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Sub. H. B. No. 493 As Reported by the House Insurance CommitteeAs Reported by the House Insurance Committee
130th General Assembly | Regular Session | 2013-2014 |
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Representatives Sears, Henne
A BILL
To amend sections 1561.31, 2305.25, 2305.252,
4121.129, 4121.45, 4123.01, 4123.26, 4123.27,
4123.29, 4123.291, 4123.292, 4123.32, 4123.322,
4123.34, 4123.35, 4123.353, 4123.36, 4123.37,
4123.40, 4123.41, 4123.411, 4123.47, 4123.511,
4123.512, 4123.54, 4123.542, 4123.66, 4123.82,
4123.83, 4125.05, 4729.80, and 4729.86; to enact
sections 4121.443, 4121.447, and 4123.323; to
repeal section 4121.419 of the Revised Code; and
to amend Section 1 of Sub. H.B. 34 of the 130th
General Assembly, as subsequently amended, to make
changes to Ohio's Workers' Compensation Law.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That sections 1561.31, 2305.25, 2305.252,
4121.129, 4121.45, 4123.01, 4123.26, 4123.27, 4123.29, 4123.291,
4123.292, 4123.32, 4123.322, 4123.34, 4123.35, 4123.353, 4123.36,
4123.37, 4123.40, 4123.41, 4123.411, 4123.47, 4123.511, 4123.512,
4123.54, 4123.542, 4123.66, 4123.82, 4123.83, 4125.05, 4729.80,
and 4729.86 be amended and sections 4121.443, 4121.447, and
4123.323 of the Revised Code be enacted to read as follows:
Sec. 1561.31. Each deputy mine inspector shall inspect each
mine in the inspector's district, the owner, lessee, agent, or
operator of which is an employer as defined in section 4123.01 of
the Revised Code, or any other mine at which three or more persons
work, at intervals not exceeding three months between inspections,
and all other mines in the inspector's district as often as
practical, noting particularly the location and condition of
buildings, the condition of the boiler, machinery, workings of the
mine, the traveling ways and haulageways, the circulation and
condition of the air and drainage, and the condition of electrical
circuits and appliances. The inspector shall make tests for
poisonous, explosive, and noxious gases, and shall specifically
order compliance with any section of this chapter and Chapters
1563., 1565., and 1567. and sections 1509.09, 1509.12, 1509.13,
1509.14, 1509.15, 1509.17, and 1509.18 of the Revised Code that
the inspector finds is being violated.
Upon completion of the inspection of a mine, the inspector
shall fill out a report of the conditions found during inspections
on a form provided by the chief of the division of mineral
resources management, which form shall provide for statements as
to whether the laws are being observed or violated, and if
violated, the nature and extent thereof, the date of the
inspection, the number of persons employed in and about the mine,
whether or not a certificate of compliance the proof of workers'
compensation coverage issued pursuant to section 4123.35 of the
Revised Code is posted and the date of expiration thereof, and
matters, things, and practices that specifically are covered by
law, order of the chief, or previous order of the inspector. The
inspector shall make this report in quadruplicate or
quintuplicate, and send the original to the chief, post a copy at
the mine, give a copy to the mine superintendent, and retain a
copy for the inspector's files. Where the miners of a mine have a
mine safety committee, the inspector shall post one additional
copy of the report of that mine at that mine for the use and
possession of the committee. The report required by this section
shall be known as the inspector's routine report.
If an inspector orders compliance with this chapter and
Chapters 1563., 1565., and 1567. and sections 1509.09, 1509.12,
1509.13, 1509.14, 1509.15, 1509.17, and 1509.18 of the Revised
Code, and is assured by the superintendent of the mine to which
the order applies that the order will be complied with, the
inspector shall revisit the mine within a reasonable period of
time and ascertain whether or not the order has been complied
with. The inspector shall report the inspector's findings to the
chief on a form to be provided by the chief, and take action to
enforce compliance.
Sec. 2305.25. As used in this section and sections 2305.251
to 2305.253 of the Revised Code:
(A)(1) "Health care entity" means an entity, whether acting
on its own behalf or on behalf of or in affiliation with other
health care entities, that conducts as part of its regular
business activities professional credentialing or quality review
activities involving the competence of, professional conduct of,
or quality of care provided by health care providers, including
both individuals who provide health care and entities that provide
health care.
(2) "Health care entity" includes any entity described in
division (A)(1) of this section, regardless of whether it is a
government entity; for-profit or nonprofit corporation; limited
liability company; partnership; professional corporation; state or
local society composed of physicians, dentists, optometrists,
psychologists, or pharmacists; or other health care organization.
(B) "Health insuring corporation" means an entity that holds
a certificate of authority under Chapter 1751. of the Revised
Code. "Health insuring corporation" includes wholly owned
subsidiaries of a health insuring corporation.
(C) "Hospital" means either of the following:
(1) An institution that has been registered or licensed by
the department of health as a hospital;
(2) An entity, other than an insurance company authorized to
do business in this state, that owns, controls, or is affiliated
with an institution that has been registered or licensed by the
department of health as a hospital.
(D) "Incident report or risk management report" means a
report of an incident involving injury or potential injury to a
patient as a result of patient care provided by health care
providers, including both individuals who provide health care and
entities that provide health care, that is prepared by or for the
use of a peer review committee of a health care entity and is
within the scope of the functions of that committee.
(E)(1) "Peer review committee" means a utilization review
committee, quality assessment committee, performance improvement
committee, tissue committee, credentialing committee, or other
committee that does either of the following:
(a) Conducts professional credentialing or quality review
activities involving the competence of, professional conduct of,
or quality of care provided by health care providers, including
both individuals who provide health care and entities that provide
health care;
(b) Conducts any other attendant hearing process initiated as
a result of a peer review committee's recommendations or actions.
(2) "Peer review committee" includes all of the following:
(a) A peer review committee of a hospital or long-term care
facility or a peer review committee of a nonprofit health care
corporation that is a member of the hospital or long-term care
facility or of which the hospital or facility is a member;
(b) A peer review committee of a community mental health
center;
(c) A board or committee of a hospital, a long-term care
facility, or other health care entity when reviewing professional
qualifications or activities of health care providers, including
both individuals who provide health care and entities that provide
health care;
(d) A peer review committee, professional standards review
committee, or arbitration committee of a state or local society
composed of members who are in active practice as physicians,
dentists, optometrists, psychologists, or pharmacists;
(e) A peer review committee of a health insuring corporation
that has at least a two-thirds majority of member physicians in
active practice and that conducts professional credentialing and
quality review activities involving the competence or professional
conduct of health care providers that adversely affects or could
adversely affect the health or welfare of any patient;
(f) A peer review committee of a health insuring corporation
that has at least a two-thirds majority of member physicians in
active practice and that conducts professional credentialing and
quality review activities involving the competence or professional
conduct of a health care facility that has contracted with the
health insuring corporation to provide health care services to
enrollees, which conduct adversely affects, or could adversely
affect, the health or welfare of any patient;
(g) A peer review committee of a sickness and accident
insurer that has at least a two-thirds majority of physicians in
active practice and that conducts professional credentialing and
quality review activities involving the competence or professional
conduct of health care providers that adversely affects or could
adversely affect the health or welfare of any patient;
(h) A peer review committee of a sickness and accident
insurer that has at least a two-thirds majority of physicians in
active practice and that conducts professional credentialing and
quality review activities involving the competence or professional
conduct of a health care facility that has contracted with the
insurer to provide health care services to insureds, which conduct
adversely affects, or could adversely affect, the health or
welfare of any patient;
(i) A peer review committee of any insurer authorized under
Title XXXIX of the Revised Code to do the business of medical
professional liability insurance in this state that conducts
professional quality review activities involving the competence or
professional conduct of health care providers that adversely
affects or could affect the health or welfare of any patient;
(j) A peer review committee of the bureau of workers'
compensation or the industrial commission that is responsible for
reviewing the professional qualifications and the performance of
providers certified by the bureau to participate in the health
partnership program or of providers conducting medical
examinations or file reviews for the bureau or the commission;
(k) Any other peer review committee of a health care entity.
(F) "Physician" means an individual authorized to practice
medicine and surgery, osteopathic medicine and surgery, or
podiatric medicine and surgery.
(G) "Sickness and accident insurer" means an entity
authorized under Title XXXIX of the Revised Code to do the
business of sickness and accident insurance in this state.
(H) "Tort action" means a civil action for damages for
injury, death, or loss to a patient of a health care entity. "Tort
action" includes a product liability claim, as defined in section
2307.71 of the Revised Code, and an asbestos claim, as defined in
section 2307.91 of the Revised Code, but does not include a civil
action for a breach of contract or another agreement between
persons.
Sec. 2305.252. (A) Proceedings and records within the scope
of a peer review committee of a health care entity shall be held
in confidence and shall not be subject to discovery or
introduction in evidence in any civil action against a health care
entity or health care provider, including both individuals who
provide health care and entities that provide health care, arising
out of matters that are the subject of evaluation and review by
the peer review committee. No individual who attends a meeting of
a peer review committee, serves as a member of a peer review
committee, works for or on behalf of a peer review committee, or
provides information to a peer review committee shall be permitted
or required to testify in any civil action as to any evidence or
other matters produced or presented during the proceedings of the
peer review committee or as to any finding, recommendation,
evaluation, opinion, or other action of the committee or a member
thereof. Information, documents, or records otherwise available
from original sources are not to be construed as being unavailable
for discovery or for use in any civil action merely because they
were produced or presented during proceedings of a peer review
committee, but the information, documents, or records are
available only from the original sources and cannot be obtained
from the peer review committee's proceedings or records. An
individual who testifies before a peer review committee, serves as
a representative of a peer review committee, serves as a member of
a peer review committee, works for or on behalf of a peer review
committee, or provides information to a peer review committee
shall not be prevented from testifying as to matters within the
individual's knowledge, but the individual cannot be asked about
the individual's testimony before the peer review committee,
information the individual provided to the peer review committee,
or any opinion the individual formed as a result of the peer
review committee's activities. An order by a court to produce for
discovery or for use at trial the proceedings or records described
in this section is a final order.
(B) Division (A) of this section applies to a peer review
committee of the bureau of workers' compensation that is
responsible for reviewing the professional qualifications and the
performance of providers certified by the bureau to participate in
the health partnership program created under sections 4121.44 and
4121.441 of the Revised Code, except that the proceedings and
records within the scope of the peer review committee are subject
to discovery or court subpoena and may be admitted into evidence
in any criminal action or administrative or civil action
initiated, prosecuted, or adjudicated by the bureau involving an
alleged violation of applicable statutes or administrative rules.
The bureau may share proceedings and records within the scope of
the peer review committee, including claimant records and claim
file information, with law enforcement agencies, licensing boards,
and other governmental agencies that are prosecuting,
adjudicating, or investigating alleged violations of applicable
statutes or administrative rules. Recipients of claimant records
and claim file information provided by the bureau pursuant to this
division shall take appropriate measures to maintain the
confidentiality of the information.
Sec. 4121.129. (A) There is hereby created the workers'
compensation audit committee consisting of at least three members.
One member shall be the member of the bureau of workers'
compensation board of directors who is a certified public
accountant. The board, by majority vote, shall appoint two
additional members of the board to serve on the audit committee
and may appoint additional members who are not board members, as
the board determines necessary. Members of the audit committee
serve at the pleasure of the board, and the board, by majority
vote, may remove any member except the member of the committee who
is the certified public accountant member of the board. The board,
by majority vote, shall determine how often the audit committee
shall meet and report to the board. If the audit committee meets
on the same day as the board holds a meeting, no member shall be
compensated for more than one meeting held on that day. The audit
committee shall do all of the following:
(1) Recommend to the board an accounting actuarial firm to
perform the annual audits analysis required under section 4123.47
of the Revised Code;
(2) Recommend an auditing firm for the board to use when
conducting audits under section 4121.125 of the Revised Code;
(3) Review the results of each annual audit and management
review and, if any problems exist, assess the appropriate course
of action to correct those problems and develop an action plan to
correct those problems;
(4) Monitor the implementation of any action plans created
pursuant to division (A)(3) of this section;
(5) Review all internal audit reports on a regular basis.
(B) There is hereby created the workers' compensation
actuarial committee consisting of at least three members. One
member shall be the member of the board who is an actuary. The
board, by majority vote, shall appoint two additional members of
the board to serve on the actuarial committee and may appoint
additional members who are not board members, as the board
determines necessary. Members of the actuarial committee serve at
the pleasure of the board and the board, by majority vote, may
remove any member except the member of the committee who is the
actuary member of the board. The board, by majority vote, shall
determine how often the actuarial committee shall meet and report
to the board. If the actuarial committee meets on the same day as
the board holds a meeting, no member shall be compensated for more
than one meeting held on that day. The actuarial committee shall
do both of the following:
(1) Recommend actuarial consultants for the board to use for
the funds specified in this chapter and Chapters 4123., 4127., and
4131. of the Revised Code;
(2) Review calculations on rate schedules and performance
prepared by the actuarial consultants with whom the board enters
into a contract.
(C)(1) There is hereby created the workers' compensation
investment committee consisting of at least four members. Two of
the members shall be the members of the board who serve as the
investment and securities experts on the board. The board, by
majority vote, shall appoint two additional members of the board
to serve on the investment committee and may appoint additional
members who are not board members. Each additional member the
board appoints shall have at least one of the following
qualifications:
(a) Experience managing another state's pension funds or
workers' compensation funds;
(b) Expertise that the board determines is needed to make
investment decisions.
Members of the investment committee serve at the pleasure of
the board and the board, by majority vote, may remove any member
except the members of the committee who are the investment and
securities expert members of the board. The board, by majority
vote, shall determine how often the investment committee shall
meet and report to the board. If the investment committee meets on
the same day as the board holds a meeting, no member shall be
compensated for more than one meeting held on that day.
(2) The investment committee shall do all of the following:
(a) Develop the investment policy for the administration of
the investment program for the funds specified in this chapter and
Chapters 4123., 4127., and 4131. of the Revised Code in accordance
with the requirements specified in section 4123.442 of the Revised
Code;
(b) Submit the investment policy developed pursuant to
division (C)(2)(a) of this section to the board for approval;
(c) Monitor implementation by the administrator of workers'
compensation and the bureau of workers' compensation chief
investment officer of the investment policy approved by the board;
(d) Recommend outside investment counsel with whom the board
may contract to assist the investment committee in fulfilling its
duties;
(e) Review the performance of the bureau of workers'
compensation chief investment officer and any investment
consultants retained by the administrator to assure that the
investments of the assets of the funds specified in this chapter
and Chapters 4123., 4127., and 4131. of the Revised Code are made
in accordance with the investment policy approved by the board and
that the best possible return on to assure compliance with the
investment is achieved policy and effective management of the
funds.
Sec. 4121.443. (A) The bureau of workers' compensation may
summarily suspend the certification of a provider to participate
in the health partnership program created under sections 4121.44
and 4121.441 of the Revised Code without a prior hearing if the
bureau determines any of the following apply to the provider:
(1) The professional license, certification, or registration
held by the provider has been revoked or suspended.
(2) The provider has been convicted of or has pleaded guilty
to a violation of section 2913.48 or sections 2923.31 to 2923.36
of the Revised Code or any other criminal offense related to the
delivery of or billing for health care benefits.
(3) The continued participation by the provider in the health
partnership program presents a danger to the health and safety of
claimants.
(B) The bureau shall issue a written order of summary
suspension by certified mail or in person in accordance with
section 119.07 of the Revised Code. The order shall not be subject
to suspension by the court during pendency of any appeal filed
under section 119.12 of the Revised Code. If the provider subject
to the summary suspension requests an adjudicatory hearing by the
bureau, the date set for the hearing shall be not later than
fifteen days, but not earlier than seven days, after the provider
requests the hearing, unless otherwise agreed to by both the
bureau and the provider.
(C) Any summary suspension imposed under this section shall
remain in effect, unless reversed on appeal, until a final
adjudication order issued by the bureau pursuant to this section
and Chapter 119. of the Revised Code takes effect. The bureau
shall issue its final adjudication order within seventy-five days
after completion of its hearing. A failure to issue the order
within the seventy-five-day time period shall result in
dissolution of the summary suspension order but shall not
invalidate any subsequent, final adjudication order.
Sec. 4121.447. Each contract the administrator of workers'
compensation enters into with a managed care organization under
division (B)(4) of section 4121.44 of the Revised Code shall
require the managed care organization to enter into a data
security agreement with the state board of pharmacy governing the
managed care organization's use of the board's drug database
established and maintained under section 4729.75 of the Revised
Code.
This section does not apply if the board does not establish
or maintain the drug database.
Sec. 4121.45. (A) There is hereby created a workers'
compensation ombudsperson system to assist claimants and employers
in matters dealing with the bureau of workers' compensation and
the industrial commission. The industrial commission nominating
council shall appoint a chief ombudsperson. The chief
ombudsperson, with the advice and consent of the advisory
commission nominating council, may appoint such assistant
ombudspersons as the nominating council deems necessary. The
positions position of chief ombudsperson and assistant
ombudspersons are is for terms a term of six years. A person
appointed to the position of chief ombudsperson or assistant
ombudspersons shall serve at the pleasure of the nominating
council. The chief ombudsperson may not be transferred, demoted,
or suspended during the person's tenure and may be removed by the
nominating council only on the grounds of malfeasance or neglect
of duty upon notice and public hearing a vote of not fewer than
nine members of the nominating council. The
ombudspersons chief
ombudsperson shall devote their the chief ombudsperson's full time
and attention to the duties of their the ombudsperson's office.
The administrator of workers' compensation shall furnish the
ombudspersons chief ombudsperson with the office space, supplies,
and clerical assistance that will enable the
ombudspersons chief
ombudsperson and the ombudsperson system staff to perform their
duties effectively. The ombudsperson program shall be funded out
of the budget of the bureau and the chief ombudsperson and
assistant ombudspersons the ombudsperson system staff shall be
carried on the bureau payroll
but. The chief ombudsperson and the
ombudsperson system shall be under the direction of the nominating
council. The administrator and all employees of the bureau and the
commission shall give the ombudspersons the ombudsperson system
staff full and prompt cooperation in all matters relating to the
duties of the ombudspersons chief ombudsperson.
(B) The ombudspersons ombudsperson system staff shall:
(1) Answer inquiries or investigate complaints made by
employers or claimants under this chapter and Chapter 4123. of the
Revised Code as they relate to the processing of a claim for
workers' compensation benefits;
(2) Provide claimants and employers with information
regarding problems which arise out of the functions of the bureau,
commission hearing officers, and the commission and the procedures
employed in the processing of claims;
(3) Answer inquiries or investigate complaints of an employer
as they relate to reserves established and premiums charged in
connection with the employer's account;
(4) Comply with Chapter 102. and sections 2921.42 and 2921.43
of the Revised Code and the nominating council's human resource
and ethics policies;
(5) Not express any opinions as to the merit of a claim or
the correctness of a decision by the various officers or agencies
as the decision relates to a claim for benefits or compensation.
