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OhioBWC - Basics: (Policy library) - File

ODJFS Policy PS

Policy Name:

Ohio Department of Job and Family Services (ODJFS) Reimbursement and Claim Adjustment

Policy #:

CP-15-02

Code/Rule Reference:

R.C. 4123.56(A), 4121.63, 4141.21, 4141.22, and 4141.43

Effective Date:

11/14/2016

Approved:

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

Origin:

Claims Policy

Supersedes:

Policy # CP-15-02, effective 03/07/2013

History:

New 03/07/2013

 

 

I. POLICY PURPOSE

 

The purpose of this policy is to ensure BWC accurately adjusts awards of Temporary Total Compensation (TT) and Living Maintenance (LM) to injured workers (IW) and properly reimburses ODJFS when ODJFS pays unemployment compensation to an IW for the same period the IW receives TT or LM payments.

 

II. APPLICABILITY

 

This policy applies to Field Operations staff.

 

III. DEFINITIONS

 

Designee:  BWC field staff member in each service office authorized to access the ODJFS Ohio Job Insurance (OJI) system.

 

Non-Settled Claims:  A claim in which BWC and the IW have not reached a full and final settlement.

 

Ohio Job Insurance (OJI):  ODJFS system detailing ODJFS’s payment of unemployment compensation benefits.

 

Settled Claims:  A claim in which BWC and the IW have reached a full and final settlement, and the claim is closed in whole or in part. 

 

IV. POLICY

 

A.    It is the policy of BWC to reimburse ODJFS for state unemployment compensation benefits ODJFS paid to an IW prior to BWC awarding TT or LM for the same period. 

 

B.    If reimbursement to ODJFS is required, BWC shall adjust the TT or LM benefit plan as follows:

1.    If BWC has not released the TT or LM payment, BWC shall adjust the TT or LM benefit plan reflecting the ODJFS reimbursement.

2.    If BWC released the TT or LM payment, BWC shall adjust the TT or LM benefit plan reflecting the ODJFS reimbursement and place the IW in overpaid status equal to the amount BWC paid to ODJFS.

 

C.   Reimbursement to ODJFS shall equal the unemployment compensation benefits ODJFS paid to the IW up to, but not exceeding, the TT or LM rate for the same period.

 

D.   BWC shall pay the IW any balance of TT or LM that is over and above the amount BWC has reimbursed to ODJFS.

 

E.    BWC shall not reimburse ODJFS for unemployment compensation paid to an injured worker in the following circumstances:

1.    BWC awarded TT or LM prior to ODJFS’s payment of unemployment compensation during the concurrent period;

2.    The unemployment compensation benefits are funded by an entity other than ODJFS (e.g., another state, the federal government);

3.    BWC pays compensation other than TT or LM during a concurrent period of unemployment compensation benefits.

 

F.    BWC shall investigate unemployment compensation payments before awarding TT or LM and/or when BWC receives information that indicates payment of unemployment compensation.  Information and documentation received from parties to the claim will be noted and imaged into the claim file and may be disclosed at hearing.

 

 

 

 

 

 

 


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