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Policy and Procedure Name:
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Disability Relief
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Policy #:
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CP-08-01
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Code/Rule Reference:
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R.C.
4123.343, R.C. 4123.63;
O.A.C.
4123-3-35
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Industrial Commission (IC) Resolution/Memo
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N/A
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Effective Date:
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02/26/24
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Approved:
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Shawn Crosby, Chief Operating Officer
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Origin:
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Claims Policy
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Supersedes:
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Policy # CP-08-01, effective 02/16/22
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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
Employee With A Disability
IV. POLICY
A. Disability
Relief and Qualifying Pre-Existing Conditions
B. Employer
and Claim Eligibility
C. Application
D. IW
Rights
E. Employer
Rights
V. PROCEDURE
A. General Claim Note and Documentation
Requirements
B. Disability Relief Application Processing
The purpose of this policy is to ensure BWC reduces costs to
an employer’s risk by charging a percentage of the qualifying claim’s costs to
the statutory surplus fund instead of to the employer’s experience when an
employer hires and retains employees with a qualifying pre-existing condition,
disease, or military service disability.
This policy applies to BWC Claims
Services, Legal, and Employer Services staff.
Employee With A Disability: For the purpose of this policy, an employee who has a pre-existing
physical or mental impairment, or both, whether congenital or due to an injury
or disease, such that the impairment constitutes a disability that interferes
with obtaining employment or reemployment and whose disability is due to any of
the diseases or conditions listed in IV.A.2.a-z of this policy.
1. When
an employee with a qualifying pre-existing condition, as defined in R.C.
4123.343 or R.C. 4123.63, is injured, disabled, or dies as a result of an
injury or occupational disease sustained in the course of, or arising out of,
their employment and the employer believes that the pre-existing condition
delayed recovery or increased the costs of the claim, the employer may file an
application with BWC to have a percentage of a qualifying claim’s costs charged
to the surplus fund instead of to the employer’s experience.
2. It
is the policy of BWC to consider disability relief for an employer when an
injured worker (IW) has any of the following qualifying pre-existing conditions:
a. Epilepsy;
b. Diabetes;
c. Cardiac
disease;
d. Arthritis;
e. Amputated
foot, leg, arm or hand;
f.
Loss of sight of one or both eyes or partial loss of uncorrected vision
of more than 75% bilaterally;
g. Residual
disability from poliomyelitis;
h. Cerebral
palsy;
i.
Multiple sclerosis;
j.
Parkinson’s disease;
k. Cerebral
vascular accident (stroke);
l.
Tuberculosis;
m. Silicosis;
n. Psycho-neurotic
disability following treatment in a recognized medical or mental institution;
o. Hemophilia;
p. Chronic
osteomyelitis;
q. Ankylosis
of joints;
r. Hyperinsulinism;
s. Muscular
dystrophies;
t.
Arteriosclerosis;
u. Thrombophlebitis;
v. Varicose
veins;
w. Cardiovascular
pulmonary or respiratory diseases of firefighters or police officers employed
by a municipal corporation or township as a regular member of a lawfully
constituted police or fire department;
x. Coal
miner’s pneumoconiosis (black lung disease);
y. Disability
with respect to an individual who has completed a rehabilitation program
conducted pursuant to sections R.C. 4121.61 through R.C. 4129.69; or
z. Another
qualifying preexisting injury pursuant to 4123.63.
3. A
disability relief award is not evidence to support a substantial aggravation of
that qualifying condition.
1. Employers
that are eligible for disability relief include:
a. Public
employer taxing districts;
b. Private
state-fund employers;
c. Any
employer who has been granted a previous disability relief; or
d. Certain
bankrupt employers as determined on a case-by-case basis.
2. Employers
that are ineligible for disability relief include:
a. Non-complying
and/or out-of-business employers;
b. Self-insuring
employers; or
c. State
agencies and universities.
3. BWC
will only consider an application for disability relief in claims where the IW
has received:
a. Temporary
total (TT) disability (or wages in lieu of TT);
b. Permanent
total disability;
c. Scheduled
loss/loss of use, facial disfigurement, or accrued benefits paid under
4123.57(B); or
d. Death
benefits.
1. Eligible
employers or employer representatives must file an Application for Disability
Relief (CHP-4A) form.
2. The
CHP-4A must be filed:
a. With
supporting medical evidence; and
b. While
the claim is within the employer’s experience, as follows:
i.
For private state-fund employer claims,
the CHP-4A must be filed by June 30th of the year:
a) No
more than six years from the year of the date of injury or occupational disease
if the date of injury (DOI) is between January 1st and June 30th.
b) No more
than seven years from the year of the DOI or occupational disease if the
DOI is between July 1st and December 31st.
ii.
