OhioBWC - Basics: (Policy library) - File

Change of Occupation

Policy and Procedure Name:

CHANGE OF OCCUPATION

Policy #:

CP-03-02

Code/Rule Reference:

R.C. 4123.57 (D) and (E); 4123.68 (W) (Y) (Z) and (BB)

O.A.C. 4123-3-25; 4121-3-25; and 4123-3-16

Effective Date:

09/30/20

Approved:

Ann Shannon, Chief of Claims Policy and Support

Origin:

Claims Policy

Supersedes:

Policy # CP-03-02, effective 05/24/17 and Procedure # CP-03-02.PR1, effective 05/24/17

History:

Previous versions of this policy are available upon request


 

Table of Contents

 

I. POLICY PURPOSE

II. APPLICABILITY

III. DEFINITIONS

None

IV. POLICY

A.          General Policy Statement

B.          Eligibility for Change of Occupation

C.         Payment for a Change of Occupation Award

V. PROCEDURE

A.          General Claim Note and Documentation Requirements

B.          Processing a Change of Occupation Request

D.         How to Pay a Change of Occupation Award

E.          Change of Occupation and Other Types of Compensation

 

 


 

I. POLICY PURPOSE

 

The purpose of this policy is to ensure that BWC allows a change of occupation award to an injured worker who is entitled to the award by statute.

 

II. APPLICABILITY

 

This policy applies to Claims Services staff.

 

III. DEFINITIONS

 

None

 

IV. POLICY

 

A.     General Policy Statement

1.     It is the policy of BWC to make an appropriate determination on a change of occupation award for the purpose of substantially reducing an injured worker’s exposure to a harmful agent.  This includes when an injured worker:

a.     Has contracted, in the course of employment, silicosis, coal miners’ pneumoconiosis, or asbestosis. The award is payable up to a maximum of 130 weeks.

b.     Has any dust-induced occupational diseases.  The award is payable up to a maximum of 130 weeks.

c.      Specific to firefighters or police officers, have contracted, in the course of employment, cardiovascular, pulmonary, or respiratory disease. The award is payable up to a maximum of 105 weeks.

2.     It is the policy of BWC that a change of occupation is only payable:

a.     When a fire fighter (paid or volunteer) or a police officer have contracted any of the following conditions:

i.       Cardiovascular;

ii.      Pulmonary; or

iii.     Respiratory, in the course of employment.

b.     When an injured worker, other than a fire fighter or police officer, has contracted any of the following conditions in the course of employment:

i.       Silicosis;

ii.      Coal miners’ pneumoconiosis (black lung);

iii.     Asbestosis; or

iv.    Any dust-induced occupational disease.

3.     It is the policy of BWC that if an injured worker has received a change of occupation award or has one of the occupational diseases in section IV. A. 2. a. and b., that any requests for compensation, except for temporary total compensation, permanent total compensation and death, shall be referred to the Ohio Industrial Commission (IC).

4.     It is the policy of BWC to not pay a change of occupation award concurrently with:

a.     Temporary Total Disability; or

b.     Permanent Total Disability.

5.     If the injured worker has multiple allowed claims, he or she is entitled to only one change of occupation award.

6.     If the exposure occurred before January 1, 1967, only the change of occupation award may be paid to the injured worker.  No other types of compensation are payable.

 

B.     Eligibility for Change of Occupation

1.     A request for change of occupation award must be filed on a C-86 Motion with supporting medical evidence.

2.     In order to qualify for the award and permit BWC to pay the change of occupation award, the injured worker shall establish by appropriate evidence that:

a.     He or she has contracted in the course of employment one of the occupational diseases identified in section IV. A. 2. a. and b.; and

b.     He or she has been medically advised that a change of occupation is recommended to substantially decrease further exposure; and

c.      He or she has changed or shall change occupations to one in which the exposure is substantially decreased.

3.     It is the policy of BWC, that this award may be made to an injured worker who continues to work for the same employer as long as the job change substantially decreases the injured worker’s exposure to the harmful agent.

