OhioBWC - Basics: (Policy library) - File

Policy and Procedure Name:

Jurisdiction (Statute of Limitations, Statutory life of a Claim)

Policy #:

CP-10-01

Code/Rule Reference:

R.C. 4123.032; R.C. 4123.28; R.C. 4123.52; R.C. 4123.84; R.C. 4123.85

Effective Date:

05/25/18

Approved:

Kevin R. Abrams, Chief Operating Officer

Origin:

Claims Policy

Supersedes:

CP-10-01, effective 09/29/17 and CP-10-01.PR1, effective 07/12/17

History:

CP-10-01

Rev. 09/29/17, 06/14/16; New 11/07/14

CP-10-01.PR1

Rev. 07/12/17, 03/06/17, 06/14/16, 04/13/15; New 11/07/14

 

 

I. POLICY PURPOSE

 

The purpose of this policy is to ensure BWC staff can recognize, effectively investigate and accurately resolve jurisdictional issues in a claim.

 

II. APPLICABILITY

 

This policy applies to claims services staff.

 

III. DEFINITIONS

 

Claimant: the individual seeking workers’ compensation benefits, typically the injured worker (IW) or a dependent of a deceased IW.

 

Continuing Jurisdiction: the authority of the Ohio Bureau of Workers' Compensation (BWC) or the Ohio Industrial Commission (IC) to exercise legal responsibility and authority to review, modify or make a decision in a claim over a period of time, as specified by law.

 

Emergency Management Worker: An individual who has registered for service pursuant to R.C. 5502.34, in connection with the development, maintenance, and operation of any state or local emergency management agency authorized by law, and who has met the minimum requirements of R.C. 4123.031 to 4123.037, or who has been registered as an emergency management worker pursuant to R.C. 5502.34 during a disaster or emergency.

 

Jurisdiction: the legal responsibility and authority to make a decision in a claim.

 

Lost Time Claim: a claim with eight or more days of lost time from work directly caused by a work-related injury, even if compensation or wages in lieu of compensation have not been paid to the IW; or, any claim in which BWC awards compensation.

 

Medical Only Claim: a claim with seven or fewer days of lost time from work directly caused by a work-related injury.

 

Statutory Life of a Claim: the period during which BWC and/or the IC may, by law, make or modify a finding or award related to disability, compensation, dependency or benefits in a claim.

 

IV. POLICY

 

A.    Time Period for Filing a Claim

1.    Injury or death due-to-injury claim – Occurring prior to 9/29/2017:

a.    A claimant (who is not an emergency management worker or an emergency management worker’s dependent) must file a notice of injury or death with BWC or the IC within two (2) years of the injury or death.

b.    The deadline for filing a claim applicable to an emergency management worker or an emergency management worker’s dependent is as provided in section IV.A.4, below.

2.    Injury or death due to injury claim – Occurring on or after 9/29/2017:

a.    A claimant (who is not an emergency management worker or an emergency management worker’s dependent) must file a notice of injury or death with BWC or the IC within one year of the injury or death.

b.    The deadline for filing a claim applicable to an emergency management worker or an emergency management worker’s dependent remains as provided in section IV.A.4, below.

3.    Occupational Disease or death-due-to-occupational-disease claim: A claimant must file a notice of injury or death due to an occupational disease:

a.    Within two years after death; or

b.    Two years from the most recent of the following dates (all three dates must have occurred before the statute of limitations begins to run):

i.      The date the employee first became aware, through medical diagnosis, that he or she is suffering from an occupational related disease; or

ii.     The date the employee first received medical treatment for such disease; or

iii.    The date the employee first quit work due to the disease; or

c.     For a period beyond the two-year requirement, but within six months after the date of diagnosis of a disease as occupationally related by a licensed physician. 

4.    Emergency Management Worker: A claimant that is an emergency management worker or the emergency management worker’s dependent must file a notice of injury or death with BWC or the IC:

a.    Within one (1) year of the date of injury or death; or

b.    If the emergency management worker filed an injury claim within one year of an injury, and the emergency management worker subsequently dies from that injury, within six (6) months after the date of death.

5.    Calculation of the Deadline for Filing Claims: The time period for filing a notification of injury is determined by excluding the first day (i.e., date of injury, death or disability) and including the last day of the notification timeframe.

a.    If the last day for filing the claim is a day in which a public office is closed, or a day in which a public office closes before its usual closing time, the notification may be filed on the next succeeding business day. 

b.    If an employer who is required to report a work-related injury within seven days of acquiring knowledge of an injury or knowledge of a diagnosis of an occupational disease that results in seven days or more of total disability, fails to make the report, the claimant shall get an additional day added to the time period to file, up to two additional years, for each day the employer fails to make the report.

c.     The notice requirement is satisfied:

i.      If the employer, with knowledge of an injury, pays the IW wages in lieu of compensation for total compensation; or,

ii.     If a self-insuring employer provides compensation or medical benefits.

 

B.    Statutory Life of a Claim/Continuing Jurisdiction

1.    A claim will expire or end under the following circumstances:

a.    If the date of injury is on or after August 25, 2006 – five (5) years from the date of injury, the date of payment of compensation, wages in lieu of compensation or medical bill payment, whichever is later.

b.    If the date of injury is December 11, 1967 to August 24, 2006 and the claim is lost-time - ten (10) years from the date of last compensation, wages in lieu of compensation or medical bill payment.

c.     If the date of injury is October 20, 1987 to August 24, 2006 and the claim is medical only - six (6) years from the date of injury or last medical bill payment.

d.    If the date of injury is December 11, 1967 to October 19, 1987 and the claim is medical only - six (6) years from the date of injury.

e.    If the date of injury is prior to December 11, 1967 – ten (10) years from the date of injury, or payment of compensation, wages in lieu of compensation or medical bill payment.

2.    The last date of payment of compensation is the date which appears on the face of the last warrant issued in payment of compensation, or the date of the last transfer made by electronic fund transfer or electronic benefits transfer.

3.    BWC will not take any action on a claim that has statutorily expired.

4.    If BWC or the IC suspends a claim, the statute of limitations related to the statutory life of the claim stops running as of the date of that suspension (tolls).

5.    BWC and the IC has continuing jurisdiction during the statutory life of a claim and may make modification or change with respect to former findings or orders when justified.

 

V.  PROCEDURE

 

A. Time Period for Filing a Claim

1.    Claims services staff shall review the First Report of an Injury, Occupational Disease or Death (FROI) or equivalent to determine if the claim is filed within the required time limits pursuant to the Jurisdiction policy.

2.    Claims services staff shall issue an initial denial order for claims not filed within the required timeframes.

3.    Claims filed within the required timeframes shall be processed pursuant to the Initial Claim Determination policy and procedure.

 

B.    Statutory Life of Claim/Continuing Jurisdiction

1.    When a subsequent application is filed and the claims management system indicates the claim has expired, claims services staff shall:

a.    Request a COGNOS report, if available, to verify the correct expiration date; or

b.    Review the claim activity and manually calculate the applicable expiration date.

2.    Claims services staff shall consult with the BWC attorney whenever it is unclear if the claim has expired.

3.    If claims services staff determine the claim has expired, claims services staff shall send the “Out of Statute of Limitations Letter for Lost Time Claims” or the “Out of Statute of Limitations Letter for Medical Only Claims” to the claimant.