For the purpose of carrying out the chief ombudsperson's
duties, the chief ombudsperson or the
chief ombudsperson's
assistants ombudsperson system staff, notwithstanding sections
4123.27 and 4123.88 of the Revised Code, has the right at all
reasonable times to examine the contents of a claim file and
discuss with parties in interest the contents of the file as long
as the ombudsperson does not divulge information that would tend
to prejudice the case of either party to a claim or that would
tend to compromise a privileged attorney-client or doctor-patient
relationship.
(C) The chief ombudsperson shall:
(1) Assist any service office in its duties whenever it
requires assistance or information that can best be obtained from
central office personnel or records;
(2) Annually assemble reports from each assistant
ombudsperson as to their activities for the preceding year
together with their recommendations as to changes or improvements
in the operations of the workers' compensation system. The chief
ombudsperson shall prepare a written report summarizing the
activities of the ombudsperson system together with a digest of
recommendations. The chief ombudsperson shall transmit the report
to the nominating council.
(3) Comply with Chapter 102. and sections 2921.42 and 2921.43
of the Revised Code and the nominating council's human resource
and ethics policies.
(D) No ombudsperson or assistant ombudsperson shall:
(1) Represent a claimant or employer in claims pending before
or to be filed with the administrator, a district or staff hearing
officer, the commission, or the courts of the state, nor shall an
ombudsperson or assistant ombudsperson undertake any such
representation for a period of one year after the ombudsperson's
or assistant ombudsperson's employment terminates or be eligible
for employment by the bureau or the commission or as a district or
staff hearing officer for one year;
(2) Express any opinions as to the merit of a claim or the
correctness of a decision by the various officers or agencies as
the decision relates to a claim for benefits or compensation.
(E) The chief ombudsperson and assistant ombudspersons shall
receive compensation at a level established by the nominating
council commensurate with the individual's background, education,
and experience in workers' compensation or related fields. The
chief ombudsperson and assistant ombudspersons are full-time
permanent employees in the classified civil unclassified service
of the state and are entitled to all benefits that accrue to such
employees, including, without limitation, sick, vacation, and
personal leaves. Assistant ombudspersons serve at the pleasure of
the chief ombudsperson.
(F) In the event of a vacancy in the position of chief
ombudsperson, the nominating council may appoint a person to serve
as acting chief ombudsperson until a chief ombudsperson is
appointed. The acting chief ombudsperson shall be under the
direction and control of the nominating council and may be removed
by the nominating council with or without just cause.
Sec. 4123.01. As used in this chapter:
(a) Every person in the service of the state, or of any
county, municipal corporation, township, or school district
therein, including regular members of lawfully constituted police
and fire departments of municipal corporations and townships,
whether paid or volunteer, and wherever serving within the state
or on temporary assignment outside thereof, and executive officers
of boards of education, under any appointment or contract of hire,
express or implied, oral or written, including any elected
official of the state, or of any county, municipal corporation, or
township, or members of boards of education.
As used in division (A)(1)(a) of this section, the term
"employee" includes the following persons when responding to an
inherently dangerous situation that calls for an immediate
response on the part of the person, regardless of whether the
person is within the limits of the jurisdiction of the person's
regular employment or voluntary service when responding, on the
condition that the person responds to the situation as the person
otherwise would if the person were on duty in the person's
jurisdiction:
(i) Off-duty peace officers. As used in division (A)(1)(a)(i)
of this section, "peace officer" has the same meaning as in
section 2935.01 of the Revised Code.
(ii) Off-duty firefighters, whether paid or volunteer, of a
lawfully constituted fire department.
(iii) Off-duty first responders, emergency medical
technicians-basic, emergency medical technicians-intermediate, or
emergency medical technicians-paramedic, whether paid or
volunteer, of an ambulance service organization or emergency
medical service organization pursuant to Chapter 4765. of the
Revised Code.
(b) Every person in the service of any person, firm, or
private corporation, including any public service corporation,
that (i) employs one or more persons regularly in the same
business or in or about the same establishment under any contract
of hire, express or implied, oral or written, including aliens and
minors, household workers who earn one hundred sixty dollars or
more in cash in any calendar quarter from a single household and
casual workers who earn one hundred sixty dollars or more in cash
in any calendar quarter from a single employer, or (ii) is bound
by any such contract of hire or by any other written contract, to
pay into the state insurance fund the premiums provided by this
chapter.
(c) Every person who performs labor or provides services
pursuant to a construction contract, as defined in section 4123.79
of the Revised Code, if at least ten of the following criteria
apply:
(i) The person is required to comply with instructions from
the other contracting party regarding the manner or method of
performing services;
(ii) The person is required by the other contracting party to
have particular training;
(iii) The person's services are integrated into the regular
functioning of the other contracting party;
(iv) The person is required to perform the work personally;
(v) The person is hired, supervised, or paid by the other
contracting party;
(vi) A continuing relationship exists between the person and
the other contracting party that contemplates continuing or
recurring work even if the work is not full time;
(vii) The person's hours of work are established by the other
contracting party;
(viii) The person is required to devote full time to the
business of the other contracting party;
(ix) The person is required to perform the work on the
premises of the other contracting party;
(x) The person is required to follow the order of work set by
the other contracting party;
(xi) The person is required to make oral or written reports
of progress to the other contracting party;
(xii) The person is paid for services on a regular basis such
as hourly, weekly, or monthly;
(xiii) The person's expenses are paid for by the other
contracting party;
(xiv) The person's tools and materials are furnished by the
other contracting party;
(xv) The person is provided with the facilities used to
perform services;
(xvi) The person does not realize a profit or suffer a loss
as a result of the services provided;
(xvii) The person is not performing services for a number of
employers at the same time;
(xviii) The person does not make the same services available
to the general public;
(xix) The other contracting party has a right to discharge
the person;
(xx) The person has the right to end the relationship with
the other contracting party without incurring liability pursuant
to an employment contract or agreement.
Every person in the service of any independent contractor or
subcontractor who has failed to pay into the state insurance fund
the amount of premium determined and fixed by the administrator of
workers' compensation for the person's employment or occupation or
if a self-insuring employer has failed to pay compensation and
benefits directly to the employer's injured and to the dependents
of the employer's killed employees as required by section 4123.35
of the Revised Code, shall be considered as the employee of the
person who has entered into a contract, whether written or verbal,
with such independent contractor unless such employees or their
legal representatives or beneficiaries elect, after injury or
death, to regard such independent contractor as the employer.
(d) Every person to whom all of the following apply:
(i) The person is a resident of a state other than this state
and is covered by that other state's workers' compensation law;
(ii) The person performs labor or provides services for that
person's employer while temporarily within this state;
(iii) The laws of that other state do not include the
provisions described in division (H)(4) of section 4123.54 of the
Revised Code.
(2) "Employee" does not mean:
(a) A duly ordained, commissioned, or licensed minister or
assistant or associate minister of a church in the exercise of
ministry;
(b) Any officer of a family farm corporation;
(c) An individual incorporated as a corporation; or
(d) An individual who otherwise is an employee of an employer
but who signs the waiver and affidavit specified in section
4123.15 of the Revised Code on the condition that the
administrator has granted a waiver and exception to the
individual's employer under section 4123.15 of the Revised Code.
Any employer may elect to include as an "employee" within
this chapter, any person excluded from the definition of
"employee" pursuant to division (A)(2) of this section. If an
employer is a partnership, sole proprietorship, individual
incorporated as a corporation, or family farm corporation, such
employer may elect to include as an "employee" within this
chapter, any member of such partnership, the owner of the sole
proprietorship, the individual incorporated as a corporation, or
the officers of the family farm corporation. In the event of an
election, the employer shall serve upon the bureau of workers'
compensation written notice naming the persons to be covered,
include such employee's remuneration for premium purposes in all
future payroll reports, and no person excluded from the definition
of "employee" pursuant to division (A)(2) of this section,
proprietor, individual incorporated as a corporation, or partner
shall be deemed an employee within this division until the
employer has served such notice.
For informational purposes only, the bureau shall prescribe
such language as it considers appropriate, on such of its forms as
it considers appropriate, to advise employers of their right to
elect to include as an "employee" within this chapter a sole
proprietor, any member of a partnership, an individual
incorporated as a corporation, the officers of a family farm
corporation, or a person excluded from the definition of
"employee" under division (A)(2) of this section, that they should
check any health and disability insurance policy, or other form of
health and disability plan or contract, presently covering them,
or the purchase of which they may be considering, to determine
whether such policy, plan, or contract excludes benefits for
illness or injury that they might have elected to have covered by
workers' compensation.
(1) The state, including state hospitals, each county,
municipal corporation, township, school district, and hospital
owned by a political subdivision or subdivisions other than the
state;
(2) Every person, firm, professional employer organization as
defined in section 4125.01 of the Revised Code, and private
corporation, including any public service corporation, that (a)
has in service one or more employees or shared employees regularly
in the same business or in or about the same establishment under
any contract of hire, express or implied, oral or written, or (b)
is bound by any such contract of hire or by any other written
contract, to pay into the insurance fund the premiums provided by
this chapter.
All such employers are subject to this chapter. Any member of
a firm or association, who regularly performs manual labor in or
about a mine, factory, or other establishment, including a
household establishment, shall be considered an employee in
determining whether such person, firm, or private corporation, or
public service corporation, has in its service, one or more
employees and the employer shall report the income derived from
such labor to the bureau as part of the payroll of such employer,
and such member shall thereupon be entitled to all the benefits of
an employee.
(C) "Injury" includes any injury, whether caused by external
accidental means or accidental in character and result, received
in the course of, and arising out of, the injured employee's
employment. "Injury" does not include:
(1) Psychiatric conditions except where the claimant's
psychiatric conditions have arisen from an injury or occupational
disease sustained by that claimant or where the claimant's
psychiatric conditions have arisen from sexual conduct in which
the claimant was forced by threat of physical harm to engage or
participate;
(2) Injury or disability caused primarily by the natural
deterioration of tissue, an organ, or part of the body;
(3) Injury or disability incurred in voluntary participation
in an employer-sponsored recreation or fitness activity if the
employee signs a waiver of the employee's right to compensation or
benefits under this chapter prior to engaging in the recreation or
fitness activity;
(4) A condition that pre-existed an injury unless that
pre-existing condition is substantially aggravated by the injury.
Such a substantial aggravation must be documented by objective
diagnostic findings, objective clinical findings, or objective
test results. Subjective complaints may be evidence of such a
substantial aggravation. However, subjective complaints without
objective diagnostic findings, objective clinical findings, or
objective test results are insufficient to substantiate a
substantial aggravation.
(D) "Child" includes a posthumous child and a child legally
adopted prior to the injury.
(E) "Family farm corporation" means a corporation founded for
the purpose of farming agricultural land in which the majority of
the voting stock is held by and the majority of the stockholders
are persons or the spouse of persons related to each other within
the fourth degree of kinship, according to the rules of the civil
law, and at least one of the related persons is residing on or
actively operating the farm, and none of whose stockholders are a
corporation. A family farm corporation does not cease to qualify
under this division where, by reason of any devise, bequest, or
the operation of the laws of descent or distribution, the
ownership of shares of voting stock is transferred to another
person, as long as that person is within the degree of kinship
stipulated in this division.
(F) "Occupational disease" means a disease contracted in the
course of employment, which by its causes and the characteristics
of its manifestation or the condition of the employment results in
a hazard which distinguishes the employment in character from
employment generally, and the employment creates a risk of
contracting the disease in greater degree and in a different
manner from the public in general.
(G) "Self-insuring employer" means an employer who is granted
the privilege of paying compensation and benefits directly under
section 4123.35 of the Revised Code, including a board of county
commissioners for the sole purpose of constructing a sports
facility as defined in section 307.696 of the Revised Code,
provided that the electors of the county in which the sports
facility is to be built have approved construction of a sports
facility by ballot election no later than November 6, 1997.
(H) "Private employer" means an employer as defined in
division (B)(2) of this section.
(I) "Professional employer organization" has the same meaning
as in section 4125.01 of the Revised Code.
(J) "Public employer" means an employer as defined in
division (B)(1) of this section.
(I)(K) "Sexual conduct" means vaginal intercourse between a
male and female; anal intercourse, fellatio, and cunnilingus
between persons regardless of gender; and, without privilege to do
so, the insertion, however slight, of any part of the body or any
instrument, apparatus, or other object into the vaginal or anal
cavity of another. Penetration, however slight, is sufficient to
complete vaginal or anal intercourse.
(J)(L) "Other-states' insurer" means an insurance company
that is authorized to provide workers' compensation insurance
coverage in any of the states that permit employers to obtain
insurance for workers' compensation claims through insurance
companies.
(K)(M) "Other-states' coverage" means insurance both of the
following:
(1) Insurance coverage
purchased secured by an eligible
employer for workers' compensation claims that arise of employees
who are in employment relationships localized in a state or states
other than this state
and that are filed by the employees of the
employer or those
employee's
employees' dependents, as
applicable, in that other state or those other states;
(2) Insurance coverage secured by an eligible employer for
workers' compensation claims that arise in a state other than this
state where an employer elects to obtain coverage through either
the administrator or an other-states' insurer.
(N) "Limited other-states coverage" means insurance coverage
provided by the administrator to an eligible employer for workers'
compensation claims of employees who are in an employment
relationship localized in this state but are temporarily working
in a state other than this state, or those employees' dependents.
Sec. 4123.26. (A) Every employer shall keep records of, and
furnish to the bureau of workers' compensation upon request, all
information required by the administrator of workers' compensation
to carry out this chapter. In January of each year
(B) Except as otherwise provided in division (C) of this
section, every private employer
of the state employing one or
more employees regularly in the same business, or in or about the
same establishment, shall prepare and mail submit a payroll report
to the bureau at its main office in Columbus a statement
containing. Until the policy year commencing July 1, 2015, a
private employer shall submit the payroll report in January of
each year. For a policy year commencing on or after July 1, 2015,
the employer shall submit the payroll report on or before August
fifteenth of each year unless otherwise specified by the
administrator in rules the administrator adopts. The employer
shall include all of the following information in the payroll
report, as applicable:
(A) The (1) For payroll reports submitted prior to July 1,
2015, the number of employees employed during the preceding year
from the first day of January through the thirty-first day of
December who are localized in this state;
(B)(2) For payroll reports submitted on or after July 1,
2015, the number of employees localized in this state employed
during the preceding policy year from the first day of July
through the thirtieth day of June;
(3) The number of such employees localized in this state
employed at each kind of employment and the aggregate amount of
wages paid to such employees;
(C)(4)(a) If an employer elects to obtain secure
other-states' coverage or limited other-states' coverage pursuant
to section 4123.292 of the Revised Code through either the
administrator, if the administrator elects to offer such coverage,
or an other-states' insurer for claims arising in a state or
states other than this state, all of the following information:
(1) The amount of wages the employer paid to the employer's
employees for performing labor or providing services for the
employer in this state;
(2) The amount of wages the employer paid to the employer's
employees for performing labor or providing services for the
employer in a state or states other than this state.
The allocation of wages identified by the employer pursuant
to divisions (C)(1) and (2) of this section shall not be presumed
to be an indication of the law under which an employee is eligible
to receive compensation and benefits required under divisions
(B)(1) to (3) of this section and any additional information
required by the administrator in rules the administrator adopts,
with the advice and consent of the bureau of workers' compensation
board of directors, to allow the employer to secure other-states'
coverage or limited other-states' coverage.
(D)(5)(a) In accordance with the rules adopted by the
administrator pursuant to division (D)(C) of section 4123.32 of
the Revised Code, if the employer employs employees who are
covered under the federal "Longshore and Harbor Workers'
Compensation Act," 98 Stat. 1639, 33 U.S.C. 901 et seq., and under
this chapter and Chapter 4121. of the Revised Code, both of the
following amounts:
(1)(i) The amount of wages the employer pays to those
employees when the employees perform labor and provide services
for which the employees are eligible to receive compensation and
benefits under the federal "Longshore and Harbor Workers'
Compensation Act;";
(2)(ii) The amount of wages the employer pays to those
employees when the employees perform labor and provide services
for which the employees are eligible to receive compensation and
benefits under this chapter and Chapter 4121. of the Revised Code.
(b) The allocation of wages identified by the employer
pursuant to divisions (D)(1)(B)(5)(a)(i) and (2)(ii) of this
section shall not be presumed to be an indication of the law under
which an employee is eligible to receive compensation and
benefits.
The information shall be furnished on a blank to be prepared
by the bureau. The bureau shall furnish the blanks to employers
free of charge upon request therefor. Every employer receiving
from the bureau any blank, with directions to fill out the same,
shall cause the same to be properly filled out so as to answer
fully and correctly all questions therein propounded, and give all
the information therein sought, or if unable to do so, the
employer shall give to the bureau in writing good and sufficient
reasons for such failure. (C) Beginning August 1, 2015, each
employer that is recognized by the administrator as a professional
employer organization shall submit a monthly payroll report
containing the number of employees employed during the preceding
calendar month, the number of those employees employed at each
kind of employment, and the aggregate amount of wages paid to
those employees.
(D) An employer described in division (B) of this section
shall submit the payroll report required under this section to the
bureau on a form prescribed by the bureau. The bureau may require
that the information required to be furnished be verified under
oath and returned to the bureau within the period fixed by it or
by law. The bureau or any person employed by the bureau for that
purpose, may examine, under oath, any employer, or the officer,
agent, or employee thereof, for the purpose of ascertaining any
information which the employer is required to furnish to the
bureau.
(E) No private employer shall fail to furnish to the bureau
the annual statement payroll report required by this section, nor
shall any employer fail to keep records of or furnish such other
information as may be required by the bureau under this section.
Whoever violates this section shall forfeit five hundred
dollars, to be collected in a civil action brought against the
employer in the name of the state, to be paid into the state
insurance fund and become a part thereof
(F) The administrator may adopt rules setting forth penalties
for failure to submit the payroll report required by this section,
including but not limited to exclusion from alternative rating
plans and discount programs.
Sec. 4123.27. Information contained in the annual statement
payroll report provided for in section 4123.26 of the Revised
Code, and such other information as may be furnished to the bureau
of workers' compensation by employers in pursuance of that
section, 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 nor be used in any court in any action or proceeding
pending therein unless the bureau is a party to the action or
proceeding; but the. The information contained in the statement
payroll report may be tabulated and published by the bureau in
statistical form for the use and information of other state
departments and the public. No person in the employ of the bureau,
except those who are authorized by the administrator of workers'
compensation, shall divulge any information secured by the person
while in the employ of the bureau in respect to the transactions,
property, claim files, records, or papers of the bureau or in
respect to the business or mechanical, chemical, or other
industrial process of any company, firm, corporation, person,
association, partnership, or public utility to any person other
than the administrator or to the superior of such employee of the
bureau.
