Employer Complaint Policy
Administrative Code (OAC) 4123-14-06.
Suttles, Interim Chief Employer Services
Employer Complaint Policy dated January 11, 2016.
April 5, 2013. Revised March 2, 2018.
I. Policy Purpose
policy will guide Ohio Bureau of Workers’ Compensation (BWC) staff in resolving
employer disputes with a BWC decision that requires additional research and
analysis to determine the proper resolution.
complaints are assigned to BWC business units, or in certain circumstances to
the BWC claims office. This policy applies to BWC business units, BWC service
offices, employers, and authorized representatives.
Complaint: An employer dispute with a BWC
decision, or application of a rule or policy, that requires additional research
and analysis to determine proper resolution.
Criteria: The requirements
an employer must meet to enter a program or qualify for certain treatment under
BWC employer policies. Eligibility criteria are specified in each BWC
personnel: Employees responsible
for the employer’s finances who include, but are not limited to the owner,
Chief Operating Officer and Chief Financial Officer.
circumstance: A substantial
reason, or mitigating factor, that justifies granting the employer’s request
Immediate family: Means a person’s spouse, significant
other (or domestic partner), children, step-children, grandchildren, parents,
step-parents, father-in-law, mother-in-law, brother-in-law, sister-in-law,
son-in-law, daughter-in-law, grandparents, brother, sister, step-siblings,
and/or legal guardian or other person who stands in the place of a parent.
requirements: The activities
an employer must complete to receive a program discount, which may include
activities an employer must complete to remain in a program from year-to-year.
Examples of program requirements include (but are not limited to) application
for the program, program attendance, and reporting requirements. Program
requirements are specified in each BWC program-specific policy.
Complaint: BWC staff must investigate the employer’s complaint prior to issuing
a decision to ascertain:
The relief that the
employer is requesting to resolve the complaint.
The reason the
employer is requesting relief.
Whether the employer
has met eligibility criteria and program requirements related to the applicable
program or policy.
Whether the employer
meets the criteria for granting relief under an extenuating circumstance in
this policy or an extenuating circumstance that is program-specific.
Whether the employer
has filed the complaint within two years of receipt of BWC’s decision giving
rise to the complaint, unless a different time is provided in rule or law. (OAC
BWC staff cannot
grant relief where the employer fails to meet eligibility criteria and program
requirements. Refer to
the program specific EM policy to determine whether the employer has met all
eligibility criteria and program requirements.
Relief should be
granted for the missing of a filing or report deadline only if an extenuating
circumstance can be verified through documentation.
The following do
not qualify as extenuating circumstances for any BWC employer program or
Changes in the
management staff within the organization.
Change in personnel
or CPA organization (other than the scenarios described in section D.4 and D.5
Bookkeeper or CPA
Confusion over Ohio
workers’ compensation laws or rules.
Implementation of a
new computer system.
for All BWC Programs and Policies: BWC has identified certain “extenuating
circumstances” that allow BWC staff to grant the employer’s request for relief
for any program or policy. These circumstances are outlined in section D, below.
In each of the
extenuating circumstances outlined, there must be a causal relationship
between the extenuating circumstance and the event giving rise to the
employer’s request for relief.
supporting documentation are provided for each of the circumstances, but
appropriate documentation is not limited to the documentation listed below.
circumstance may be utilized only to extend the required timeframe to
meet a specific requirement. It cannot be used to allow non-completion
of the specific requirement.
Qualify as Extenuating Circumstances.
BWC or Ohio Attorney
General Office (AGO) Error.
BWC or AGO error results in the employer being rejected from participation in
an employer program or prevents the employer from filing appropriate paperwork
or documentation in a timely manner. Examples:
BWC credited the
wrong employer’s policy.
make www.bwc.ohio.gov unavailable,
preventing an employer from completing a required task on BWC’s website.
BWC records to
Screen of error
messages encountered by employer.
Fraud or Gross
Negligence by Employer’s Staff or Agent.
The fraudulent action, illegal action, or gross negligence of an employee or
agent that prevents the employer from filing appropriate paperwork or
documentation in a timely manner. The employee or agent must have been directly
involved with the completion or oversight of functions related to the protested
issue. Employer relief is limited to those situations where the employer can verify
through documentation that it has initiated legal action against the employee
BWC staff should work through their supervisor to seek advice from BWC Legal
Division to determine if the documents presented by the employer are valid
legal documents for this circumstance.
For criminal or
civil fraud or other illegal acts: Proof that the employer has filed formal
criminal charges or actively pursued legal action for civil fraud or other
illegal acts. A conviction is not required.
negligence: Proof that the employer has filed a civil complaint against the
employee or agent for recovery in any court. The employer is not required to
prevail in the civil action. Acceptable documentation may also include rulings
from other state or federal governmental agencies attesting that the action is
considered gross negligence.
An unpredictable event that was outside of the employer’s control that
prevented the employer from filing appropriate paperwork in a timely manner.
Acts of nature such
as a tornado or flood.
events such as water line break or fire.
iii. Terrorist activities.
Outages such as
network failure of an internet service provider (ISP) or power outage.
News report, police
report, or insurance claim related to a natural disaster or significant event.
Statement from ISP
provider or power company verifying date(s) and times of outages.
Injury or Death of Essential Personnel or Immediate Family of Essential
Essential personnel within the organization, or immediate family of essential
personnel, suffers a serious illness, injury or death that prevents the employer
from filing appropriate paperwork or documentation in a timely manner.
For serious illness
or injury: A physician’s verification must accompany the request. Such
verification should not include specific medical reasons for the absence. The
physician verification must include the dates the essential personnel, or a
member of an essential person’s immediate family, was treated, and the
essential person missed work for this serious illness or injury. For death: A
death certificate. If the death is for an immediate family member of an
essential person, proof of the relationship between the essential person and
the deceased, and proof the essential person missed work for the death, is
essential personnel’s responsibilities that relate to the employer’s request.
Called to Active Military Duty.
Essential personnel within the organization such as the owner, Chief Operating
Officer, or Chief Financial Officer, called to active military duty, preventing
the employer from filing appropriate paperwork in a timely manner.
Military order/call to active duty notice and documentation regarding essential
personnel’s responsibilities that relate to the employer’s request.
Circumstances: Additional extenuating circumstances may apply to a program or
policy; see the “Resolution of Complaints” section of the program-specific
policy to determine if additional extenuating circumstances exist to allow
granting of the employer’s complaint.
BWC staff must
obtain management level sign-off on each recommendation to approve or deny an
employer’s request for relief.
Complaints that are
more complex or involve larger financial impacts will require additional
management level sign-offs. Consult the Complaint Tracker Approval Sign-Off
Chart to determine the level of sign-off required for each recommendation.