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OhioBWC - Basics: (Policy library) - File

Policy Name:

Interstate Jurisdiction

Policy #:

CP-09-07

Code/Rule Reference:

R.C. 4123.54; O.A.C 4123-17-23

Effective Date:

11/14/2016

Approved:

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

Origin:

Claims Policy

Supersedes:

Policy #CP-09-07, effective 09/17/14

History:

New 09/17/14

Review date:

11/14/2019

 

 

I.       POLICY PURPOSE

 

The purpose of this policy is to ensure when employment activities involve multiple states, Ohio Bureau of Workers’ Compensation (BWC) staff recognize, effectively investigate and accurately determine the application of Ohio workers’ compensation coverage.

 

II.      APPLICABILITY

 

This policy applies to Field Operations staff.

 

III.     DEFINITIONS

 

Claimant: One who asserts a right, demand or claim for workers’ compensation benefits; for purposes of this policy, typically the injured worker (IW) or a dependent of a deceased IW.

 

Decision on the Merits: A decision from an administrative or judicial body or an insurance carrier determining the compensability of a workers’ compensation claim for reasons other than jurisdiction.

 

Extraterritorial Coverage (also referred to as “Extraterritorial Jurisdiction”): Workers’ compensation coverage for an Ohio employee who is injured while temporarily performing duties outside the state, or the recognition of another state’s coverage for a non-Ohio employee temporarily working in Ohio.

 

Interstate Jurisdiction: Determination of which state bears legal responsibility and authority for a claim when employment activities occur in multiple states

 

Jurisdiction: The legal responsibility and authority to make a decision in a claim; for purposes of this policy, the determination of whether the claimant is an Ohio employee.

 

Ohio Employee: An employee who is covered by Ohio workers’ compensation due to the employer’s responsibility to report payroll for that employee pursuant to O.A.C. 4123-17-23(A), (C), or (D).

 

IV.    POLICY

 

A.    It is the policy of BWC that Ohio workers’ compensation coverage applies to an employee who is:

1.    Hired to work specifically in Ohio, regardless of where the contract of hire was entered; or

2.    Working inside and outside of Ohio and the employer’s supervising office is in Ohio.

 

B.    Ohio Employee Injured Outside Ohio

1.    It is the policy of BWC that BWC’s extraterritorial coverage applies:

a.    To an Ohio employee injured while temporarily working outside the state; or

b.    To an Ohio employee injured outside of Ohio when the employee meets the criteria of IV.A, above.

2.    It is the policy of BWC to evaluate if an employee is temporarily working outside the state on a case-by-case basis

3.    There is no prescribed time period that defines when an employee is considered “temporarily” working outside the state.

 

C.   Out-of-State Employee Working Temporarily in Ohio: 90-Day Rule

1.    It is the policy of BWC to recognize the extraterritorial coverage of an out-of-state employer when all of the following apply:

a.    The employee is not a resident of Ohio;

b.    The employee has worked in Ohio 90 consecutive days or less; and

c.    The date of injury is on or after September 17, 2014.

2.    Multiple periods of an employee working 90 consecutive days or less in Ohio are calculated as distinct temporary periods.

 

D.   Signature Requirements in Interstate Jurisdiction Claims

1.    Subject to the exception in section IV.D.3 below, a claimant is required to sign and submit to BWC:

a.    A First Report of an Injury, Occupational Disease or Death (FROI), having a revision date of 12/18/08 or later;

b.    An “Interstate Jurisdiction Waiver.”; or

c.    An equivalent document

2.    If the required signed document is not received by BWC within twenty-eight (28) days from the time it is requested by BWC, the claim will be dismissed.

3.    When BWC determines the 90-Day Rule applies:

a.    The employee/claimant‘s signature on a FROI or “Interstate Jurisdiction Waiver” is not required; and

b.    BWC will disallow the claim.

 

E.    Claim Filed on Behalf of an Employee/Claimant

1.    If a claim has been filed on behalf of an employee/claimant in another state (e.g., by a medical provider or the employer), but Ohio is determined to have jurisdiction, the claimant may be eligible to receive Ohio benefits when:

a.    The employee/claimant elects to pursue the claim in Ohio by satisfying the requirements of IV.D;

b.    The employee/claimant has not otherwise elected to accept workers’ compensation benefits, if benefits were paid in the out-of-state claim; and

c.    The employee/claimant provides to BWC proof of withdrawal or refusal of acceptance of benefits in the other claim.

2.    If the employee/claimant fails to provide proof of withdrawal or refusal of acceptance of the other claim within twenty-eight (28) days from the time it is requested by BWC, BWC will dismiss the claim.

3.    An employee/claimant is not entitled to receive continuing benefits under the workers’ compensation laws of two different states.

4.    Compensation and benefits awarded by BWC are paid only to the extent those payments exceed any amounts paid in the out-of-state claim.

 

F.    If an employee/claimant receives benefits or compensation from Ohio and BWC becomes aware the employee/claimant did not disclose receiving benefits, compensation or damages from another state, whether pursued by the employee before or after receiving benefits and/or compensation from Ohio, BWC will disallow the claim and pursue collection of:

1.    The amount of the compensation or benefits paid to the employee by BWC; and

2.    Any interest, attorney’s fees, and costs BWC incurs in collecting that payment.

 

 

BWC staff may refer to the corresponding procedure for this policy entitled “Procedure for Interstate Jurisdiction” for further guidance.

 


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