Notwithstanding the restrictions imposed by this section, the
governor, select or standing committees of the general assembly,
the auditor of state, the attorney general, or their designees,
pursuant to the authority granted in this chapter and Chapter
4121. of the Revised Code, may examine any records, claim files,
or papers in possession of the industrial commission or the
bureau. They also are bound by the privilege that attaches to
these papers.
The administrator shall report to the director of job and
family services or to the county director of job and family
services the name, address, and social security number or other
identification number of any person receiving workers'
compensation whose name or social security number or other
identification number is the same as that of a person required by
a court or child support enforcement agency to provide support
payments to a recipient or participant of public assistance, as
that term is defined in section 5101.181 of the Revised Code, and
whose name is submitted to the administrator by the director under
section 5101.36 of the Revised Code. The administrator also shall
inform the director of the amount of workers' compensation paid to
the person during such period as the director specifies.
Within fourteen days after receiving from the director of job
and family services a list of the names and social security
numbers of recipients or participants of public assistance
pursuant to section 5101.181 of the Revised Code, the
administrator shall inform the auditor of state of the name,
current or most recent address, and social security number of each
person receiving workers' compensation pursuant to this chapter
whose name and social security number are the same as that of a
person whose name or social security number was submitted by the
director. The administrator also shall inform the auditor of state
of the amount of workers' compensation paid to the person during
such period as the director specifies.
The bureau and its employees, except for purposes of
furnishing the auditor of state with information required by this
section, shall preserve the confidentiality of recipients or
participants of public assistance in compliance with section
5101.181 of the Revised Code.
Sec. 4123.29. (A) The administrator of workers'
compensation, subject to the approval of the bureau of workers'
compensation board of directors, shall do all of the following:
(1) Classify occupations or industries with respect to their
degree of hazard and determine the risks of the different classes
according to the categories the national council on compensation
insurance establishes that are applicable to employers in this
state;
(2)(a) Fix the rates of premium of the risks of the classes
based upon the total payroll in each of the classes of occupation
or industry sufficiently large to provide a fund for the
compensation provided for in this chapter and to maintain a state
insurance fund from year to year. The administrator shall set the
rates at a level that assures the solvency of the fund. Where the
payroll cannot be obtained or, in the opinion of the
administrator, is not an adequate measure for determining the
premium to be paid for the degree of hazard, the administrator may
determine the rates of premium upon such other basis, consistent
with insurance principles, as is equitable in view of the degree
of hazard, and whenever in this chapter reference is made to
payroll or expenditure of wages with reference to fixing premiums,
the reference shall be construed to have been made also to such
other basis for fixing the rates of premium as the administrator
may determine under this section.
(b) If an employer elects to obtain other-states' coverage,
including limited other-states' coverage, pursuant to section
4123.292 of the Revised Code through either the administrator, if
the administrator elects to offer such coverage, or an
other-states' insurer, calculate the employer's premium for the
state insurance fund in the same manner as otherwise required
under division (A) of this section and section 4123.34 of the
Revised Code, except that when the administrator determines the
expenditure of wages, payroll, or both upon which to base may
establish in rule an alternative calculation of the employer's
premium, the administrator shall use only to appropriately account
for the expenditure of wages, payroll, or both attributable to the
labor performed and services provided by that employer's employees
when those employees performed labor and provided services in this
state only and to which the in the other state or states for which
the employer elects to secure other-states' coverage does not
apply.
(c) If an employer elects to obtain other-states' coverage
pursuant to section 4123.292 of the Revised Code through an
other-states' insurer, calculate the employer's premium for the
state insurance fund in the same manner as otherwise required
under division (A) of this section and section 4123.34 of the
Revised Code, except that when the administrator determines the
expenditure of wages, payroll, or both upon which to base the
employer's premium, the administrator shall use only the
expenditure of wages, payroll, or both attributable to the labor
performed and services provided by that employer's employees when
those employees performed labor and provided services in this
state only and to which the other-states' coverage does not apply.
The administrator may adopt rules setting forth the information
that an employer electing to obtain other-states' coverage through
an other-states' insurer shall report for purposes of determining
the expenditure of wages, payroll, or both attributable to the
labor performed and services provided in this state.
(d) The administrator in setting or revising rates shall
furnish to employers an adequate explanation of the basis for the
rates set.
(3) Develop and make available to employers who are paying
premiums to the state insurance fund alternative premium plans.
Alternative premium plans shall include retrospective rating
plans. The administrator may make available plans under which an
advanced deposit may be applied against a specified deductible
amount per claim.
(4)(a) Offer to insure the obligations of employers under
this chapter under a plan that groups, for rating purposes,
employers, and pools the risk of the employers within the group
provided that the employers meet all of the following conditions:
(i) All of the employers within the group are members of an
organization that has been in existence for at least two years
prior to the date of application for group coverage;
(ii) The organization was formed for purposes other than that
of obtaining group workers' compensation under this division;
(iii) The employers' business in the organization is
substantially similar such that the risks which are grouped are
substantially homogeneous;
(iv) The group of employers consists of at least one hundred
members or the aggregate workers' compensation premiums of the
members, as determined by the administrator, are expected
estimated to exceed one hundred fifty thousand dollars during the
coverage period;
(v) The formation and operation of the group program in the
organization will substantially improve accident prevention and
claims handling for the employers in the group;
(vi) Each employer seeking to enroll in a group for workers'
compensation coverage has an industrial insurance account in good
standing with the bureau of workers' compensation such that at the
time the agreement is processed no outstanding premiums,
penalties, or assessments are due from any of the employers. The
administrator shall adopt rules setting forth the criteria by
which the administrator will determine whether an employer's
account is in good standing.
(b) If an organization sponsors more than one employer group
to participate in group plans established under this section, that
organization may submit a single application that supplies all of
the information necessary for each group of employers that the
organization wishes to sponsor.
(c) In providing employer group plans under division (A)(4)
of this section, the administrator shall consider an employer
group as a single employing entity for purposes of group rating.
No employer may be a member of more than one group for the purpose
of obtaining workers' compensation coverage under this division.
(d) At the time the administrator revises premium rates
pursuant to this section and section 4123.34 of the Revised Code,
if the premium rate of an employer who participates in a group
plan established under this section changes from the rate
established for the previous year, the administrator, in addition
to sending the invoice with the rate revision to that employer,
shall send a copy of that invoice to the third-party administrator
that administers the group plan for that employer's group.
(e) In providing employer group plans under division (A)(4)
of this section, the administrator shall establish a program
designed to mitigate the impact of a significant claim that would
come into the experience of a private, state fund group-rated
employer or a taxing district employer for the first time and be a
contributing factor in that employer being excluded from a
group-rated plan. The administrator shall establish eligibility
criteria and requirements that such employers must satisfy in
order to participate in this program. For purposes of this
program, the administrator shall establish a discount on premium
rates applicable to employers who qualify for the program.
(f) In no event shall division (A)(4) of this section be
construed as granting to an employer status as a self-insuring
employer.
(g) The administrator shall develop classifications of
occupations or industries that are sufficiently distinct so as not
to group employers in classifications that unfairly represent the
risks of employment with the employer.
(5) Generally promote employer participation in the state
insurance fund through the regular dissemination of information to
all classes of employers describing the advantages and benefits of
opting to make premium payments to the fund. To that end, the
administrator shall regularly make employers aware of the various
workers' compensation premium packages developed and offered
pursuant to this section.
(6) Make available to every employer who is paying premiums
to the state insurance fund a program whereby the employer or the
employer's agent pays to the claimant or on behalf of the claimant
the first fifteen thousand dollars of a compensable workers'
compensation medical-only claim filed by that claimant that is
related to the same injury or occupational disease. No formal
application is required; however, an employer must elect to
participate by telephoning the bureau after July 1, 1995. Once an
employer has elected to participate in the program, the employer
will be responsible for all bills in all medical-only claims with
a date of injury the same or later than the election date, unless
the employer notifies the bureau within fourteen days of receipt
of the notification of a claim being filed that it does not wish
to pay the bills in that claim, or the employer notifies the
bureau that the fifteen thousand dollar maximum has been paid, or
the employer notifies the bureau of the last day of service on
which it will be responsible for the bills in a particular
medical-only claim. If an employer elects to enter the program,
the administrator shall not reimburse the employer for such
amounts paid and shall not charge the first fifteen thousand
dollars of any medical-only claim paid by an employer to the
employer's experience or otherwise use it in merit rating or
determining the risks of any employer for the purpose of payment
of premiums under this chapter. A certified health care provider
shall extend to an employer who participates in this program the
same rates for services rendered to an employee of that employer
as the provider bills the administrator for the same type of
medical claim processed by the bureau and shall not charge,
assess, or otherwise attempt to collect from an employee any
amount for covered services or supplies that is in excess of that
rate. If an employer elects to enter the program and the employer
fails to pay a bill for a medical-only claim included in the
program, the employer shall be liable for that bill and the
employee for whom the employer failed to pay the bill shall not be
liable for that bill. The administrator shall adopt rules to
implement and administer division (A)(6) of this section. Upon
written request from the bureau, the employer shall provide
documentation to the bureau of all medical-only bills that they
are paying directly. Such requests from the bureau may not be made
more frequently than on a semiannual basis. Failure to provide
such documentation to the bureau within thirty days of receipt of
the request may result in the employer's forfeiture of
participation in the program for such injury. The provisions of
this section shall not apply to claims in which an employer with
knowledge of a claimed compensable injury or occupational disease,
has paid wages in lieu of compensation or total disability.
(B) The administrator, with the advice and consent of the
board, by rule, may do both of the following:
(1) Grant an employer who makes pays the employer's
semiannual annual estimated premium payment at least one month in
full prior to the last day on which the payment may be made
without penalty start of the policy year for which the estimated
premium is due, a discount as the administrator fixes from time to
time;
(2) Levy a minimum annual administrative charge upon risks
where semiannual premium reports develop a charge less than the
administrator considers adequate to offset administrative costs of
processing.
Sec. 4123.291. (A) An adjudicating committee appointed by
the administrator of workers' compensation to hear any matter
specified in divisions (B)(1) to (7) of this section shall hear
the matter within sixty days of the date on which an employer
files the request, protest, or petition. An employer desiring to
file a request, protest, or petition regarding any matter
specified in divisions (B)(1) to (7) of this section shall file
the request, protest, or petition to the adjudicating committee on
or before twenty-four months after the administrator sends notice
of the determination about which the employer is filing the
request, protest, or petition.
(B) An employer who is adversely affected by a decision of an
adjudicating committee appointed by the administrator may appeal
the decision of the committee to the administrator or the
administrator's designee. The employer shall file the appeal in
writing within thirty days after the employer receives the
decision of the adjudicating committee. The administrator or the
designee shall hear the appeal and hold a hearing, provided that
the decision of the adjudicating committee relates to one of the
following:
(1) An employer request for a waiver of a default in the
payment of premiums pursuant to section 4123.37 of the Revised
Code;
(2) An employer request for the settlement of liability as a
noncomplying employer under section 4123.75 of the Revised Code;
(3) An employer petition objecting to the an assessment of a
premium made pursuant to section 4123.37 of the Revised Code and
the rules adopted pursuant to that section;
(4) An employer request for the abatement of penalties
assessed pursuant to section 4123.32 of the Revised Code and the
rules adopted pursuant to that section;
(5) An employer protest relating to an audit finding or a
determination of a manual classification, experience rating, or
transfer or combination of risk experience;
(6) Any decision relating to any other risk premium matter
under Chapters 4121., 4123., and 4131. of the Revised Code;
(7) An employer petition objecting to the amount of security
required under division (D) of section 4125.05 of the Revised Code
and the rules adopted pursuant to that section.
(C) The bureau of workers' compensation board of directors,
based upon recommendations of the workers' compensation actuarial
committee, shall establish the policy for all adjudicating
committee procedures, including, but not limited to, specific
criteria for manual premium rate adjustment.
Sec. 4123.292. (A) Notwithstanding sections 4123.35 and
4123.82 of the Revised Code, an employer may elect to obtain
other-states' coverage through an other-states' insurer or, if the
administrator of workers' compensation elects to offer such
coverage, through the administrator pursuant to division (B) of
this section. An employer who elects to obtain other-states'
coverage shall submit a written notice to the administrator
stating that election on a form prescribed by the administrator
and, if the employer elects to obtain that coverage through an
other-states' insurer, the name of the other-states' insurer
through whom the employer has obtained that coverage. If an
employer fails to pay the employer's premium for other-states'
coverage, the administrator shall consider the employer to be
noncompliant for the purposes of having other-states' coverage but
shall not consider the employer to be a noncomplying employer for
purposes of this chapter or Chapter 4121., 4127., or 4131. of the
Revised Code unless the employer otherwise fails to comply with
and the employer's premiums in this state for any and all
noncompliant periods of time shall be calculated in the same
manner as otherwise required under division (A) of section 4123.29
and section 4123.35 4123.34 of the Revised Code, using both the
wages reported in this state and the wages that the employer
claimed would be reported to the other-states' insurer for
securing coverage.
(B) The administrator may secure offer other-states' coverage
to allow an employer who wishes to obtain other-states' coverage
pursuant to this section and who elects to
obtain secure that
coverage through the administrator for workers' compensation
claims
arising in a state or states other than this state. If the
administrator elects to secure a vehicle through which the
administrator will provide other-states' coverage, the
administrator shall follow the competitive bidding requirements
specified in Chapter 125. of the Revised Code to select one
or
more other-states' insurer insurers, and the administrator, with
the advice and consent of the bureau of workers' compensation
board of directors, shall award the a contract to provide
other-states' coverage for employers located in this state to the
one or more other-states'
insurer insurers that is are the lowest
and best bidder bidders.
(C) If the administrator elects to secure other-states'
coverage pursuant to division (B) of this section, the
administrator shall calculate an employer's premium for
other-states' coverage provided through the administrator
separately from calculating any other premiums or assessments
charged under this chapter or Chapter 4121., 4127., or 4131. of
the Revised Code. The administrator shall calculate the employer's
other-states' coverage premium in the same manner the
administrator calculates an employer's premium for the state
insurance fund pursuant to division (A) of section 4123.29 and
section 4123.34 of the Revised Code, except that, when calculating
the employer's premium for other-states' coverage under this
division, the administrator shall do all of the following:
(1) Base the employer's other-states' coverage premium on the
terms specified in the contract the administrator enters into with
an insurance company pursuant to division (B) of this section;
(2) When determining the expenditure of wages, payroll, or
both upon which to base the employer's other-states' coverage
premium, use only the amount of wages, payroll, or both the
employer paid to the employer's employees for performing labor or
providing services for the employer in a state or states other
than this state;
(3) Not take into account the amount of wages, payroll, or
both the employer paid to the employer's employees for performing
labor or providing services for the employer in this state or any
compensation or benefits paid for claims covered by the state
insurance fund
Notwithstanding sections 4123.35 and 4123.82 of the
Revised Code, the administrator may offer limited other-states'
coverage to allow an employer who wishes to obtain limited
other-states' coverage pursuant to this section. An employer who
elects to obtain limited other-states' coverage shall submit a
written notice to the administrator stating that election on a
form prescribed by the administrator.
If the administrator elects to secure a vehicle through which
the administrator will provide limited other-states' coverage, the
administrator shall follow the competitive bidding requirements
specified in Chapter 125. of the Revised Code to select one or
more other-states' insurers and, with the advice and consent of
the board, award a contract to provide limited other-states'
coverage to the lowest and best bidders.
(D) If the administrator elects to secure offer other states'
coverage or limited other-states' coverage, the administrator,
with the advice and consent of the board, shall adopt rules to
implement divisions (B) and (C) of this section.
(E) An other-states' insurer that provides other-states'
coverage to an employer pursuant to this section shall do all of
the following when calculating the employer's premium for that
coverage:
(1) When determining the amount of wages, payroll, or both
upon which to base the employer's premium, use only the amount of
wages, payroll, or both the employer paid to the employer's
employees for performing labor or providing services for the
employer in a state or states other than this state;
(2) Not take into account the amount of wages, payroll, or
both the employer paid to the employer's employees for performing
labor or providing services for the employer in this state or any
compensation or benefits paid for claims otherwise covered by this
chapter or Chapter 4121., 4127., or 4131. of the Revised Code;
(3) Take into account any other factors the other-states'
insurer uses to calculate premiums for workers' compensation
insurance.
(F) The board and the individual members thereof, the
administrator, and the bureau of workers' compensation shall not
incur any obligation or liability if another state determines that
the other-states' coverage or limited other-states' coverage
provided under this section does not satisfy the requirements
specified in that state's workers' compensation law for obtaining
workers' compensation coverage in that state.
Sec. 4123.32. The administrator of workers' compensation,
with the advice and consent of the bureau of workers' compensation
board of directors, shall adopt rules with respect to the
collection, maintenance, and disbursements of the state insurance
fund including all of the following:
(A) A rule providing that the premium security deposit
collected from any employer entitles the employer to the benefits
of this chapter for the remainder of the six months and also for
an additional adjustment period of two months, and, thereafter, if
the employer pays the premium due at the close of any six-month
period, coverage shall be extended for an additional eight-month
period beginning from the end of the six-month period for which
the employer pays the premium due;
(B) A rule providing for ascertaining the correctness of any
employer's report of estimated or actual expenditure of wages and
the determination and adjustment of proper premiums and the
payment of those premiums by the employer for or during any period
less than eight months and notwithstanding any payment or
determination of premium made when exceptional conditions or
circumstances in the judgment of the administrator justify the
action;
(C)(B) Such special rules as the administrator considers
necessary to safeguard the fund and that are just in the
circumstances, covering the rates to be applied where one employer
takes over the occupation or industry of another or where an
employer first makes application for state insurance, and the
administrator may require that if any employer transfers a
business in whole or in part or otherwise reorganizes the
business, the successor in interest shall assume, in proportion to
the extent of the transfer, as determined by the administrator,
the employer's account and shall continue the payment of all
contributions due under this chapter;
(D)(C) A rule providing that an employer who employs an
employee covered under the federal "Longshore and Harbor Workers'
Compensation Act," 98 Stat. 1639, 33 U.S.C. 901 et seq., and this
chapter and Chapter 4121. of the Revised Code shall be assessed a
premium in accordance with the expenditure of wages, payroll, or
both attributable to only labor performed and services provided by
such an employee when the employee performs labor and provides
services for which the employee is not eligible to receive
compensation and benefits under that federal act.