 

C.    Payment for a Change of Occupation Award

1.     It is the policy of BWC to pay a change of occupation award to an injured worker meeting the eligibility requirements listed in section IV. B. of this policy.

2.     It is the policy of BWC, that an injured worker who has established eligibility is entitled for the first thirty (30) weeks of compensation if he or she discontinues current employment or changes employment to a job in which the exposure is substantially reduced.  For subsequent weeks:

a.     An injured worker who has contracted, in the course of employment, silicosis, coal miners’ pneumoconiosis, asbestosis, or any dust-induced occupational disease is only eligible to receive an additional hundred (100) weeks immediately following the expiration of the first thirty (30) weeks.

b.     A firefighter or police officer who has contracted, in the course of employment, cardiovascular, pulmonary, or respiratory disease is only eligible to receive an additional seventy-five (75) weeks immediately following the expiration of the first thirty (30) weeks.

c.      In both instances listed above (i.e., IV. C. 2. a. and b.), the injured worker must submit evidence to BWC on a:

i.       Wage statement that documents the change of employment and loss of wages; or

ii.      Wage loss statement for job search documenting reasonable attempts to secure employment.

3.     BWC staff shall refer to section V. D. of the procedures for details on paying a change of occupation award to eligible injured workers.

 

V. PROCEDURE

 

A.     General Claim Note and Documentation Requirements

1.     BWC staff shall refer to the Standard Claim File Documentation and Altered Documents policy and procedure for claim note and documentation requirements; and

2.     Shall follow any other specific instructions for claim notes and documentation included in this procedure.

 

B.     Processing a Change of Occupation Request

1.     Claims services staff shall:

a.     Receive a request on a Motion (C-86), and

b.     Review supporting documentation to determine if the injured worker has established eligibility as outlined in the policy.

2.     Claims services staff shall issue a decision in one of two methods:

a.     BWC Subsequent order, or

b.     Notice of Referral (NOR) to the IC.

3.     The BWC Subsequent order shall contain:

a.     A starting date of the award (date injured worker quit/changed employment); and

b.     Include the ending date, if award is only for the first 30 weeks; and

c.      An explanation of the evidence on which the award was based in the add text box.

4.     Claims services staff shall refer to the Orders, Waivers, Hearings and Appeals policy and procedure for additional information.

C.    NOR 

1.     Claims services staff shall send a NOR to the IC when the evidence does not support the payment of the award as requested

2.     The NOR shall contain BWC’s recommendation and reason for the objection to the payment of the award as requested.

3.     Claims services staff shall refer to the Notice of Referral to the Industrial Commission policy and procedure for additional information.

D.    How to Pay a Change of Occupation Award

1.     Claims services staff shall refer to the Wages policy and procedure for additional information, if wages need to be established in the claim.

2.     Claims services staff shall pay the first thirty (30) weeks after the date the employee discontinues or changes the former job (initiating as of the date of the discontinuance or change) at fifty percent (50%) of the statewide average weekly wage (SAWW) as of the date of occurance (DOO) per week.

3.   Claims services staff shall pay at sixty-six and two-thirds percent (66 2/3%) of the wage loss resulting directly from the change of occupation, for the additional number of weeks as outlined in the policy. This amount cannot be greater than one half (50%) of the SAWW as of the DOO.

a.   Claims services staff shall select the following in the claim:

i.    Indemnity Payments;

ii.   Click add; and

iii.   Select Benefit Type of Change of Occupation.

b.   Claims services staff shall enter the following in the claim:

i.    The start date and number of weeks; and

ii.   Manually calculated rate in the Override Weekly Benefit Rate along with a Comment.

 

E.     Change of Occupation and Other Types of Compensation

1.   Claims services staff shall only pay a change of occupation award to eligible injured workers, identified in section IV. A. 2. a. and b.

2.   Claims services staff shall send a NOR to the IC for a request for compensation, except for temporary total disability, permanent total disability and death, if an injured worker has received a change of occupation award or has one of the occupational diseases outlined in section IV. A. 1. and 2.