|
Policy and Procedure Name:
|
Interstate Jurisdiction
|
|
Policy #:
|
CP-09-07
|
|
Code/Rule Reference:
|
R.C. 4123.54, OAC 4123-17-23
|
|
Effective Date:
|
02/28/20
|
|
Approved:
|
Ann M. Shannon, Chief of Claims Policy and Support
|
|
Origin:
|
Claims Policy
|
|
Supersedes:
|
Policy # CP-09-07, effective 11/14/16 and Procedure # CP-09-07.PR.1,
effective 11/14/16
|
|
History:
|
Previous versions of this
policy are available upon request.
|
Table of Contents
I. POLICY
PURPOSE
II.
APPLICABILITY
III.
DEFINITIONS
Claimant
Decision on
the Merits
Extraterritorial
Coverage
Interstate
Jurisdiction
Jurisdiction
Ohio Employee
Uninsured
Employer Fund
IV. POLICY
A. Coverage
B. Ohio
Employees Injured Outside Ohio
C. Out-of-State
Employees Working Temporarily in Ohio: 90-Day Rule
D. Signature
Requirements in Interstate Jurisdiction Claims
E. Claims
Filed on Behalf of a Claimant
F. Failure
to Disclose Receipt of Out-of-State Benefits
V. PROCEDURE
A. Standard
Claim File Documentation
B. Interstate
Jurisdiction Investigation
C. Sending
the Interstate Jurisdiction Waiver
D. Claims
Filed on Behalf of a Claimant
E. Final
Actions
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.
This policy applies to BWC claims services staff.
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 for that employee pursuant to
O.A.C. 4123-17-23(A), (C), or (D).
Uninsured Employer
Fund: A fund in another state that responds when an employer does
not have workers’ compensation insurance in effect in that state to respond to
a claim.
1. Ohio
workers’ compensation coverage applies to employees who are hired to work
specifically in Ohio, regardless of where the contract of hire was entered.
2.
It is the policy of BWC to also provide workers’ compensation coverage
to employees working inside and outside of Ohio when the employer’s supervising
office is in Ohio.
1. It is the
policy of BWC that BWC’s extraterritorial coverage applies:
a. To Ohio
employees injured while temporarily working outside the state; or
b. To Ohio
employees injured outside of Ohio, when the employee meets the criteria 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
Employees 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 for 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. In
general, a claimant must 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 BWC
determines that the 90-Day Rule applies, submission of the aforementioned documents
is not required.
1. If a claim
has been filed on behalf of a 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
claimant elects to pursue the claim in Ohio by satisfying the requirements above;
b. Benefits
were paid in the out-of-state claim and the claimant has not otherwise elected
to accept workers’ compensation benefits; and
c. The
claimant provides to BWC proof of withdrawal or refusal of acceptance of
benefits in the other claim.
2. A claimant
is not entitled to receive continuing benefits under the workers’ compensation
laws of two different states.
3. Compensation
and benefits awarded by BWC are paid only to the extent those payments exceed
any amounts paid in the out-of-state claim.
1. A claimant
who receives benefits or compensation from BWC must disclose receipt of
benefits, compensation, or damages from another state, whether pursued before
or after receiving benefits or compensation from Ohio.
2. If the
claimant fails to disclose the receipt of such out-of-state benefits, it is the
policy of BWC to:
a. Disallow
the claim; and
b. Pursue collection
of:
i. The
amount of the compensation or benefits paid to the claimant by BWC; and
ii. Any
interest, attorney’s fees, and costs BWC incurs in collecting that payment.
1. BWC staff
shall refer to the Standard
Claim File Documentation and Altered Documents policy and procedure for
claim note requirements; and
2. Shall
follow any other specific instructions for claim notes included in this
procedure.
1. Upon
receipt of a new claim, claims services staff shall review the claim to
determine:
a. If BWC’s
extraterritorial jurisdiction coverage applies. This coverage applies if the
employee:
i. Was
hired to work out-of-state and is not an Ohio employee; or
ii. Is
an Ohio employee working temporarily in another state covered by BWC’s
extraterritorial coverage.
b. Whether
the 90-Day
Rule applies to an out-of-state employee working temporaily in Ohio.
Claims services staff shall:
i. Obtain
the date the employee began working temporarily in Ohio from the employer or
employee; and
ii. Calculate
the total number of consecutive days worked in Ohio.
2. If the
total consecutive days worked in Ohio are 90 or less:
a. The 90-Day Rule
applies. Ohio does not have jurisdiction;
b. The
out-of-state employer’s extraterritorial coverage applies; and
c. Claims
services staff shall deny the claim.
3. If the
total consecutive days worked in Ohio are more than 90 days, Ohio has
jurisdiction in the claim and claims services staff shall continue considering
the claim.
4. If an Employer/Employee
Agreement to Select Ohio as the State of Exclusive Remedy for Workers’
Compensation Claims (C-110) or an Employer/Employee
Agreement to Select a State Other Than Ohio as the State of Exclusive Remedy
for Workers’ Compensation Claims (C-112) has been filed with
BWC, claims services staff shall determine appropriate jurisdiction by consulting
with:
a. Their
supervisor;
b. An
Employer Services Specialist (ESS); or
c. A
BWC attorney.
1. If the
claim does not have a FROI with a revision date of 12/18/08 or later signed by
the claimant, claims services staff shall send the claimant the “Interstate
Jurisdiction Waiver” (waiver).
2. If BWC
does not receive the signed waiver, or equivalent form, within 28 days from the
time it is requested, claims services staff shall dismiss the claim.
1. When
claims services staff determines that Ohio has jurisdiction and the claim has
been filed on a claimant’s behalf in another state, but the claimant chooses to
pursue the claim in Ohio:
a. Claims
services staff shall:
i. Consult
with a BWC attorney to determine if the claimant elected to accept any benefits
that were paid in the out-of-state claim; and
ii. Contact
the claimant to request proof of withdrawal or refusal of acceptance of
benefits in the out-of-state claim.
b. If the
claimant fails to provide proof of withdrawal or refusal of acceptance of benefits
paid in the out-of-state claim within 28 days from the time it is requested by
BWC, claims services staff shall dismiss the Ohio claim.
2. If claims
services staff allows the claim and later becomes aware the claim is being
pursued in another state against an uninsured employer fund, claims services staff:
a. Shall
consult with a BWC attorney; and
b. May issue
a “Reminder of an Ohio Claim” letter.
1. Upon
determination of jurisdiction, claims services staff shall indicate in the
claims management system:
a. The status
of Ohio jurisdiction;
b. Which state
could have jurisdiction of the claim; and
c. The
final decision on interstate jurisdiction.
2. Claims
services staff may review the following for additional information:
a. BWC
Employer Management Multistate
Jurisdiction Payroll and Coverage policy; and
b. The Out-of-State
Employers fact sheet.