(E)(D) A rule providing for all of the following:
(1) If, within two months immediately after the expiration of
the six-month period, an employer fails to file a report of the
employer's actual payroll expenditures for the period pursuant to
section 4123.26 of the Revised Code for private employers or
pursuant to section 4123.41 of the Revised Code for public
employers, the premium
found to be and assessments due from the
employer for the period shall be calculated based on the estimated
payroll of the employer used in calculating the estimated premium
due, increased in an amount equal to one per cent of the premium,
but the increase shall not be less than three nor more than
fifteen dollars by ten per cent;
(2) The premium determined by the administrator to be due
from an employer shall be payable on or before the end of the
coverage period established by the premium security deposit, or
within the time specified by the administrator if the period for
which the advance premium has been paid is less than eight months.
(a) If an employer fails to pay the premium or assessments when
due for a policy year commencing prior to July 1, 2015, the
administrator may add a late fee penalty of not more than thirty
dollars to the premium plus an additional penalty amount as
follows:
(a)(i) For a premium from sixty-one to ninety days past due,
the prime interest rate, multiplied by the premium due;
(b)(ii) For a premium from ninety-one to one hundred twenty
days past due, the prime interest rate plus two per cent,
multiplied by the premium due;
(c)(iii) For a premium from one hundred twenty-one to one
hundred fifty days past due, the prime interest rate plus four per
cent, multiplied by the premium due;
(d)(iv) For a premium from one hundred fifty-one to one
hundred eighty days past due, the prime interest rate plus six per
cent, multiplied by the premium due;
(e)(v) For a premium from one hundred eighty-one to two
hundred ten days past due, the prime interest rate plus eight per
cent, multiplied by the premium due;
(f)(vi) For each additional thirty-day period or portion
thereof that a premium remains past due after it has remained past
due for more than two hundred ten days, the prime interest rate
plus eight per cent, multiplied by the premium due.
(b) For purposes of division (D)(2)(a) 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.
(c) If an employer fails to pay the premium or assessments
when due for a policy year commencing on or after July 1, 2015,
the administrator may assess a penalty at the interest rate
established by the state tax commissioner pursuant to section
5703.47 of the Revised Code.
(3) Notwithstanding the interest rates specified in division
(E)(D)(2)(a) or (c) of this section, at no time shall the
additional penalty amount assessed under division (E)(D)(2)(a) or
(c) of this section exceed fifteen per cent of the premium due.
(4) If an employer recognized by the administrator as a
professional employer organization fails to make a timely payment
of premiums or assessments as required by section 4123.35 of the
Revised Code, the administrator shall revoke the professional
employer organization's registration pursuant to section 4125.06
of the Revised Code.
(5) An employer may appeal a late fee penalty or additional
penalty to an adjudicating committee pursuant to section 4123.291
of the Revised Code.
For purposes of division (E) 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.
(5)(6) If the employer files an appropriate payroll report,
within the time provided by law or within the time specified by
the administrator if the period for which the employer paid an
estimated premium is less than eight months, the employer shall
not be in default and division (E)(D)(2) of this section shall not
apply if the employer pays the premiums within fifteen days after
being first notified by the administrator of the amount due.
(6)(7) Any deficiencies in the amounts of the premium
security deposit paid by an employer for any period prior to July
1, 2015, shall be subject to an interest charge of six per cent
per annum from the date the premium obligation is incurred. In
determining the interest due on deficiencies in premium security
deposit payments, a charge in each case shall be made against the
employer in an amount equal to interest at the rate of six per
cent per annum on the premium security deposit due but remaining
unpaid sixty days after notice by the administrator.
(7)(8) Any interest charges or penalties provided for in
divisions (E)(D)(2) and (6)(7) of this section shall be credited
to the employer's account for rating purposes in the same manner
as premiums.
(F)(E) A rule providing that each employer, on the occasion
of instituting coverage under this chapter for an effective date
prior to July 1, 2015, shall submit a premium security deposit.
The deposit shall be calculated equivalent to thirty per cent of
the semiannual premium obligation of the employer based upon the
employer's estimated expenditure for wages for the ensuing
six-month period plus thirty per cent of an additional adjustment
period of two months but only up to a maximum of one thousand
dollars and not less than ten dollars. The administrator shall
review the security deposit of every employer who has submitted a
deposit which is less than the one-thousand-dollar maximum. The
administrator may require any such employer to submit additional
money up to the maximum of one thousand dollars that, in the
administrator's opinion, reflects the employer's current payroll
expenditure for an eight-month period.
(G)(F) A rule providing that each employer, on the occasion
of instituting coverage under this chapter, shall submit an
application fee and an application for coverage that completely
provides all of the information required for the administrator to
establish coverage for that employer, and that the employer's
failure to pay the application fee or to provide all of the
information completely requested on the application may be grounds
for the administrator to deny coverage for that employer.
(H)(G) A rule providing that, in addition to any other
remedies permitted in this chapter, the administrator may
discontinue an employer's coverage if the employer fails to pay
the premium due on or before the premium's due date.
(I)(H) A rule providing that if after a final adjudication it
is determined that an employer has failed to pay an obligation,
billing, account, or assessment that is greater than one thousand
dollars on or before its due date, the administrator may
discontinue the employer's coverage in addition to any other
remedies permitted in this chapter, and that the administrator
shall not discontinue an employer's coverage pursuant to this
division prior to a final adjudication regarding the employer's
failure to pay such obligation, billing, account, or assessment on
or before its due date.
(J)(I) As used in divisions (G) and (H) and (I) of this
section:
(1) "Employer" has the same meaning as in division (B) of
section 4123.01 of the Revised Code except that "employer" does
not include the state, a state hospital, or a state university or
college.
(2) "State university or college" has the same meaning as in
section 3345.12 of the Revised Code and also includes the Ohio
agricultural research and development center and OSU extension.
(3) "State hospital" means the Ohio state university hospital
and its ancillary facilities and the medical university of Ohio at
Toledo hospital.
Sec. 4123.322. (A) Notwithstanding any provision to the
contrary in section 4123.32 or 4123.41 of the Revised Code, the
The administrator of workers' compensation, with the advice and
consent of the bureau of workers' compensation board of directors,
may shall adopt rules with respect to the collection, maintenance,
and disbursements of the state insurance fund to provide for a
system of prospective payment of workers' compensation premiums.
If the administrator elects to adopt rules establishing a
prospective payment system, those rules which shall include all of
the following:
(1) A requirement that, notwithstanding section 4123.26 of
the Revised Code, on or before the thirtieth day of June of each
year, or such other date as the administrator establishes, every
employer mentioned in division (B)(2) of section 4123.01 of the
Revised Code shall file with the bureau of workers' compensation
an estimate of the employer's payroll for the immediately
following twelve-month period or other period as the administrator
establishes;
(2) A requirement that upon an initial application for
coverage, an a private employer mentioned in division (B)(2) of
section 4123.01 of the Revised Code shall file with the
application an estimate of the employer's payroll for the
unexpired period from the date of application to the period ending
on the following thirtieth day of June or other date as
established by the administrator determines pursuant to division
(A)(1) of this section rules the administrator adopts, and shall
pay the amount the administrator determines by rule in order to
establish coverage for the employer as described in division
(B)(12) of section 4121.121 of the Revised Code;
(3) A requirement that, notwithstanding section 4123.26 or
4123.41 of the Revised Code, on or before the first day of January
of each year, or such other date as the administrator establishes,
every employer mentioned in division (B)(1) of section 4123.01 of
the Revised Code, except for a state agency or a state university
or college, shall file with the bureau an estimate of the
employer's payroll for the immediately following twelve-month
period or other period as the administrator establishes;
(4)(2) A requirement that upon an initial application for
coverage, an a public employer mentioned in division (B)(1) of
section 4123.01 of the Revised Code, except for a state agency or
state university or college, shall file with the application an
estimate of the employer's payroll for the unexpired period from
the date of application to the period ending on the following
thirty-first day of December or other date as established by the
administrator determines pursuant to division (A)(3) of this
section rules the administrator adopts, and shall pay the amount
the administrator determines by rule in order to establish
coverage for the employer as described in division (B)(12) of
section 4121.121 of the Revised Code;
(5) The assessment of a penalty if an employer fails to
timely file the estimates of payroll required by the rules adopted
pursuant to this section;
(6)(3) A requirement that an employer complete periodic
payroll reports of actual expenditures for previous coverage
periods for reconciliation with estimated payroll reports;
(7)(4) The assessment of a penalty for late payroll
reconciliation reports and for late payment of any reconciliation
premium;
(8)(5) The establishment of a transition period during which
time the bureau shall determine the adequacy of existing premium
security deposits of employers, the establishment of provisions
for additional premium payments during that transition, the
provision of a credit of those deposits toward the first premium
due from an employer under the rules adopted under divisions
(A)(1) to (7)(4) of this section, and the establishment of
penalties for late payment or failure to comply with the rules.
(B) For purposes of division (A)(6)(3) of this section, an
employer shall make timely payment of any premium owed when actual
payroll expenditures exceeded estimated payroll, and the employer
shall receive premium credit when the estimated payroll exceeded
the actual payroll.
(C) For purposes of division (A)(7)(4) of this section, if
the employer's actual payroll substantially exceeds the estimated
payroll, the administrator may assess additional penalties
specified in rules the administrator adopts on the reconciliation
premium.
(D) As used in this section, "state university or college"
has the same meaning as in section 4123.32 of the Revised Code.
Sec. 4123.323. (A) Except as provided in division (B) of
this section, a payment required under this chapter or Chapter
4121. of the Revised Code, including a payment due for purposes of
continuing coverage, is due on the date specified in those
chapters, unless otherwise provided in a rule adopted by the
administrator of workers' compensation, with the advice and
consent of the bureau of workers' compensation board of directors.
(B) For purposes of collection referrals to the attorney
general under section 131.02 of the Revised Code, a premium
payment is due thirty days after the date upon which a private
employer must submit the payroll report for the corresponding
policy year pursuant to section 4123.26 of the Revised Code or the
date upon which a public employer must submit the payroll report
for the corresponding policy year pursuant to section 4123.41 of
the Revised Code, as applicable.
Sec. 4123.34. It shall be the duty of the bureau of workers'
compensation board of directors and the administrator of workers'
compensation to safeguard and maintain the solvency of the state
insurance fund and all other funds specified in this chapter and
Chapters 4121., 4127., and 4131. of the Revised Code. The
administrator, in the exercise of the powers and discretion
conferred upon the administrator in section 4123.29 of the Revised
Code, shall fix and maintain, with the advice and consent of the
board, for each class of occupation or industry, the lowest
possible rates of premium consistent with the maintenance of a
solvent state insurance fund and the creation and maintenance of a
reasonable surplus, after the payment of legitimate claims for
injury, occupational disease, and death that the administrator
authorizes to be paid from the state insurance fund for the
benefit of injured, diseased, and the dependents of killed
employees. In establishing rates, the administrator shall take
into account the necessity of ensuring sufficient money is set
aside in the premium payment security fund to cover any defaults
in premium obligations. The administrator shall observe all of the
following requirements in fixing the rates of premium for the
risks of occupations or industries:
(A) The administrator shall keep an accurate account of the
money paid in premiums by each of the several classes of
occupations or industries, and the losses on account of injuries,
occupational disease, and death of employees thereof, and also
keep an account of the money received from each individual
employer and the amount of losses incurred against the state
insurance fund on account of injuries, occupational disease, and
death of the employees of the employer.
(B) A portion of the money paid into the state insurance fund
shall be set aside for the creation of a surplus fund account
within the state insurance fund. Any references in this chapter or
in Chapter 4121., 4125., 4127., or 4131. of the Revised Code to
the surplus fund, the surplus created in this division, the
statutory surplus fund, or the statutory surplus of the state
insurance fund are hereby deemed to be references to the surplus
fund account. The administrator may transfer the portion of the
state insurance fund to the surplus fund account as the
administrator determines is necessary to satisfy the needs of the
surplus fund account and to guarantee the solvency of the state
insurance fund and the surplus fund account. In addition to all
statutory authority under this chapter and Chapter 4121. of the
Revised Code, the administrator has discretionary and contingency
authority to make charges to the surplus fund account. The
administrator shall account for all charges, whether statutory,
discretionary, or contingency, that the administrator may make to
the surplus fund account. A revision of basic rates shall be made
annually on the first day of July.
Notwithstanding any provision of the law to the contrary, one
hundred eighty days after the effective date on which
self-insuring employers first may elect under division (D) of
section 4121.66 of the Revised Code to directly pay for
rehabilitation expenses, the administrator shall calculate the
deficit, if any, in the portion of the surplus fund account that
is used for reimbursement to self-insuring employers for all
expenses other than handicapped reimbursement under section
4123.343 of the Revised Code. The administrator, from time to
time, may determine whether the surplus fund account has such a
deficit and may assess all self-insuring employers who
participated in the portion of the surplus fund account during the
accrual of the deficit and who during that time period have not
made the election under division (D) of section 4121.66 of the
Revised Code the amount the administrator determines necessary to
reduce the deficit.
Revisions For policy years commencing prior to July 1, 2016,
revisions of basic rates for private employers shall be in
accordance with the oldest four of the last five calendar years of
the combined accident and occupational disease experience of the
administrator in the administration of this chapter, as shown by
the accounts kept as provided in this section, excluding. For a
policy year commencing on or after July 1, 2016, revisions of
basic rates for private employers shall be in accordance with the
oldest four of the last five policy years combined accident and
occupational disease experience of the administrator in the
administration of this chapter, as shown by the accounts kept as
provided in this section.
Revisions of basic rates for public employers shall be in
accordance with the oldest four of the last five policy years of
the combined accident and occupational disease experience of the
administrator in the administration of this chapter, as shown by
the accounts kept as provided in this section.
In revising basic rates, the administrator shall exclude the
experience of employers that are no longer active if the
administrator determines that the inclusion of those employers
would have a significant negative impact on the remainder of the
employers in a particular manual classification; and the. The
administrator shall adopt rules, with the advice and consent of
the board, governing rate revisions, the object of which shall be
to make an equitable distribution of losses among the several
classes of occupation or industry, which rules shall be general in
their application.
(C) The administrator may apply that form of rating system
that the administrator finds is best calculated to merit rate or
individually rate the risk more equitably, predicated upon the
basis of its individual industrial accident and occupational
disease experience, and may encourage and stimulate accident
prevention. The administrator shall develop fixed and equitable
rules controlling the rating system, which rules shall conserve to
each risk the basic principles of workers' compensation insurance.
(D) The administrator, from the money paid into the state
insurance fund, shall set aside into an account of the state
insurance fund titled a premium payment security fund sufficient
money to pay for any premiums due from an employer and uncollected
that are in excess of the employer's premium security deposit.
The fund shall be in the custody of the treasurer of state.
All investment earnings of the fund shall be deposited in the
fund. Disbursements from the fund shall be made by the bureau of
workers' compensation upon order of the administrator to the state
insurance fund. The use of the moneys held by the premium payment
security fund account is restricted to reimbursement to the state
insurance fund of premiums due and uncollected in excess of an
employer's premium security deposit. The moneys constituting the
premium payment security fund shall be maintained without regard
to or reliance upon any other fund. This section does not prevent
the deposit or investment of the premium payment security fund
with any other fund created by this chapter, but the premium
payment security fund is separate and distinct for every other
purpose and a strict accounting thereof shall be maintained.
(E) The administrator may grant discounts on premium rates
for employers who meet either of the following requirements:
(1) Have not incurred a compensable injury for one year or
more and who maintain an employee safety committee or similar
organization or make periodic safety inspections of the workplace.
(2) Successfully complete a loss prevention program
prescribed by the superintendent of the division of safety and
hygiene and conducted by the division or by any other person
approved by the superintendent.
(F)(1) In determining the premium rates for the construction
industry the administrator shall calculate the employers' premiums
based upon the actual remuneration construction industry employees
receive from construction industry employers, provided that the
amount of remuneration the administrator uses in calculating the
premiums shall not exceed an average weekly wage equal to one
hundred fifty per cent of the statewide average weekly wage as
defined in division (C) of section 4123.62 of the Revised Code.
(2) Division (F)(1) of this section shall not be construed as
affecting the manner in which benefits to a claimant are awarded
under this chapter.
(3) As used in division (F) of this section, "construction
industry" includes any activity performed in connection with the
erection, alteration, repair, replacement, renovation,
installation, or demolition of any building, structure, highway,
or bridge.
(G) The administrator of workers' compensation shall not
place a limit on the length of time that an employer may
participate in the bureau of workers' compensation drug free
workplace and workplace safety programs.
Sec. 4123.35. (A) Except as provided in this section, and
until the policy year commencing July 1, 2015, every private
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.
Except as otherwise provided in this section, for a policy
year commencing on or after July 1, 2015, every private employer
and every publicly owned utility shall pay annually in the month
of June immediately preceding the policy year into the state
insurance fund the amount of estimated annual premium the
administrator fixes for the employment or occupation of the
employer, the amount of which estimated 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 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. Upon receipt of the payroll report required by
division (B) of section 4123.26 of the Revised Code, the
administrator shall adjust the premium and assessments charged to
each employer for the difference between estimated gross payrolls
and actual gross payrolls, and any balance due to the
administrator shall be immediately paid by the employer. Any
balance due the employer shall be credited to the employer's
account.
For a policy year commencing on or after July 1, 2015, each
employer that is recognized by the administrator as a professional
employer organization shall pay monthly into the state insurance
fund the amount of premium the administrator fixes for the
employer for the prior month based on the actual payroll of the
employer reported pursuant to division (C) of section 4123.26 of
the Revised Code.
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 issued
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. The administrator shall provide each
employer written proof of workers' compensation coverage as is
required in section 4123.83 of the Revised Code. Proper posting of
the notice constitutes the employer's compliance with the notice
requirement mandated in section 4123.54 4123.83 of the Revised
Code.
If the administrator adopts rules to establish a prospective
payment of premium under section 4123.322 of the Revised Code,
every employer mentioned in division (B)(2) of section 4123.01 of
the Revised Code and every publicly owned utility shall pay into
the state insurance fund the amount of premium the administrator
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 and based upon the estimates and reconciliations
required by the rules the administrator adopts under section
4123.322 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 A private 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, until July 1, 2015, 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.
After July 1, 2015,
an employer who first becomes a subscriber to the fund on any day
other than the first day of July shall pay premiums according to
rules adopted by the administrator, with the advice and consent of
the bureau of workers' compensation board of directors, for the
remainder of the policy year for which the coverage is effective.
The administrator, with the advice and consent of the board,
shall adopt rules to permit employers to make periodic payments of
the semiannual premium and assessment 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. The
administrator, in the rules the administrator adopts, may set an
administrative fee for these periodic 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 issue 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
requirements of divisions (B)(1)(a), (b), and (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, including 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 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. The administrator shall not waive
any of the requirements listed in divisions (B)(2)(a) to (j) of
this section for a public employer who does not satisfy the
criteria established in the rules the administrator adopts.
