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OhioBWC - Basics: (Policy library) - File

Policy Name:

Due Process

Policy #:

CP-04-06

Code/Rule Reference:

The Fifth Amendment to the U.S. Constitution; the Ohio Constitution, Article I, Section 16.

Effective Date:

08/08/16

Approved:

Rick Percy, Chief of Operational Policy, Analytics, and Compliance (Signature on file)

Origin:

Claims Policy

Supersedes:

Policy #CP-04-06, effective 08/06/2013

History:

New 08/06/2013

 

 

 

I.   POLICY PURPOSE

 

The purpose of this policy is to ensure BWC staff are aware of the legal principle and expectations of due process in workers’ compensation claims.

 

II. APPLICABILITY

 

This policy applies to BWC staff and managed care organization (MCO) staff.

 

III. DEFINITIONS

 

Due Process: The legal principle that government may not deprive an individual of life, liberty or protected property rights without providing:

·         Notice; and

·         An opportunity to be heard.

 

Notice: A legal concept describing the requirement that government makes a party aware of a legal process affecting their rights, obligations or duties.

 

Opportunity to Be Heard: A legal concept describing the requirement that government affords a party the chance to present the party’s views or objections.

 

Parties to the Claim: For purposes of this policy, the injured worker and employer. BWC is also a party to the claim if the claim is appealed to the Industrial Commission or court.

 

IV. POLICY

 

A.    It is the policy of BWC to ensure that a party is afforded appropriate due process when BWC (or a managed care organization, on behalf of BWC) is taking action in a claim that affects the rights, obligations or duties of the party. 

 

B.    The type of due process afforded to a party depends on the impact to the party’s protected rights. Providing due process may include:

1.    BWC calling or sending a letter to the parties advising the parties of a request for action in a claim;

2.    BWC advising the parties of the opportunity to provide additional information or evidence to be considered when BWC is taking action in a claim; or

3.    BWC issuing an order to the parties, advising the parties of the right to appeal.

 

C.   The type of due process BWC provides is addressed in the specific subject-matter policies and procedures. These steps may not be expressly identified as “due process” but are provided to achieve the “notice” and “opportunity to be heard” requirements.

 

D.   Miscellaneous issues related to due process:

 

1.    If the last day for response to a notice falls on a weekend, a legal holiday, a day in which BWC is closed or a day in which BWC closes before its usual closing time, the last day for response shall be the next business day.

2.    Due process is not required and will not be provided for employers that are out of business or no longer doing business in Ohio. However, the employer may specifically request continued notice or may retain an authorized representative to oversee the employer’s claims.

 


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