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
C. NOR
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, they are 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 Motion (C-86) with supporting medical evidence.
2.
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.
They
have contracted in the course of employment one of the occupational
diseases identified in section IV. A.2.a. and b.;
and
b. They have been
medically advised that a change of occupation is recommended to substantially
decrease further exposure; and
c.
They
have 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 30 weeks of compensation if they discontinue 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 100 weeks immediately following the
expiration of the first 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 75 weeks immediately following the expiration of the first 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 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, Appeals and Hearings policy and procedure for additional
information.
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.
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 30 weeks after the date the employee
discontinues or changes the former job (initiating as of the date of the
discontinuance or change) at 50% of the statewide average weekly wage (SAWW) as
of the date of occurrence (DOO) per week.
3.
Claims
services staff shall pay at 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 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.
The
manually calculated rate in the Override Weekly Benefit Rate along with a comment.
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.