(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) 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. 4123.353. (A) 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, who is granted the status of self-insuring employer
pursuant to section 4123.35 of the Revised Code shall do all of
the following:
(1) Reserve funds as necessary, in accordance with sound and
prudent actuarial judgment, to cover the costs the public employer
may potentially incur to remain in compliance with this chapter
and Chapter 4121. of the Revised Code;
(2) Include all activity under this chapter and Chapter 4121.
of the Revised Code in a single fund on the public employer's
accounting records;
(3) Within ninety days after the last day of each fiscal
year, prepare and maintain a report of the reserved funds
described in division (A)(1) of this section and disbursements
made from those reserved funds;
(4) Within ninety days after the last day of each fiscal
year, obtain a written report prepared by a member of the American
academy of actuaries, certifying whether the reserved funds
described in division (A)(1) of this section are sufficient to
cover the costs the public employer may potentially incur to
remain in compliance with this chapter and Chapter 4121. of the
Revised Code, are computed in accordance with accepted loss
reserving standards, and are fairly stated in accordance with
sound loss reserving principles.
(B) A public employer who is subject to division (A) of this
section shall make the reports required by that division available
for inspection by the administrator of workers' compensation and
any other person at all reasonable times during regular business
hours.
Sec. 4123.36. Whenever an employer fails to pay a premium
due, and the administrator of workers' compensation determines the
employer's account to be uncollectible, the administrator shall
cover the default in excess of the employer's premium security
deposit by transfer of money from the premium payment security
fund account to the state insurance fund. The transfer establishes
coverage of the employer for the immediately completed six-month
period together with the ensuing two-month adjustment period and
the employer is not liable to respond in damages at common law or
by statute for injuries or death of any employees wherever
occurring during that eight-month period. Payments from the
premium payment security fund may not be used to cover a default
of an employer with respect to any period longer than eight
months. Thereafter, the employer shall be considered a
noncomplying employer under this chapter and shall not be entitled
to the benefits and protection of this chapter until the employer
again establishes coverage pursuant to this chapter through
reimbursement to the premium payment security fund for the money
paid to the state insurance fund, on account of the default,
payment of any semiannual premium obligations due but in default,
and submission of a new premium security deposit pursuant to
section 4123.32 of the Revised Code.
Sec. 4123.37. In this section "amenable employer" has the
same meaning as "employer" as defined in division (J)(I) of
section 4123.32 of the Revised Code.
If the administrator of workers' compensation finds that any
person, firm, or private corporation, including any public service
corporation, is, or has been at any time after January 1, 1923, an
amenable employer and has not complied with section 4123.35 of the
Revised Code the administrator shall determine the period during
which the person, firm, or corporation was an amenable employer
and shall forthwith give notice of the determination to the
employer. Within twenty days thereafter the employer shall furnish
the bureau with the payroll covering the period included in the
determination and, if the employer is an amenable employer at the
time of the determination, shall pay a premium security deposit
for the eight months next succeeding the date of the determination
and shall pay into the state insurance fund the amount of premium
and assessments applicable to such payroll.
If the administrator
determines that the employer is an amenable employer prior to the
policy year commencing July 1, 2015, the administrator may require
the employer to pay a premium security deposit.
If the employer does not furnish the payroll and pay the
applicable premium, assessments, and, if applicable, the premium
security deposit within the twenty days, the administrator shall
forthwith make an assessment of the premium amounts due from the
employer for the period the administrator determined the employer
to be an amenable employer including the premium security deposit
according to section 4123.32 of the Revised Code if the employer
is an amenable employer at the time of the determination, basing
the assessment upon the information in the possession of the
administrator.
The administrator shall give to the employer assessed written
notice of the assessment. The notice shall be mailed to the
employer at the employer's residence or usual place of business by
certified mail. Unless the employer to whom the notice of
assessment is directed files with the bureau within twenty days
after receipt thereof, a petition in writing, verified under oath
by the employer, or the employer's authorized agent having
knowledge of the facts, setting forth with particularity the items
of the assessment objected to, together with the reason for the
objections, the assessment shall become conclusive and the amount
thereof shall be due and payable from the employer so assessed to
the state insurance fund. When a petition objecting to an
assessment is filed the bureau shall assign a time and place for
the hearing of the same and shall notify the petitioner thereof by
certified mail. When an employer files a petition the assessment
made by the administrator shall become due and payable ten days
after notice of the finding made at the hearing has been sent by
certified mail to the party assessed. An appeal may be taken from
any finding to the court of common pleas of Franklin county upon
the execution by the party assessed of a bond to the state in
double the amount found due and ordered paid by the bureau
conditioned that the party will pay any judgment and costs
rendered against it for the premium.
When no petition objecting to an assessment is filed or when
a finding is made affirming or modifying an assessment after
hearing, a certified copy of the assessment as affirmed or
modified may be filed by the administrator in the office of the
clerk of the court of common pleas in any county in which the
employer has property or in which the employer has a place of
business. The clerk, immediately upon the filing of the
assessment, shall enter a judgment for the state against the
employer in the amount shown on the assessment. The judgment may
be filed by the clerk in a loose leaf book entitled "special
judgments for state insurance fund." The judgment shall bear the
same rate of interest, have the same effect as other judgments,
and be given the same preference allowed by law on other judgments
rendered for claims for taxes. An assessment or judgment under
this section shall not be a bar to the adjustment of the
employer's account upon the employer furnishing the employer's
payroll records to the bureau.
The administrator, for good cause shown, may waive a default
in the payment of premium where the default is of less than sixty
days' duration, and upon payment by the employer of the premium
for the period, the employer and the employer's employees are
entitled to all of the benefits and immunities provided by this
chapter.
Sec. 4123.40. On or before the first day of July of every
year, the administrator of workers' compensation shall estimate
the gross payroll of all state employers for the succeeding
biennium or fiscal year.
The administrator shall determine and certify for the office
of budget and management that rate or rates which, when applied to
the gross payroll estimate, will produce an amount equal to the
estimated cost of awards or claim payments to be made during the
like fiscal period, as determined by the administrator.
The rate certified shall be applied and made a part of the
gross payroll calculation for the period for which the foregoing
estimates have been made, in conformity with section 125.21 of the
Revised Code. The amounts collected shall be remitted to the
bureau of workers' compensation as provided in section 125.21 of
the Revised Code.
If the historical amounts remitted to the bureau for a fiscal
period are greater or less than actual historical awards or claim
payments for the like period by reason of an error in the prior
estimates of gross payroll or awards or payments, the overage or
shortage difference shall be included returned to the state
employer or recovered by the bureau in a manner determined by the
administrator in determining the rate for the next succeeding
fiscal period.
In fixing the amount of contribution to be made by the state
and each of its departments, agencies, and instrumentalities, the
administrator shall classify departments, agencies, and
instrumentalities into such groups as will equitably determine the
contributions in accordance with their
expected individual
accident experience so that the state and its departments,
agencies, and instrumentalities contribute an amount sufficient to
meet individual obligations and maintain a solvent public
insurance fund the obligations of the participants in total.
Moneys collected from state employers shall not be used to
pay compensation or other benefits attributable to service of
persons as employees of counties or taxing districts therein, nor
shall moneys collected from counties and taxing districts therein
be used to pay compensation or other benefits attributable to
service of persons as employees of the state.
Sec. 4123.41. (A) By (1) For policy years that begin prior
to January 1, 2016, by the first day of January of each year, the
bureau of workers' compensation shall furnish to the county
auditor of each county and the chief fiscal officer of each taxing
district in a county and of each district activity and institution
mentioned in section 4123.39 of the Revised Code forms containing
the premium rates applicable to the county, district, district
activity, or institution as an employer, on which to report the
amount of money expended by the county, district, district
activity, or institution during the previous twelve calendar
months for the services of employees under this chapter.
(B) Each county auditor and each fiscal officer of a
district, district activity, and institution shall calculate on
the form it receives from the bureau under division (A) of this
section the premium due as its proper contribution to the public
insurance fund and issue a warrant in favor of the bureau for the
amount due from the county, district, district activity, or
institution to the public insurance fund.
(2) For a policy year commencing on or after January 1, 2016,
by the first day of November of each year, the bureau shall
furnish to the county auditor of each county and the chief fiscal
officer of each taxing district in a county and of each district
activity and institution mentioned in section 4123.39 of the
Revised Code forms showing the estimated premium due from the
county, district, district activity, or institution for the
forthcoming policy year.
After the conclusion of each policy year, the county auditor
of each county and the chief fiscal officer of each taxing
district in a county and of each district activity and institution
mentioned in section 4123.39 of the Revised Code shall, on or
before the fifteenth day of February immediately following the
conclusion of the policy year, report the amount of money expended
by the county, district, district activity, or institution during
the policy year for the services of employees under this chapter.
The bureau shall adjust the premium and assessments charged to the
employer for the difference between estimated gross payrolls and
actual gross payrolls, and the employer immediately shall pay any
balance due to the bureau. Any balance due the employer shall be
credited to the employer's account.
The administrator may adopt rules setting forth penalties for
failure to submit the report of money expended as required by this
division, including, but not limited to, exclusion from
alternative rating plans and discount programs.
(B)(1) Except as otherwise provided in division (B) of this
section, payments due under this section shall be made according
to the following schedule:
(1) On (a) For payments of premium and assessments due for a
policy year that commences prior to July 1, 2015:
(i) On or before the fifteenth day of May of each immediately
following the conclusion of the policy year, no less than
forty-five per cent of the annual amount due for the policy year;
(2)(ii) On or before the first day of September immediately
following the conclusion of each the policy year, no less than the
total amount due for the policy year.
(b) For the policy year commencing January 1, 2015:
(i) On or before the fifteenth day of May immediately
following the conclusion of the policy year, no less than fifty
per cent of the annual amount due for the policy year;
(ii) On or before the first day of September immediately
following the conclusion of the policy year, no less than the
total amount due for the policy year.
(c) For the policy year commencing January 1, 2016:
(i) On or before the fifteenth day of May in that policy
year, no less than fifty per cent of the annual premium estimated
by the bureau.
(ii) On or before the first day of September in that policy
year, no less than the total amount of annual premium estimated by
the bureau.
(d) For a policy year commencing on or after January 1, 2017,
the total amount of annual premium estimated by the bureau on or
before the thirty-first day of December immediately preceding the
start of the policy year.
(2) The administrator, with the advice and consent of the
bureau of workers' compensation board of directors, shall adopt
rules to permit employers to make periodic payments of the premium
and assessments due under this section. The rules shall include
provisions for the assessment of interest charges, if appropriate,
and for the assessment of penalties when an employer fails to make
timely premium payments. The administrator may adopt rules to
establish an administrative fee for those periodic payments.
(C) The legislative body of any county, district, district
activity, or institution may reimburse the fund from which the
workers' compensation payments are made by transferring to the
fund from any other fund of the county, district, district
activity, or institution, the proportionate amount of the payments
that should be chargeable to the fund, whether the fund is derived
from taxation or otherwise. The proportionate amount of the
payments chargeable to the fund may be based on payroll, relative
exposure, relative loss experience, or any combination of these
factors, as determined by the legislative body.
(1) The workers' compensation program payments of any county,
district, district activity, or institution may include all
payments required by any bureau of workers' compensation rating
plan.
(2) The workers' compensation program payments of any county,
district, district activity, or institution, except for a county
board of developmental disabilities, a board of alcohol, drug
addiction, and mental health services, a board of mental health
services, and a board of alcohol and drug addiction services, also
may include any of the following:
(a) Direct administrative costs incurred in the management of
the county, district, district activity, or institution's workers'
compensation program;
(b) Indirect costs that are necessary and reasonable for the
proper and efficient administration of the workers' compensation
program as documented in a cost allocation plan. The indirect cost
plan shall conform to the United States office of management and
budget circular A-87 "cost principles for state and local
governments," 2 C.F.R. 225, as most recently amended on May 10,
2004. The plan shall not authorize payment from the fund of any
general government expense required to carry out the overall
governmental responsibilities.
(3) Within sixty days before a legislative body changes the
method used for calculating the proportionate amount of the
payments chargeable to the fund, it shall notify, consult with,
and give information supporting the change to any elected official
affected by the change. A transfer made pursuant to division
(B)(2) of this section is not subject to section 5705.16 of the
Revised Code.
(D) Any county board of developmental disabilities, board of
alcohol, drug addiction, and mental health services, board of
mental health services, or board of alcohol and drug addiction
services whose workers' compensation payments, on or before
September 28, 2012, includes costs referred to in division (C)(2)
of this section may continue to do so on and after September 28,
2012.
(E) The bureau may investigate the correctness of the
information provided by the county auditor and chief fiscal
officer under division (B)(A) of this section, and if the bureau
determines at any time that the county, district, district
activity, or institution has not reported the correct information,
the administrator of workers' compensation may make deductions or
additions as the facts warrant and take those facts into
consideration in determining the current or future contributions
to be made by the county, district, district activity, or
institution. If the county, district, district activity, or
institution does not furnish the report in the time required by
this section, the administrator may fix the amount of contribution
the county, district, district activity, or institution must make
and certify that amount for payment.
(F) The For payments of premium and assessments for a policy
year prior to the policy year commencing January 1, 2015, the
administrator shall provide a discount to any county, district,
district activity, or institution that pays its total amount due
to the public insurance fund on or before the fifteenth day of May
of each year as its proper contribution for premiums. The
administrator shall base the discount provided under this division
on the savings generated by the early payment to the public
insurance fund. The administrator may provide the discount through
a refund to the county, district, district activity, or
institution or an offset against the future contributions due to
the public insurance fund from the county, district, district
activity, or institution.
(G) The administrator may impose an interest penalty for late
payment of any amount due from a county, district, district
activity, and institution at the interest rate established by the
state tax commissioner pursuant to section 5703.47 of the Revised
Code.
(H) If the administrator adopts rules for the prospective
payment of premium as permitted under section 4123.322 of the
Revised Code, every employer mentioned in division (B)(1) of
section 4123.01 of the Revised Code, except for a state agency or
a state university or college as defined in section 4123.32 of the
Revised Code, shall pay into the state insurance fund the amount
of premium the administrator 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 and based upon
the estimates and reconciliations required by the rules the
administrator adopts under section 4123.322 of the Revised Code.
Sec. 4123.411. (A) For the purpose of carrying out sections
4123.412 to 4123.418 of the Revised Code, the administrator of
workers' compensation, with the advice and consent of the bureau
of workers' compensation board of directors, shall levy an
assessment against all employers at a rate, of at least five but
not to exceed ten cents per one hundred dollars of payroll, such
rate to be determined annually for each employer group listed in
divisions (A)(1) to (3) of this section, which will produce an
amount no greater than the amount the administrator estimates to
be necessary to carry out such sections for the period for which
the assessment is levied. In the event the amount produced by the
assessment is not sufficient to carry out such sections the
additional amount necessary shall be provided from the income
produced as a result of investments made pursuant to section
4123.44 of the Revised Code.
Assessments shall be levied according to the following
schedule:
(1) Private For private fund employers, except self-insuring
employers--:
(a) For policy years commencing prior to July 1, 2015, in
January and July of each year upon gross payrolls of the preceding
six months;
(b) For policy years commencing on or after July 1, 2015, in
June of each year upon gross payrolls estimated for the next
twelve months.
(2) Counties For counties and taxing district employers
therein, except county hospitals that are self-insuring
employers--:
(a) For policy years commencing prior to January 1, 2015, in
January of each year upon gross payrolls of the preceding twelve
months;
(b) For policy years commencing on or after January 1, 2015,
in December of each year upon gross payrolls estimated for the
next twelve months.
(3) The For the state as an employer--in January, April,
July, and October of each year upon gross payrolls of the
preceding three months or at other intervals as the administrator
establishes.
After the completion of each policy year that commences on or
after July 1, 2015, for private fund employers or that commences
on or after January 1, 2015, for counties and taxing district
employers therein, the assessments levied under this section shall
be adjusted for the difference between estimated gross payrolls
and actual gross payrolls reported by the employer on the payroll
report submitted by a private employer pursuant to section 4123.26
of the Revised Code, or, for a public employer, submitted pursuant
to section 4123.41 of the Revised Code.
Amounts assessed in accordance with this section shall be
collected from each employer as prescribed in rules the
administrator adopts.
The moneys derived from the assessment provided for in this
section shall be credited to the disabled workers' relief fund
created by section 4123.412 of the Revised Code. The administrator
shall establish by rule classifications of employers within
divisions (A)(1) to (3) of this section and shall determine rates
for each class so as to fairly apportion the costs of carrying out
sections 4123.412 to 4123.418 of the Revised Code.
(B) For all injuries and disabilities occurring on or after
January 1, 1987, the administrator, for the purposes of carrying
out sections 4123.412 to 4123.418 of the Revised Code, shall levy
an assessment against all employers at a rate per one hundred
dollars of payroll, such rate to be determined annually for each
classification of employer in each employer group listed in
divisions (A)(1) to (3) of this section, which will produce an
amount no greater than the amount the administrator estimates to
be necessary to carry out such sections for the period for which
the assessment is levied. The administrator annually shall
establish the contributions due from employers for the disabled
workers' relief fund at rates as low as possible but that will
assure sufficient moneys to guarantee the payment of any claims
against that fund.
Amounts assessed in accordance with this division shall be
billed at the same time premiums are billed and credited to the
disabled workers' relief fund created by section 4123.412 of the
Revised Code. The administrator shall determine the rates for each
class in the same manner as the administrator fixes the rates for
premiums pursuant to section 4123.29 of the Revised Code.
(C) For a self-insuring employer, the bureau of workers'
compensation shall pay to employees who are participants
regardless of the date of injury, any amounts due to the
participants under section 4123.414 of the Revised Code and shall
bill the self-insuring employer, semiannually, for all amounts
paid to a participant.
Sec. 4123.47. (A) The administrator of workers' compensation
shall have an actuarial audits analysis of the state insurance
fund and all other funds specified in this chapter and Chapters
4121., 4127., and 4131. of the Revised Code made at least once
each year. The
audits analysis shall be made and certified by
recognized insurance, credentialed property or casualty actuaries
who shall be selected by the bureau of workers' compensation board
of directors. The audits shall cover the premium rates,
classifications, and all other matters involving the
administration of the state insurance fund and all other funds
specified in this chapter and Chapters 4121., 4127., and 4131. of
the Revised Code. The expense of the
audits analysis shall be paid
from the state insurance fund. The administrator shall make copies
of the
audits analysis available to the workers' compensation
audit committee at no charge and to the public at cost.
(B) The auditor of state annually shall conduct an audit of
the administration of this chapter by the industrial commission
and the bureau of workers' compensation and the safety and hygiene
fund. The cost of the audit shall be charged to the administrative
costs of the bureau as defined in section 4123.341 of the Revised
Code. The audit shall include audits of all fiscal activities,
claims processing and handling, and employer premium collections.
The auditor shall prepare a report of the audit together with
recommendations and transmit copies of the report to the
industrial commission, the board, the administrator, the governor,
and to the general assembly. The auditor shall make copies of the
report available to the public at cost.