For public employer taxing
district claims, the CHP-4A must be filed by December 31st of
the year no more than six years from the year of the DOI or occupational
disease.
iii.
For a claim involving a private state
fund employer or a public employer taxing district employer participating in a
retrospective rating plan, the application must be filed within the time
provided immediately above in Sections IV.C.2.b.i and ii, as applicable.
1. An
employer's application for disability relief does not affect the rights of the
IW to receive any benefits or compensation.
2. The IW
is not required to provide information to an employer about any pre-existing
conditions.
1. Upon
filing the CHP-4A, the employer has the right to an informal conference with
BWC. Informal conferences may be in person, by phone, or via any other
remote technology as circumstances dictate, or as agreed by the parties.
2. The
employer may request withdrawal of the application at any time, either in
writing or verbally.
3. Settlement
of a claim does not affect the employer’s right to have a disability relief
application considered.
4. Pursuant
to R.C. 4123.511, the employer may appeal a BWC Order on disability relief to
the Ohio Industrial Commission (IC).
1. BWC
staff will refer to the Standard
Claim File Documentation and Altered Documents policy and procedure for
claim note and documentation requirements; and
2. Must
follow any other specific instructions for claim notes and documentation
included in this procedure.
1. If a
CHP-4A is not directly filed with BWC’s Legal Division, any BWC staff who
receives a CHP-4A must immediately, without imaging the document(s) into the
claim, date stamp and forward the CHP-4A with supporting documentation to:
BWC Legal Division
Disability Relief
Unit, L-26
30 W. Spring Street
Columbus, Ohio 43215-2256
2.
Application Review
a.
Legal staff will complete an initial
review of the CHP-4A and supporting evidence to ensure:
i.
The employer is eligible to receive
relief, as described in Section IV.B of this policy;
ii.
The application is filed while the
claim is within the employer’s experience;
iii.
The employer had coverage on the DOI;
b. That BWC has awarded compensation to the IW for:
i.
TT disability (or wages in lieu
of TT);
ii.
Scheduled loss/loss of use, facial disfigurement, or accrued
benefits paid under 4123.57(B);
iii.
Permanent total disability; or
iv.
Death benefits.
c.
The employer has supplied medical
evidence that:
i.
The employee suffered from a qualifying pre-existing condition listed in
Section IV.A.2.a-z of this policy;
ii. The
condition pre-existed the injury, occupational disease, or death (e.g.,
evidence that the employee was hospitalized or obtained extensive medical
treatment for the qualifying pre-existing condition);
iii. Supports the
allegation that:
a) The
injury, occupational disease, or death would not have occurred but for the employee’s
qualifying pre-existing condition; or
b) The
injury, occupational disease, or death was caused, in part, through aggravation
of the qualifying pre-existing condition; or
c) The qualifying
pre-existing condition delayed recovery or increased the cost of treating the
allowed conditions in the claim.
d. Legal
staff will review each claim for:
i.
Pending BWC or IC applications;
ii. Previous
award denied or granted by the IC or BWC for the same disability;
iii. Motions or
appeals; and
iv. If
applicable, other related claims.
e.
Legal staff will deny or dismiss a
CHP-4A for an allowed claim not meeting eligibility criteria outlined in this
policy.
f.
If the IW files for an additional
condition in the claim being reviewed, Legal staff will continue to process the
CHP-4A. The filing of an additional condition does not stay the request for
disability relief.
3.
Disability Relief Conference
a.
Legal staff will schedule an informal
determination conference and serve notice of the upcoming conference
electronically or by mail to the employer and the employer representative, if
applicable, giving a minimum of two weeks notification, unless the employer
waives this requirement.
b.
The BWC legal representative assigned
to hold the conference and the employer and/or the employer representative will
meet in a manner that is mutually agreed upon by all parties to discuss the
merits of the application.
i.
If all parties reach agreement at the
time of the meeting, the employer or the employer representative may sign
a Waiver of Appeal Period (C-108) to have the
order processed immediately.
ii.
If the parties do not reach agreement,
BWC may not process the order until after the 14-day appeal period expires.
4.
Determination
a.
Legal Staff Responsibilities
i.
Once legal staff has made a
determination on the disability relief, legal staff will issue an order.
ii.
Legal staff must send a copy of the
order to:
a)
The employer;
b)
The employer’s representative; and
c)
The risk file.
iii.
The disability relief application
packet and order are automatically imaged into the claims management system,
initiating a work item for claims services staff.
b.
Claims services staff will enter the
disability percentage and the condition for which the disability percentage was
awarded in the relevant fields found under the Claim
Details>Occurrence>Profiles tab as follows:
i.
After the IC order is final, if an
appeal is filed;
ii.
At the conclusion of the appeal period,
if no appeal is filed; or
iii.
Immediately, upon receipt of a waiver
of the appeal period.