Policy and Procedure Name:
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CHANGE OF OCCUPATION
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Policy #:
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CP-03-02
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Code/Rule Reference:
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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
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Effective Date:
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09/30/20
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Approved:
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Ann Shannon, Chief of Claims Policy and Support
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Origin:
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Claims Policy
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Supersedes:
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Policy # CP-03-02, effective 05/24/17 and Procedure # CP-03-02.PR1,
effective 05/24/17
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History:
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Previous versions of this policy are available upon
request
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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
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.
This policy applies to Claims Services staff.
None
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.
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.
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.
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.
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.