(C) The administrator may retain the services of a recognized
actuary on a consulting basis for the purpose of evaluating the
actuarial soundness of premium rates and classifications and all
other matters involving the administration of the state insurance
fund. The expense of services provided by the actuary shall be
paid from the state insurance fund.
Sec. 4123.511. (A) Within seven days after receipt of any
claim under this chapter, the bureau of workers' compensation
shall notify the claimant and the employer of the claimant of the
receipt of the claim and of the facts alleged therein. If the
bureau receives from a person other than the claimant written or
facsimile information or information communicated verbally over
the telephone indicating that an injury or occupational disease
has occurred or been contracted which may be compensable under
this chapter, the bureau shall notify the employee and the
employer of the information. If the information is provided
verbally over the telephone, the person providing the information
shall provide written verification of the information to the
bureau according to division (E) of section 4123.84 of the Revised
Code. The receipt of the information in writing or facsimile, or
if initially by telephone, the subsequent written verification,
and the notice by the bureau shall be considered an application
for compensation under section 4123.84 or 4123.85 of the Revised
Code, provided that the conditions of division (E) of section
4123.84 of the Revised Code apply to information provided verbally
over the telephone. Upon receipt of a claim, the bureau shall
advise the claimant of the claim number assigned and the
claimant's right to representation in the processing of a claim or
to elect no representation. If the bureau determines that a claim
is determined to be a compensable lost-time claim, the bureau
shall notify the claimant and the employer of the availability of
rehabilitation services. No bureau or industrial commission
employee shall directly or indirectly convey any information in
derogation of this right. This section shall in no way abrogate
the bureau's responsibility to aid and assist a claimant in the
filing of a claim and to advise the claimant of the claimant's
rights under the law.
The administrator of workers' compensation shall assign all
claims and investigations to the bureau service office from which
investigation and determination may be made most expeditiously.
The bureau shall investigate the facts concerning an injury
or occupational disease and ascertain such facts in whatever
manner is most appropriate and may obtain statements of the
employee, employer, attending physician, and witnesses in whatever
manner is most appropriate.
The administrator, with the advice and consent of the bureau
of workers' compensation board of directors, may adopt rules that
identify specified medical conditions that have a historical
record of being allowed whenever included in a claim. The
administrator may grant immediate allowance of any medical
condition identified in those rules upon the filing of a claim
involving that medical condition and may make immediate payment of
medical bills for any medical condition identified in those rules
that is included in a claim. If an employer contests the allowance
of a claim involving any medical condition identified in those
rules, and the claim is disallowed, payment for the medical
condition included in that claim shall be charged to and paid from
the surplus fund created under section 4123.34 of the Revised
Code.
(B)(1) Except as provided in division (B)(2) of this section,
in claims other than those in which the employer is a
self-insuring employer, if the administrator determines under
division (A) of this section that a claimant is or is not entitled
to an award of compensation or benefits, the administrator shall
issue an order no later than twenty-eight days after the sending
of the notice under division (A) of this section, granting or
denying the payment of the compensation or benefits, or both as is
appropriate to the claimant. Notwithstanding the time limitation
specified in this division for the issuance of an order, if a
medical examination of the claimant is required by statute, the
administrator promptly shall schedule the claimant for that
examination and shall issue an order no later than twenty-eight
days after receipt of the report of the examination. The
administrator shall notify the claimant and the employer of the
claimant and their respective representatives in writing of the
nature of the order and the amounts of compensation and benefit
payments involved. The employer or claimant may appeal the order
pursuant to division (C) of this section within fourteen days
after the date of the receipt of the order. The employer and
claimant may waive, in writing, their rights to an appeal under
this division.
(2) Notwithstanding the time limitation specified in division
(B)(1) of this section for the issuance of an order, if the
employer certifies a claim for payment of compensation or
benefits, or both, to a claimant, and the administrator has
completed the investigation of the claim, the payment of benefits
or compensation, or both, as is appropriate, shall commence upon
the later of the date of the certification or completion of the
investigation and issuance of the order by the administrator,
provided that the administrator shall issue the order no later
than the time limitation specified in division (B)(1) of this
section.
(3) If an appeal is made under division (B)(1) or (2) of this
section, the administrator shall forward the claim file to the
appropriate district hearing officer within seven days of the
appeal. In contested claims other than state fund claims, the
administrator shall forward the claim within seven days of the
administrator's receipt of the claim to the industrial commission,
which shall refer the claim to an appropriate district hearing
officer for a hearing in accordance with division (C) of this
section.
(C) If an employer or claimant timely appeals the order of
the administrator issued under division (B) of this section or in
the case of other contested claims other than state fund claims,
the commission shall refer the claim to an appropriate district
hearing officer according to rules the commission adopts under
section 4121.36 of the Revised Code. The district hearing officer
shall notify the parties and their respective representatives of
the time and place of the hearing.
The district hearing officer shall hold a hearing on a
disputed issue or claim within forty-five days after the filing of
the appeal under this division and issue a decision within seven
days after holding the hearing. The district hearing officer shall
notify the parties and their respective representatives in writing
of the order. Any party may appeal an order issued under this
division pursuant to division (D) of this section within fourteen
days after receipt of the order under this division.
(D) Upon the timely filing of an appeal of the order of the
district hearing officer issued under division (C) of this
section, the commission shall refer the claim file to an
appropriate staff hearing officer according to its rules adopted
under section 4121.36 of the Revised Code. The staff hearing
officer shall hold a hearing within forty-five days after the
filing of an appeal under this division and issue a decision
within seven days after holding the hearing under this division.
The staff hearing officer shall notify the parties and their
respective representatives in writing of the staff hearing
officer's order. Any party may appeal an order issued under this
division pursuant to division (E) of this section within fourteen
days after receipt of the order under this division.
(E) Upon the filing of a timely appeal of the order of the
staff hearing officer issued under division (D) of this section,
the commission or a designated staff hearing officer, on behalf of
the commission, shall determine whether the commission will hear
the appeal. If the commission or the designated staff hearing
officer decides to hear the appeal, the commission or the
designated staff hearing officer shall notify the parties and
their respective representatives in writing of the time and place
of the hearing. The commission shall hold the hearing within
forty-five days after the filing of the notice of appeal and,
within seven days after the conclusion of the hearing, the
commission shall issue its order affirming, modifying, or
reversing the order issued under division (D) of this section. The
commission shall notify the parties and their respective
representatives in writing of the order. If the commission or the
designated staff hearing officer determines not to hear the
appeal, within fourteen days after the expiration of the period in
which an appeal of the order of the staff hearing officer may be
filed as provided in division (D) of this section, the commission
or the designated staff hearing officer shall issue an order to
that effect and notify the parties and their respective
representatives in writing of that order.
Except as otherwise provided in this chapter and Chapters
4121., 4127., and 4131. of the Revised Code, any party may appeal
an order issued under this division to the court pursuant to
section 4123.512 of the Revised Code within sixty days after
receipt of the order, subject to the limitations contained in that
section.
(F) Every notice of an appeal from an order issued under
divisions (B), (C), (D), and (E) of this section shall state the
names of the claimant and employer, the number of the claim, the
date of the decision appealed from, and the fact that the
appellant appeals therefrom.
(G) All of the following apply to the proceedings under
divisions (C), (D), and (E) of this section:
(1) The parties shall proceed promptly and without
continuances except for good cause;
(2) The parties, in good faith, shall engage in the free
exchange of information relevant to the claim prior to the conduct
of a hearing according to the rules the commission adopts under
section 4121.36 of the Revised Code;
(3) The administrator is a party and may appear and
participate at all administrative proceedings on behalf of the
state insurance fund. However, in cases in which the employer is
represented, the administrator shall neither present arguments nor
introduce testimony that is cumulative to that presented or
introduced by the employer or the employer's representative. The
administrator may file an appeal under this section on behalf of
the state insurance fund; however, except in cases arising under
section 4123.343 of the Revised Code, the administrator only may
appeal questions of law or issues of fraud when the employer
appears in person or by representative.
(H) Except as provided in section 4121.63 of the Revised Code
and division (K) of this section, payments of compensation to a
claimant or on behalf of a claimant as a result of any order
issued under this chapter shall commence upon the earlier of the
following:
(1) Fourteen days after the date the administrator issues an
order under division (B) of this section, unless that order is
appealed;
(2) The date when the employer has waived the right to appeal
a decision issued under division (B) of this section;
(3) If no appeal of an order has been filed under this
section or to a court under section 4123.512 of the Revised Code,
the expiration of the time limitations for the filing of an appeal
of an order;
(4) The date of receipt by the employer of an order of a
district hearing officer, a staff hearing officer, or the
industrial commission issued under division (C), (D), or (E) of
this section.
(I) Payments Except as otherwise provided in division (B) of
section 4123.66 of the Revised Code, payments of medical benefits
payable under this chapter or Chapter 4121., 4127., or 4131. of
the Revised Code shall commence upon the earlier of the following:
(1) The date of the issuance of the staff hearing officer's
order under division (D) of this section;
(2) The date of the final administrative or judicial
determination.
(J) The administrator shall charge the compensation payments
made in accordance with division (H) of this section or medical
benefits payments made in accordance with division (I) of this
section to an employer's experience immediately after the employer
has exhausted the employer's administrative appeals as provided in
this section or has waived the employer's right to an
administrative appeal under division (B) of this section, subject
to the adjustment specified in division (H) of section 4123.512 of
the Revised Code.
(K) Upon the final administrative or judicial determination
under this section or section 4123.512 of the Revised Code of an
appeal of an order to pay compensation, if a claimant is found to
have received compensation pursuant to a prior order which is
reversed upon subsequent appeal, the claimant's employer, if a
self-insuring employer, or the bureau, shall withhold from any
amount to which the claimant becomes entitled pursuant to any
claim, past, present, or future, under Chapter 4121., 4123.,
4127., or 4131. of the Revised Code, the amount of previously paid
compensation to the claimant which, due to reversal upon appeal,
the claimant is not entitled, pursuant to the following criteria:
(1) No withholding for the first twelve weeks of temporary
total disability compensation pursuant to section 4123.56 of the
Revised Code shall be made;
(2) Forty per cent of all awards of compensation paid
pursuant to sections 4123.56 and 4123.57 of the Revised Code,
until the amount overpaid is refunded;
(3) Twenty-five per cent of any compensation paid pursuant to
section 4123.58 of the Revised Code until the amount overpaid is
refunded;
(4) If, pursuant to an appeal under section 4123.512 of the
Revised Code, the court of appeals or the supreme court reverses
the allowance of the claim, then no amount of any compensation
will be withheld.
The administrator and self-insuring employers, as
appropriate, are subject to the repayment schedule of this
division only with respect to an order to pay compensation that
was properly paid under a previous order, but which is
subsequently reversed upon an administrative or judicial appeal.
The administrator and self-insuring employers are not subject to,
but may utilize, the repayment schedule of this division, or any
other lawful means, to collect payment of compensation made to a
person who was not entitled to the compensation due to fraud as
determined by the administrator or the industrial commission.
(L) If a staff hearing officer or the commission fails to
issue a decision or the commission fails to refuse to hear an
appeal within the time periods required by this section, payments
to a claimant shall cease until the staff hearing officer or
commission issues a decision or hears the appeal, unless the
failure was due to the fault or neglect of the employer or the
employer agrees that the payments should continue for a longer
period of time.
(M) Except as otherwise provided in this section or section
4123.522 of the Revised Code, no appeal is timely filed under this
section unless the appeal is filed with the time limits set forth
in this section.
(N) No person who is not an employee of the bureau or
commission or who is not by law given access to the contents of a
claims file shall have a file in the person's possession.
(O) Upon application of a party who resides in an area in
which an emergency or disaster is declared, the industrial
commission and hearing officers of the commission may waive the
time frame within which claims and appeals of claims set forth in
this section must be filed upon a finding that the applicant was
unable to comply with a filing deadline due to an emergency or a
disaster.
As used in this division:
(1) "Emergency" means any occasion or instance for which the
governor of Ohio or the president of the United States publicly
declares an emergency and orders state or federal assistance to
save lives and protect property, the public health and safety, or
to lessen or avert the threat of a catastrophe.
(2) "Disaster" means any natural catastrophe or fire, flood,
or explosion, regardless of the cause, that causes damage of
sufficient magnitude that the governor of Ohio or the president of
the United States, through a public declaration, orders state or
federal assistance to alleviate damage, loss, hardship, or
suffering that results from the occurrence.
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
administrator of workers' compensation, 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 (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.
If an employer is a
state risk and has paid an assessment for a violation of a
specific safety requirement, and, in a final administrative or
judicial action, it is determined that the employer did not
violate the specific safety requirement, the administrator shall
reimburse the employer from the surplus fund account under
division (B) of section 4123.34 of the Revised Code for the amount
of the assessment the employer paid for the violation.
(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 July 29, 2011.
(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. 4123.54. (A) Except as otherwise provided in divisions
(I) and (K) of this section, every employee, who is injured or who
contracts an occupational disease, and the dependents of each
employee who is killed, or dies as the result of an occupational
disease contracted in the course of employment, wherever such
injury has occurred or occupational disease has been contracted,
provided the same were not:
(1) Purposely self-inflicted; or
(2) Caused by the employee being intoxicated or under the
influence of a controlled substance not prescribed by a physician
where the intoxication or being under the influence of the
controlled substance not prescribed by a physician was the
proximate cause of the injury, is entitled to receive, either
directly from the employee's self-insuring employer as provided in
section 4123.35 of the Revised Code, or from the state insurance
fund, the compensation for loss sustained on account of the
injury, occupational disease, or death, and the medical, nurse,
and hospital services and medicines, and the amount of funeral
expenses in case of death, as are provided by this chapter.
(B) For the purpose of this section, provided that an
employer has posted written notice to employees that the results
of, or the employee's refusal to submit to, any chemical test
described under this division may affect the employee's
eligibility for compensation and benefits pursuant to this chapter
and Chapter 4121. of the Revised Code, there is a rebuttable
presumption that an employee is intoxicated or under the influence
of a controlled substance not prescribed by the employee's
physician and that being intoxicated or under the influence of a
controlled substance not prescribed by the employee's physician is
the proximate cause of an injury under either of the following
conditions:
(1) When any one or more of the following is true:
(a) The employee, through a qualifying chemical test
administered within eight hours of an injury, is determined to
have an alcohol concentration level equal to or in excess of the
levels established in divisions (A)(1)(b) to (i) of section
4511.19 of the Revised Code;
(b) The employee, through a qualifying chemical test
administered within thirty-two hours of an injury, is determined
to have one of the following controlled substances not prescribed
by the employee's physician in the employee's system that tests
above the following levels in an enzyme multiplied immunoassay
technique screening test and above the levels established in
division (B)(1)(c) of this section in a gas chromatography mass
spectrometry test:
(i) For amphetamines, one thousand nanograms per milliliter
of urine;
(ii) For cannabinoids, fifty nanograms per milliliter of
urine;
(iii) For cocaine, including crack cocaine, three hundred
nanograms per milliliter of urine;
(iv) For opiates, two thousand nanograms per milliliter of
urine;
(v) For phencyclidine, twenty-five nanograms per milliliter
of urine.
(c) The employee, through a qualifying chemical test
administered within thirty-two hours of an injury, is determined
to have one of the following controlled substances not prescribed
by the employee's physician in the employee's system that tests
above the following levels by a gas chromatography mass
spectrometry test:
(i) For amphetamines, five hundred nanograms per milliliter
of urine;
(ii) For cannabinoids, fifteen nanograms per milliliter of
urine;
(iii) For cocaine, including crack cocaine, one hundred fifty
nanograms per milliliter of urine;
(iv) For opiates, two thousand nanograms per milliliter of
urine;
(v) For phencyclidine, twenty-five nanograms per milliliter
of urine.
(d) The employee, through a qualifying chemical test
administered within thirty-two hours of an injury, is determined
to have barbiturates, benzodiazepines, methadone, or propoxyphene
in the employee's system that tests above levels established by
laboratories certified by the United States department of health
and human services.
(2) When the employee refuses to submit to a requested
chemical test, on the condition that that employee is or was given
notice that the refusal to submit to any chemical test described
in division (B)(1) of this section may affect the employee's
eligibility for compensation and benefits under this chapter and
Chapter 4121. of the Revised Code.
(C)(1) For purposes of division (B) of this section, a
chemical test is a qualifying chemical test if it is administered
to an employee after an injury under at least one of the following
conditions:
(a) When the employee's employer had reasonable cause to
suspect that the employee may be intoxicated or under the
influence of a controlled substance not prescribed by the
employee's physician;
(b) At the request of a police officer pursuant to section
4511.191 of the Revised Code, and not at the request of the
employee's employer;
(c) At the request of a licensed physician who is not
employed by the employee's employer, and not at the request of the
employee's employer.
(2) As used in division (C)(1)(a) of this section,
"reasonable cause" means, but is not limited to, evidence that an
employee is or was using alcohol or a controlled substance drawn
from specific, objective facts and reasonable inferences drawn
from these facts in light of experience and training. These facts
and inferences may be based on, but are not limited to, any of the
following:
(a) Observable phenomena, such as direct observation of use,
possession, or distribution of alcohol or a controlled substance,
or of the physical symptoms of being under the influence of
alcohol or a controlled substance, such as but not limited to
slurred speech, dilated pupils, odor of alcohol or a controlled
substance, changes in affect, or dynamic mood swings;
(b) A pattern of abnormal conduct, erratic or aberrant
behavior, or deteriorating work performance such as frequent
absenteeism, excessive tardiness, or recurrent accidents, that
appears to be related to the use of alcohol or a controlled
substance, and does not appear to be attributable to other
factors;
(c) The identification of an employee as the focus of a
criminal investigation into unauthorized possession, use, or
trafficking of a controlled substance;
(d) A report of use of alcohol or a controlled substance
provided by a reliable and credible source;
(e) Repeated or flagrant violations of the safety or work
rules of the employee's employer, that are determined by the
employee's supervisor to pose a substantial risk of physical
injury or property damage and that appear to be related to the use
of alcohol or a controlled substance and that do not appear
attributable to other factors.
(D) Nothing in this section shall be construed to affect the
rights of an employer to test employees for alcohol or controlled
substance abuse.
(E) For the purpose of this section, laboratories certified
by the United States department of health and human services or
laboratories that meet or exceed the standards of that department
for laboratory certification shall be used for processing the test
results of a qualifying chemical test.
(F) The written notice required by division (B) of this
section shall be the same size or larger than the certificate
proof of
premium payment notice workers' compensation coverage
furnished by the bureau of workers' compensation and shall be
posted by the employer in the same location as the certificate
proof of
premium payment notice workers' compensation coverage or
the certificate of self-insurance.
