Administration's (OSHA) on-site consultation program.
VOCATIONAL REHABILITATION
The Bureau of Workers' Compensation and the Rehabilitation
Services Commission shall enter into an interagency agreement for
the provision of vocational rehabilitation services and staff to
mutually eligible clients. The bureau shall provide $605,407 in
fiscal year 2012 and $605,407 in fiscal year 2013 from the State
Insurance Fund to fund vocational rehabilitation services and
staff in accordance with the interagency agreement.
Any unencumbered cash balance in excess of $45,000,000 in the
Workers' Compensation Fund (Fund 7023) on the thirtieth day of
June of each fiscal year shall be used to reduce the
administrative cost rate charged to employers to cover
appropriations for Bureau of Workers' Compensation operations.
Section 211. WCC WORKERS' COMPENSATION COUNCIL
5FV0 |
321600 |
|
Remuneration Expenses |
|
$ |
471,200 |
|
$ |
471,200 |
TOTAL 5FV0 Workers' Compensation Council Remuneration Fund
|
|
$ |
471,200 |
|
$ |
471,200 |
TOTAL ALL BUDGET FUND GROUPS |
|
$ |
471,200 |
|
$ |
471,200 |
WORKERS' COMPENSATION COUNCIL
The foregoing appropriation item 321600, Remuneration
Expenses, shall be used to pay the payroll and fringe benefit
costs for employees of the Workers' Compensation Council.
Section 221. DEPUTY INSPECTOR GENERAL FOR BWC AND OIC FUNDING
To pay for the FY 2012 costs related to the Deputy Inspector
General for the Bureau of Workers' Compensation and Industrial
Commission, on July 1, 2011, and on January 1, 2012, or as soon as
possible after each date, the Director of Budget and Management
shall transfer $212,500 in cash from the Workers' Compensation
Fund (Fund 7023) to the Deputy Inspector General for the Bureau of
Workers' Compensation and Industrial Commission Fund (Fund 5FT0).
To pay for the FY 2013 costs related to the Deputy Inspector
General for the Bureau of Workers' Compensation and Industrial
Commission, on July 1, 2012, and on January 1, 2013, or as soon as
possible after each date, the Director of Budget and Management
shall transfer $212,500 in cash from the Workers' Compensation
Fund (Fund 7023) to the Deputy Inspector General for the Bureau of
Workers' Compensation and Industrial Commission Fund (Fund 5FT0).
If additional amounts are needed, the Inspector General may
seek Controlling Board approval for additional transfers of cash
and to increase the amount appropriated in appropriation item
965604, Deputy Inspector General for the Bureau of Workers'
Compensation and Industrial Commission.
Section 301. Law contained in the Main Operating
Appropriations Act of the 129th General Assembly that applies
generally to the appropriations made in that act also applies
generally to the appropriations made in this act.
Section 311. The provisions of law contained in this act, and
their applications, are severable. If any provision of law
contained in this act, or if any application of any provision of
law contained in this act, is held invalid, the invalidity does
not affect other provisions of law contained in this act and their
applications that can be given effect without the invalid
provision or application.
Section 321. Except as otherwise provided in this act, the
amendment, enactment, or repeal by this act of a section of law is
exempt from the referendum under Ohio Constitution, Article II,
Section 1d and section 1.471 of the Revised Code and therefore
takes effect immediately when this act becomes law.
Section 322. The amendment, enactment, or repeal by this act
of the divisions and sections of law listed below are subject to
the referendum under Ohio Constitution, Article II, Section 1c and
therefore take effect on the ninety-first day after this act is
filed with the Secretary of State.
All Revised Code sections in Section 101 of this act.
The repeal of sections 4121.124 and 4121.99 of the Revised
Code.
|