(G) If a condition that pre-existed an injury is
substantially aggravated by the injury, and that substantial
aggravation is documented by objective diagnostic findings,
objective clinical findings, or objective test results, no
compensation or benefits are payable because of the pre-existing
condition once that condition has returned to a level that would
have existed without the injury.
(H)(1) Whenever, with respect to an employee of an employer
who is subject to and has complied with this chapter, there is
possibility of conflict with respect to the application of
workers' compensation laws because the contract of employment is
entered into and all or some portion of the work is or is to be
performed in a state or states other than Ohio, the employer and
the employee may agree to be bound by the laws of this state or by
the laws of some other state in which all or some portion of the
work of the employee is to be performed. The agreement shall be in
writing and shall be filed with the bureau of workers'
compensation within ten days after it is executed and shall remain
in force until terminated or modified by agreement of the parties
similarly filed. If the agreement is to be bound by the laws of
this state and the employer has complied with this chapter, then
the employee is entitled to compensation and benefits regardless
of where the injury occurs or the disease is contracted and the
rights of the employee and the employee's dependents under the
laws of this state are the exclusive remedy against the employer
on account of injury, disease, or death in the course of and
arising out of the employee's employment. If the agreement is to
be bound by the laws of another state and the employer has
complied with the laws of that state, the rights of the employee
and the employee's dependents under the laws of that state are the
exclusive remedy against the employer on account of injury,
disease, or death in the course of and arising out of the
employee's employment without regard to the place where the injury
was sustained or the disease contracted. If an employer and an
employee enter into an agreement under this division, the fact
that the employer and the employee entered into that agreement
shall not be construed to change the status of an employee whose
continued employment is subject to the will of the employer or the
employee, unless the agreement contains a provision that expressly
changes that status.
(2) If any employee or the employee's dependents pursue
workers' compensation benefits or recover damages from the
employer under the laws of another state, the amount awarded or
recovered, whether paid or to be paid in future installments,
shall be credited on the amount of any award of compensation or
benefits made to the employee or the employee's dependents by the
bureau. If an employee or the employee's dependents pursue or
receive an award of compensation or benefits under this chapter or
Chapter 4121., 4127., or 4131. of the Revised Code for the same
injury, occupational disease, or death for which the employee or
the employee's dependents previously pursued or otherwise elected
to accept workers' compensation benefits and received a decision
on the merits as defined in section 4123.542 of the Revised Code
under the laws of another state or recovered damages under the
laws of another state, the claim shall be disallowed and the
administrator or any
self-insuring employer, by any lawful means,
may collect
the from the employee or the employee's dependents
any of the following:
(i) The amount of compensation or benefits paid to or on
behalf of the employee or the employee's dependents by the
administrator or a self-insuring employer pursuant to this chapter
or Chapter 4121., 4127., or 4131. of the Revised Code for that
award;
(ii) Any interest, attorney's fees, and costs the
administrator or the self-insuring employer incurs in collecting
that payment.
(3) If an employee or the employee's dependents receive an
award of compensation or benefits under this chapter or Chapter
4121., 4127., or 4131. of the Revised Code and subsequently pursue
or otherwise elected to accept workers' compensation benefits or
damages under the laws of another state for the same injury,
occupational disease, or death the claim under this chapter or
Chapter 4121., 4127., or 4131. of the Revised Code shall be
disallowed. The administrator or any a self-insuring employer
also, by any lawful means, may collect from the employee or the
employee's dependents any or other-states' insurer any of the
following:
(i) The amount of compensation or benefits paid to or on
behalf of the employee or the employee's dependents by the
administrator or the self-insuring employer pursuant to this
chapter or Chapter 4121., 4127., or 4131. of the Revised Code for
that award;
(ii) Any interest, costs, and attorney's fees the
administrator or the self-insuring employer incurs in collecting
that payment
and any attorney's fees, penalties, interest,
awards, and;
(iii) Any costs incurred by an employer in contesting or
responding to any claim filed by the employee or the employee's
dependents for the same injury, occupational disease, or death
that was filed after the original claim for which the employee or
the employee's dependents received a decision on the merits as
described in section 4123.542 of the Revised Code. If
(4) If the employee's employer pays premiums into the state
insurance fund, the administrator shall not charge the amount of
compensation or benefits the administrator collects pursuant to
this division (H)(2) or (3) of this section to the employer's
experience. If the administrator collects any costs, penalties,
interest, awards, or attorney's fees incurred by a state fund an
employer in contesting or responding to any claim pursuant to
division (H)(2) or (3) of this section, the administrator shall
forward the amount of such costs, penalties, interest, awards, and
attorney's fees the administrator collects
collected to that
employer. If the employee's employer is a self-insuring employer,
the self-insuring employer shall deduct the amount of compensation
or benefits the self-insuring employer collects pursuant to this
division from the paid compensation the self-insuring employer
reports to the administrator under division (L) of section 4123.35
of the Revised Code.
(3) Except as otherwise stipulated in division (H)(4) of this
section, if (5) If an employee is a resident of a state other than
this state and is insured under the workers' compensation law or
similar laws of a state other than this state, the employee and
the employee's dependents are not entitled to receive compensation
or benefits under this chapter, on account of injury, disease, or
death arising out of or in the course of employment while
temporarily within this state, and the rights of the employee and
the employee's dependents under the laws of the other state are
the exclusive remedy against the employer on account of the
injury, disease, or death.
(4) Division (H)(3) of this section does not apply to an
employee described in that division, or the employee's dependents,
unless both of the following apply:
(a) The laws of the other state limit the ability of an
employee who is a resident of this state and is covered by this
chapter and Chapter 4123. of the Revised Code, or the employee's
dependents, to receive compensation or benefits under the other
state's workers' compensation law on account of injury, disease,
or death incurred by the employee that arises out of or in the
course of the employee's employment while temporarily within that
state in the same manner as specified in division (H)(3) of this
section for an employee who is a resident of a state other than
this state, or the employee's dependents;
(b) The laws of the other state limit the liability of the
employer of the employee who is a resident of this state and who
is described in division (H)(4)(a) of this section for that
injury, disease, or death, in the same manner specified in
division (H)(3) of this section for the employer of an employee
who is a resident of the other state.
(5)(6) An employee, or the dependent of an employee, who
elects to receive compensation and benefits under this chapter or
Chapter 4121., 4127., or 4131. of the Revised Code for a claim may
not receive compensation and benefits under the workers'
compensation laws of any state other than this state for that same
claim. For each claim submitted by or on behalf of an employee,
the administrator or, if the employee is employed by a
self-insuring employer, the self-insuring employer, shall request
the employee or the employee's dependent to sign an election that
affirms the employee's or employee's dependent's acceptance of
electing to receive compensation and benefits under this chapter
or Chapter 4121., 4127., or 4131. of the Revised Code for that
claim that also affirmatively waives and releases the employee's
or the employee's dependent's right to file for and receive
compensation and benefits under the laws of any state other than
this state for that claim. The employee or employee's dependent
shall sign the election form within twenty-eight days after the
administrator or self-insuring employer submits the request or the
administrator or self-insuring employer shall suspend dismiss that
claim until the administrator or self-insuring employer receives
the signed election form.
In the event a workers' compensation claim has been filed in
another jurisdiction on behalf of an employee or the dependents of
an employee, and the employee or dependents subsequently elect to
receive compensation, benefits, or both under this chapter or
Chapter 4121., 4127., or 4131. of the Revised Code, the employee
or dependent shall withdraw or refuse acceptance of the workers'
compensation claim filed in the other jurisdiction in order to
pursue compensation or benefits under the laws of this state. If
the employee or dependents were awarded workers' compensation
benefits or had recovered damages under the laws of the other
state, any compensation and benefits awarded under this chapter or
Chapters 4121., 4127., or 4131. of the Revised Code shall be paid
only to the extent to which those payments exceed the amounts paid
under the laws of the other state. If the employee or dependent
fails to withdraw or to refuse acceptance of the workers'
compensation claim in the other jurisdiction within twenty-eight
days after a request made by the administrator or a self-insuring
employer, the administrator or self-insuring employer shall
dismiss the employee's or employee's dependents' claim made in
this state.
(I) If an employee who is covered under the federal
"Longshore and Harbor Workers' Compensation Act," 98 Stat. 1639,
33 U.S.C. 901 et seq., is injured or contracts an occupational
disease or dies as a result of an injury or occupational disease,
and if that employee's or that employee's dependents' claim for
compensation or benefits for that injury, occupational disease, or
death is subject to the jurisdiction of that act, the employee or
the employee's dependents are not entitled to apply for and shall
not receive compensation or benefits under this chapter and
Chapter 4121. of the Revised Code. The rights of such an employee
and the employee's dependents under the federal "Longshore and
Harbor Workers' Compensation Act," 98 Stat. 1639, 33 U.S.C. 901 et
seq., are the exclusive remedy against the employer for that
injury, occupational disease, or death.
(J) Compensation or benefits are not payable to a claimant
during the period of confinement of the claimant in any state or
federal correctional institution, or in any county jail in lieu of
incarceration in a state or federal correctional institution,
whether in this or any other state for conviction of violation of
any state or federal criminal law.
(K) An employer, upon the approval of the administrator, may
provide for workers' compensation coverage for the employer's
employees who are professional athletes and coaches by submitting
to the administrator proof of coverage under a league policy
issued under the laws of another state under either of the
following circumstances:
(1) The employer administers the payroll and workers'
compensation insurance for a professional sports team subject to a
collective bargaining agreement, and the collective bargaining
agreement provides for the uniform administration of workers'
compensation benefits and compensation for professional athletes.
(2) The employer is a professional sports league, or is a
member team of a professional sports league, and all of the
following apply:
(a) The professional sports league operates as a single
entity, whereby all of the players and coaches of the sports
league are employees of the sports league and not of the
individual member teams.
(b) The professional sports league at all times maintains
workers' compensation insurance that provides coverage for the
players and coaches of the sports league.
(c) Each individual member team of the professional sports
league, pursuant to the organizational or operating documents of
the sports league, is obligated to the sports league to pay to the
sports league any workers' compensation claims that are not
covered by the workers' compensation insurance maintained by the
sports league.
If the administrator approves the employer's proof of
coverage submitted under division (K) of this section, a
professional athlete or coach who is an employee of the employer
and the dependents of the professional athlete or coach are not
entitled to apply for and shall not receive compensation or
benefits under this chapter and Chapter 4121. of the Revised Code.
The rights of such an athlete or coach and the dependents of such
an athlete or coach under the laws of the state where the policy
was issued are the exclusive remedy against the employer for the
athlete or coach if the athlete or coach suffers an injury or
contracts an occupational disease in the course of employment, or
for the dependents of the athlete or the coach if the athlete or
coach is killed as a result of an injury or dies as a result of an
occupational disease, regardless of the location where the injury
was suffered or the occupational disease was contracted.
Sec. 4123.542. An employee or the dependents of an employee
who receive a decision on the merits of a claim for compensation
or benefits under this chapter or Chapter 4121., 4127., or 4131.
of the Revised Code shall not file a claim for the same injury,
occupational disease, or death in another state under the workers'
compensation laws of that state. An Except as otherwise provided
in division (H) of section 4123.54 of the Revised Code, an
employee or the employee's dependents who receive a decision on
the merits of a claim for compensation or benefits under the
workers' compensation laws of another state shall not file a claim
for compensation and benefits under this chapter or Chapter 4121.,
4127., or 4131. of the Revised Code for the same injury,
occupational disease, or death.
As used in this section, "a decision on the merits" means a
decision determined or adjudicated for compensability of a claim
and not on jurisdictional grounds.
Sec. 4123.66. (A) In addition to the compensation provided
for in this chapter, the administrator of workers' compensation
shall disburse and pay from the state insurance fund the amounts
for medical, nurse, and hospital services and medicine as the
administrator deems proper and, in case death ensues from the
injury or occupational disease, the administrator shall disburse
and pay from the fund reasonable funeral expenses in an amount not
to exceed fifty-five hundred dollars. The bureau of workers'
compensation shall reimburse anyone, whether dependent, volunteer,
or otherwise, who pays the funeral expenses of any employee whose
death ensues from any injury or occupational disease as provided
in this section. The administrator may adopt rules, with the
advice and consent of the bureau of workers' compensation board of
directors, with respect to furnishing medical, nurse, and hospital
service and medicine to injured or disabled employees entitled
thereto, and for the payment therefor. In case an injury or
industrial accident that injures an employee also causes damage to
the employee's eyeglasses, artificial teeth or other denture, or
hearing aid, or in the event an injury or occupational disease
makes it necessary or advisable to replace, repair, or adjust the
same, the bureau shall disburse and pay a reasonable amount to
repair or replace the same.
(B) The administrator, in the rules the administrator adopts
pursuant to division (A) of this section, may adopt rules
specifying the circumstances under which the bureau may make
immediate payment for the first fill of prescription drugs for
medical conditions identified in an application for compensation
or benefits under section 4123.84 or 4123.85 of the Revised Code
that occurs prior to the date the administrator issues an initial
determination order under division (B) of section 4123.511 of the
Revised Code. If the claim is ultimately disallowed in a final
administrative or judicial order, and if the employer is a state
fund employer who pays assessments into the surplus fund account
created under section 4123.34 of the Revised Code, the payments
for medical services made pursuant to this division for the first
fill of prescription drugs shall be charged to and paid from the
surplus fund account and not charged through the state insurance
fund to the employer against whom the claim was filed.
(C)(1) If an employer or a welfare plan has provided to or on
behalf of an employee any benefits or compensation for an injury
or occupational disease and that injury or occupational disease is
determined compensable under this chapter, the employer or a
welfare plan may request that the administrator reimburse the
employer or welfare plan for the amount the employer or welfare
plan paid to or on behalf of the employee in compensation or
benefits. The administrator shall reimburse the employer or
welfare plan for the compensation and benefits paid if, at the
time the employer or welfare plan provides the benefits or
compensation to or on behalf of employee, the injury or
occupational disease had not been determined to be compensable
under this chapter and if the employee was not receiving
compensation or benefits under this chapter for that injury or
occupational disease. The administrator shall reimburse the
employer or welfare plan in the amount that the administrator
would have paid to or on behalf of the employee under this chapter
if the injury or occupational disease originally would have been
determined compensable under this chapter. If the employer is a
merit-rated employer, the administrator shall adjust the amount of
premium next due from the employer according to the amount the
administrator pays the employer. The administrator shall adopt
rules, in accordance with Chapter 119. of the Revised Code, to
implement this division.
(2) As used in this division, "welfare plan" has the same
meaning as in division (1) of 29 U.S.C.A. 1002.
Sec. 4123.82. (A) All contracts and agreements are void
which undertake to indemnify or insure an employer against loss or
liability for the payment of compensation to workers or their
dependents for death, injury, or occupational disease occasioned
in the course of the workers' employment, or which provide that
the insurer shall pay the compensation, or which indemnify the
employer against damages when the injury, disease, or death arises
from the failure to comply with any lawful requirement for the
protection of the lives, health, and safety of employees, or when
the same is occasioned by the willful act of the employer or any
of the employer's officers or agents, or by which it is agreed
that the insurer shall pay any such damages. No license or
authority to enter into any such agreements or issue any such
policies of insurance shall be granted or issued by any public
authority in this state. Any corporation organized or admitted
under the laws of this state to transact liability insurance as
defined in section 3929.01 of the Revised Code may by amendment of
its articles of incorporation or by original articles of
incorporation, provide therein for the authority and purpose to
make insurance in states, territories, districts, and counties,
other than the state of Ohio, and in the state of Ohio in respect
of contracts permitted by division (B) of this section,
indemnifying employers against loss or liability for payment of
compensation to workers and employees and their dependents for
death, injury, or occupational disease occasioned in the course of
the employment and to insure and indemnify employers against loss,
expense, and liability by risk of bodily injury or death by
accident, disability, sickness, or disease suffered by workers and
employees for which the employer may be liable or has assumed
liability.
(B) Notwithstanding division (A) of this section:
(1) No contract because of that division is void which
undertakes to indemnify a self-insuring employer against all or
part of such employer's loss in excess of at least fifty thousand
dollars from any one disaster or event arising out of the
employer's liability under this chapter, but no insurance
corporation shall, directly or indirectly, represent an employer
in the settlement, adjudication, determination, allowance, or
payment of claims. The superintendent of insurance shall enforce
this prohibition by such disciplinary orders directed against the
offending insurance corporation as the superintendent of insurance
deems appropriate in the circumstances and the administrator of
workers' compensation shall enforce this prohibition by such
disciplinary orders directed against the offending employer as the
administrator deems appropriate in the circumstances, which orders
may include revocation of the insurance corporation's right to
enter into indemnity contracts and revocation of the employer's
status as a self-insuring employer.
(2) The administrator may enter into a contract of indemnity
with any such employer upon such terms, payment of such premium,
and for such amount and form of indemnity as the administrator
determines and the bureau of workers' compensation board of
directors may procure reinsurance of the liability of the public
and private funds under this chapter, or any part of the liability
in respect of either or both of the funds, upon such terms and
premiums or other payments from the fund or funds as the
administrator deems prudent in the maintenance of a solvent fund
or funds from year to year. When making the finding of fact which
the administrator is required by section 4123.35 of the Revised
Code to make with respect to the financial ability of an employer,
no contract of indemnity, or the ability of the employer to
procure such a contract, shall be considered as increasing the
financial ability of the employer.
(C) Nothing in this section shall be construed to prohibit
the administrator or an other-states' insurer from providing to
employers in this state other-states' coverage or limited
other-states' coverage in accordance with section 4123.292 of the
Revised Code.
(D) Notwithstanding any other section of the Revised Code,
but subject to division (A) of this section, the superintendent of
insurance shall have the sole authority to regulate any insurance
products, except for the bureau of workers' compensation and those
products offered by the bureau, that indemnify or insure employers
against workers' compensation losses in this state or that are
sold to employers in this state.
Sec. 4123.83. Each employer paying premiums into the state
insurance fund or electing directly to pay compensation to the
employer's injured employees or the dependents of the employer's
killed employees as provided in section 4123.35 of the Revised
Code, shall post conspicuously in the employer's place or places
of employment notices, which shall be furnished in adequate number
at least annually by the bureau of workers' compensation at the
time of the payment of the premium, stating the fact that the
employer has made the payment, the date thereof, and period for
which the payment is made. The notice shall state that it is proof
of workers' compensation coverage, or that the employer has
complied with section 4123.35 of the Revised Code, and has been
authorized by the administrator of workers' compensation directly
to compensate employees or dependents, and the date of the
authorization. The notice shall indicate that coverage is
contingent on continued payment of premiums and assessments due.
The notice, when posted, constitutes sufficient notice to the
employer's employees of the fact that the employer has made
payment carries workers' compensation coverage or that the
employer has complied with the elective provisions of section
4123.35 of the Revised Code.
Sec. 4125.05. (A) Not later than thirty days after November
5, 2004, or not later than thirty days after the formation of a
professional employer organization, whichever date occurs later, a
professional employer organization operating in this state shall
register with the administrator of workers' compensation on forms
provided by the administrator. Following initial registration,
each professional employer organization shall register with the
administrator annually on or before the thirty-first day of
December. Commonly owned or controlled applicants may register as
a professional employer organization reporting entity or register
individually. Registration as a part of a professional employer
organization reporting entity shall not disqualify an individual
professional employer organization from participating in a
group-rated plan under division (A)(4) of section 4123.29 of the
Revised Code.
(B) Initial registration and each annual registration renewal
shall include all of the following:
(1) A list of each of the professional employer
organization's client employers current as of the date of
registration for purposes of initial registration or current as of
the date of annual registration renewal, or within fourteen days
of adding or releasing a client, that includes the client
employer's name, address, federal tax identification number, and
bureau of workers' compensation risk number;
(2) A fee as determined by the administrator;
(3) The name or names under which the professional employer
organization conducts business;
(4) The address of the professional employer organization's
principal place of business and the address of each office it
maintains in this state;
(5) The professional employer organization's taxpayer or
employer identification number;
(6) A list of each state in which the professional employer
organization has operated in the preceding five years, and the
name, corresponding with each state, under which the professional
employer organization operated in each state, including any
alternative names, names of predecessors, and if known, successor
business entities;
(7) The most recent financial statement prepared and audited
pursuant to division (B) of section 4125.051 of the Revised Code;
(8) If there is any deficit in the working capital required
under division (A) of section 4125.051 of the Revised Code, a
bond, irrevocable letter of credit, or securities with a minimum
market value in an amount sufficient to cover the deficit in
accordance with the requirements of that section;
(9) An attestation of the accuracy of the data submissions
from the chief executive officer of the professional employer
organization.
(C) Upon terms and for periods that the administrator
considers appropriate, the administrator may issue a limited
registration to a professional employer organization or
professional employer organization reporting entity that provides
all of the following items:
(1) A properly executed request for limited registration on a
form provided by the administrator;
(2) All information and materials required for registration
in divisions (B)(1) to (6) of this section;
(3) Information and documentation necessary to show that the
professional employer organization or professional employer
organization reporting entity satisfies all of the following
criteria:
(a) It is domiciled outside of this state.
(b) It is licensed or registered as a professional employer
organization in another state.
(c) It does not maintain an office in this state.
(d) It does not participate in direct solicitations for
client employers located or domiciled in this state.
(e) It has fifty or fewer shared employees employed or
domiciled in this state on any given day.
(D)(1) The administrator, with the advice and consent of the
bureau of workers' compensation board of directors, shall may
adopt rules in accordance with Chapter 119. of the Revised Code to
require, in addition to the requirement under division (B)(8) of
this section and except as otherwise specified in division (D)(2)
of this section, a professional employer organization to provide
security in the form of a bond or letter of credit assignable to
the Ohio bureau of workers' compensation not to exceed an amount
equal to the premiums and assessments incurred for the two most
recent payroll periods policy year, prior to any discounts or
dividends, to meet the financial obligations of the professional
employer organization pursuant to this chapter and Chapters 4121.
and 4123. of the Revised Code.
(2) As an alternative to providing security in the form of a
bond or letter of credit under division (D)(1) of this section,
the administrator shall permit a professional employer
organization to make periodic payments of prospective premiums and
assessments to the bureau.
(3) A professional employer organization may appeal the
amount of the security required pursuant to rules adopted under
division (D)(1) of this section in accordance with section
4123.291 of the Revised Code.
(3) A professional employer organization shall pay premiums
and assessments for purposes of Chapters 4121. and 4123. of the
Revised Code on a monthly basis pursuant to division (A) of
section 4123.35 of the Revised Code.
(E) Notwithstanding division (D) of this section, a
professional employer organization that qualifies for
self-insurance or retrospective rating under section 4123.29 or
4123.35 of the Revised Code shall abide by the financial
disclosure and security requirements pursuant to those sections
and the rules adopted under those sections in place of the
requirements specified in division (D) of this section or
specified in rules adopted pursuant to that division.
(F) Except to the extent necessary for the administrator to
administer the statutory duties of the administrator and for
employees of the state to perform their official duties, all
records, reports, client lists, and other information obtained
from a professional employer organization and professional
employer organization reporting entity under divisions (A), (B),
and (C) of this section are confidential and shall be considered
trade secrets and shall not be published or open to public
inspection.
(G) The list described in division (B)(1) of this section
shall be considered a trade secret.
(H) The administrator shall establish the fee described in
division (B)(2) of this section in an amount that does not exceed
the cost of the administration of the initial and renewal
registration process.
(I) A financial statement required under division (B)(7) of
this section for initial registration shall be the most recent
financial statement of the professional employer organization or
professional employer organization reporting entity of which the
professional employer organization is a member and shall not be
older than thirteen months. For each registration renewal, the
professional employer organization shall file the required
financial statement within one hundred eighty days after the end
of the professional employer organization's or professional
employer organization reporting entity's fiscal year. A
professional employer organization may apply to the administrator
for an extension beyond that time if the professional employer
organization provides the administrator with a letter from the
professional employer organization's auditor stating the reason
for delay and the anticipated completion date.
(J) Multiple, unrelated professional employer organizations
shall not combine together for purposes of obtaining workers'
compensation coverage or for forming any type of self-insurance
arrangement available under this chapter. Multiple, unrelated
professional employer organization reporting entities shall not
combine together for purposes of obtaining workers' compensation
coverage or for forming any type of self-insurance arrangement
available under this chapter.
(K) The administrator shall maintain a list of professional
employer organizations and professional employer organization
reporting entities registered under this section that is readily
available to the public by electronic or other means.
Sec. 4729.80. (A) If the state board of pharmacy establishes
and maintains a drug database pursuant to section 4729.75 of the
Revised Code, the board is authorized or required to provide
information from the database in accordance with the following:
(1) On receipt of a request from a designated representative
of a government entity responsible for the licensure, regulation,
or discipline of health care professionals with authority to
prescribe, administer, or dispense drugs, the board may provide to
the representative information from the database relating to the
professional who is the subject of an active investigation being
conducted by the government entity.
(2) On receipt of a request from a federal officer, or a
state or local officer of this or any other state, whose duties
include enforcing laws relating to drugs, the board shall provide
to the officer information from the database relating to the
person who is the subject of an active investigation of a drug
abuse offense, as defined in section 2925.01 of the Revised Code,
being conducted by the officer's employing government entity.
(3) Pursuant to a subpoena issued by a grand jury, the board
shall provide to the grand jury information from the database
relating to the person who is the subject of an investigation
being conducted by the grand jury.
(4) Pursuant to a subpoena, search warrant, or court order in
connection with the investigation or prosecution of a possible or
alleged criminal offense, the board shall provide information from
the database as necessary to comply with the subpoena, search
warrant, or court order.
(5) On receipt of a request from a prescriber or the
prescriber's delegate approved by the board, the board may shall
provide to the prescriber information from the database relating
to a patient who is either of the following, if the prescriber
certifies in a form specified by the board that it is for the
purpose of providing medical treatment to the patient who is the
subject of the request:
(a) A current patient of the prescriber;
(b) A potential patient of the prescriber based on a referral
of the patient to the prescriber.
(6) On receipt of a request from a pharmacist or the
pharmacist's delegate approved by the board, the board may shall
provide to the pharmacist information from the database relating
to a current patient of the pharmacist, if the pharmacist
certifies in a form specified by the board that it is for the
purpose of the pharmacist's practice of pharmacy involving the
patient who is the subject of the request.
(7) On receipt of a request from an individual seeking the
individual's own database information in accordance with the
procedure established in rules adopted under section 4729.84 of
the Revised Code, the board may provide to the individual the
individual's own database information.
(8) On receipt of a request from the medical director of a
managed care organization that has entered into a data security
agreement with the board required by section 5167.14 of the
Revised Code, the board shall provide to the medical director
information from the database relating to a medicaid recipient
enrolled in the managed care organization, including information
in the database related to prescriptions for the recipient that
were not covered or reimbursed under a program administered by the
department of medicaid.
(9) On receipt of a request from the medicaid director, the
board shall provide to the director information from the database
relating to a recipient of a program administered by the
department of medicaid, including information in the database
related to prescriptions for the recipient that were not covered
or paid by a program administered by the department.
(10) Except as otherwise provided in division (E) or (F) of
this section, on receipt of a request from the medical director of
a managed care organization, the board shall provide to the
medical director information from the database relating to a
claimant under Chapter 4121., 4123., 4127., or 4131. of the
Revised Code assigned to the managed care organization, including
information in the database related to prescriptions for the
claimant that were not covered or reimbursed under those chapters,
if both of the following apply:
(a) The managed care organization has entered into a contract
with the administrator of workers' compensation under division
(B)(4) of section 4121.44 of the Revised Code;
(b) The managed care organization has entered into a data
security agreement with the board as required by section 4121.447
of the Revised Code.
(11) On receipt of a request from the administrator of
workers' compensation, the board may shall provide to the
administrator information from the database relating to a claimant
under Chapter 4121., 4123., 4127., or 4131. of the Revised Code,
including information in the database related to prescriptions for
the claimant that were not covered or reimbursed under Chapter
4121., 4123., 4127., or 4131. of the Revised Code.
(11)(12) On receipt of a request from a requestor described
in division (A)(1), (2), (5), or (6) of this section who is from
or participating with another state's prescription monitoring
program, the board may provide to the requestor information from
the database, but only if there is a written agreement under which
the information is to be used and disseminated according to the
laws of this state.
(B) The state board of pharmacy shall maintain a record of
each individual or entity that requests information from the
database pursuant to this section. In accordance with rules
adopted under section 4729.84 of the Revised Code, the board may
use the records to document and report statistics and law
enforcement outcomes.
The board may provide records of an individual's requests for
database information to the following:
(1) A designated representative of a government entity that
is responsible for the licensure, regulation, or discipline of
health care professionals with authority to prescribe, administer,
or dispense drugs who is involved in an active investigation being
conducted by the government entity of the individual who submitted
the requests for database information;
(2) A federal officer, or a state or local officer of this or
any other state, whose duties include enforcing laws relating to
drugs and who is involved in an active investigation being
conducted by the officer's employing government entity of the
individual who submitted the requests for database information.
(C) Information contained in the database and any information
obtained from it is not a public record. Information contained in
the records of requests for information from the database is not a
public record. Information that does not identify a person may be
released in summary, statistical, or aggregate form.
(D) A pharmacist or prescriber shall not be held liable in
damages to any person in any civil action for injury, death, or
loss to person or property on the basis that the pharmacist or
prescriber did or did not seek or obtain information from the
database.
(E) The administrator, upon request of the board, shall
review at least quarterly a list of the individuals about whom
information was requested by a medical director of a managed care
organization and confirm that the individuals are assigned to the
managed care organization. The board may prohibit a medical
director of a managed care organization from obtaining further
information from the drug database if the administrator fails to
review and confirm the list.
(F) The board, after notice and hearing in accordance with
Chapter 119. of the Revised Code, may prohibit a medical director
of a managed care organization from obtaining further information
from the drug database or may impose a monetary penalty of not
more than five thousand dollars, for requesting information on
individuals pursuant to division (A)(10) of this section who were
not assigned to the managed care organization.
Sec. 4729.86. If the state board of pharmacy establishes and
maintains a drug database pursuant to section 4729.75 of the
Revised Code, all of the following apply:
(A)(1) No person identified in divisions (A)(1) to (10)(11)
or (B) of section 4729.80 of the Revised Code shall disseminate
any written or electronic information the person receives from the
drug database or otherwise provide another person access to the
information that the person receives from the database, except as
follows:
(a) When necessary in the investigation or prosecution of a
possible or alleged criminal offense;
(b) When a person provides the information to the prescriber
or pharmacist for whom the person is approved by the board to
serve as a delegate of the prescriber or pharmacist for purposes
of requesting and receiving information from the drug database
under division (A)(5) or (6) of section 4729.80 of the Revised
Code;
(c) When a prescriber or pharmacist provides the information
to a person who is approved by the board to serve as such a
delegate of the prescriber or pharmacist.
(2) No person shall provide false information to the state
board of pharmacy with the intent to obtain or alter information
contained in the drug database.
(3) No person shall obtain drug database information by any
means except as provided under section 4729.80 or 4729.81 of the
Revised Code.
(B) A person shall not use information obtained pursuant to
division (A) of section 4729.80 of the Revised Code as evidence in
any civil or administrative proceeding.
(C)(1) The board may restrict a person from obtaining further
information from the drug database if any of the following is the
case:
(a) The person violates division (A)(1), (2), or (3) of this
section;
(b) The person is a requestor identified in division
(A)(11)(12) of section 4729.80 of the Revised Code and the board
determines that the person's actions in another state would have
constituted a violation of division (A)(1), (2), or (3) of this
section;
(c) The person fails to comply with division (B) of this
section, regardless of the jurisdiction in which the failure to
comply occurred.
(2) The board shall determine the extent to which the person
is restricted from obtaining further information from the
database.
Section 2. That existing sections 1561.31, 2305.25,
2305.252, 4121.129, 4121.45, 4123.01, 4123.26, 4123.27, 4123.29,
4123.291, 4123.292, 4123.32, 4123.322, 4123.34, 4123.35, 4123.353,
4123.36, 4123.37, 4123.40, 4123.41, 4123.411, 4123.47, 4123.511,
4123.512, 4123.54, 4123.542, 4123.66, 4123.82, 4123.83, 4125.05,
4729.80, and 4729.86 and section 4121.419 of the Revised Code are
hereby repealed.
Section 3. That Section 1 of Sub. H.B. 34 of the 130th
General Assembly, as amended by Am. Sub. H.B. 59 of the 130th
General Assembly, be amended to read as follows:
Sec. 1. All items in this section 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 2014, and those in the second
column are for fiscal year 2015.
FND |
AI |
|
AI TITLE |
|
|
|
Appropriations
| |
|
BWC BUREAU OF WORKERS' COMPENSATION
Workers' Compensation Fund Group
7023 |
855401 |
|
William Green Lease Payments to OBA |
|
$ |
16,026,100 |
|
$ |
0 |
|
|
7023 |
855407 |
|
Claims, Risk and Medical Management |
|
$ |
118,338,586 |
|
$ |
118,338,586 |
|
|
7023 |
855408 |
|
Fraud Prevention |
|
$ |
12,114,226 |
|
$ |
12,114,226 |
|
|
7023 |
855409 |
|
Administrative Services |
|
$ |
105,857,276 |
|
$ |
105,357,276 |
|
|
7023 |
855410 |
|
Attorney General Payments |
|
$ |
4,621,850 |
|
$ |
4,621,850 |
|
|
8220 |
855606 |
|
Coal Workers' Fund |
|
$ |
147,666 |
|
$ |
147,666 |
|
|
8230 |
855608 |
|
Marine Industry |
|
$ |
75,527 |
|
$ |
75,527 |
|
|
8250 |
855605 |
|
Disabled Workers Relief Fund |
|
$ |
319,718 |
|
$ |
319,718 |
|
|
8260 |
855609 |
|
Safety and Hygiene Operating |
|
$ |
21,661,132 |
|
$ |
21,661,132 |
|
|
8260 |
855610 |
|
Safety Grants |
|
$ |
15,000,000 |
|
$ |
15,000,000 |
|
|
8290 |
855604 |
|
Long Term Care Loan Program |
|
$ |
100,000 |
|
$ |
100,000 |
|
|
TOTAL WCF Workers' Compensation
| |
|
|
|
|
|
|
|
Fund Group
| |
$ |
294,262,081 |
|
$ |
277,735,981 |
|
|
Federal Special Revenue Fund Group
3490 |
855601 |
|
OSHA Enforcement |
|
$ |
1,731,000 |
|
$ |
1,731,000 |
|
|
3FW0 |
855614 |
|
BLS SOII Grant |
|
$ |
116,919 |
|
$ |
116,919 |
|
|
TOTAL FED Federal Special Revenue Fund Group
| |
$ |
1,847,919 |
|
$ |
1,847,919 |
|
|
TOTAL ALL BUDGET FUND GROUPS
| |
$ |
296,110,000 |
|
$ |
279,583,900 |
|
|
WILLIAM GREEN LEASE PAYMENTS
Of the foregoing appropriation item 855401, William Green
Lease Payments, up to $16,026,100 shall be used to make lease
payments to the Treasurer of State at the times they are required
to be made during the period from July 1, 2013 to June 30, 2015,
pursuant to leases and agreements made under section 154.24 of the
Revised Code. If it is determined that additional appropriations
are necessary for such purpose, such amounts are hereby
appropriated.
WORKERS' COMPENSATION FRAUD UNIT
Of the foregoing appropriation item 855410, Attorney General
Payments, $828,200 in each fiscal year shall be used to fund the
expenses of the Workers' Compensation Fraud Unit within the
Attorney General's Office. These payments shall be processed at
the beginning of each quarter of each fiscal year and deposited
into the Workers' Compensation Section Fund (Fund 1950) used by
the Attorney General.
Notwithstanding section 4121.37 of the Revised Code, the
Treasurer of State shall transfer $21,661,132 cash in fiscal year
2014 and $21,661,132 cash in fiscal year 2015 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 Opportunities for
Ohioans with Disabilities Agency shall enter into an interagency
agreement for the provision of vocational rehabilitation services
and staff to mutually eligible clients. The bureau may provide not
more than $605,407 in fiscal year 2014 and not more than $605,407
in fiscal year 2015 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 4. That Section 1 of Sub. H.B. 34 of the 130th
General Assembly, as amended by Am. Sub. H.B. 59 of the 130th
General Assembly, is hereby repealed.
Section 5. The amendments to section 4125.05 of the Revised
Code by Section 1 of this act take effect July 1, 2015.
Section 6. The amendments made by Section 1 of this act to
sections 4123.01, 4123.26, 4123.29, 4123.292, 4123.54, and 4123.82
of the Revised Code apply to claims that arise on or after the
effective date of those amendments.
Section 7. This act applies to an appeal filed pursuant to
section 4123.512 of the Revised Code, as amended by this act, on
or after the effective date of this act.
Section 8. The items of law contained in this act, and their
applications, are severable. If any item of law contained in this
act, or if any application of any item of law contained in this
act, is held invalid, the invalidity does not affect other items
of law contained in this act and their applications that can be
given effect without the invalid item of law or application.
Section 9. Section 4123.26 of the Revised Code is presented
in this act as a composite of the section as amended by both Am.
Sub. H.B. 562 and Am. Sub. S.B. 334 of the 127th General Assembly.
The General Assembly, applying the principle stated in division
(B) of section 1.52 of the Revised Code that amendments are to be
harmonized if reasonably capable of simultaneous operation, finds
that the composite is the resulting version of the section in
effect prior to the effective date of the section as presented in
this act.
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