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OhioBWC - Basics: (Policy library) - File

 

Policy Name:

General Employer Complaint Policy

Policy #:

EP-07-01

Code/Rule Reference

Ohio Administrative Code (OAC) 4123-14-06.

Effective Date:

January 11, 2016

Origin:

Employer Policy

Supersedes:

The General Employer Complaint Policy dated April 5, 2013.

History:

New policy: April 5, 2013. Revised January 11, 2016.

Review Date:

January 11, 2021

 

 

I.       Policy Purpose

 

This 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.

 

II.     Applicability

 

Employer complaints are assigned to BWC business units, or in certain circumstances to the BWC service office. This policy applies to BWC business units, BWC service offices, employers, and authorized representatives.

 

III.    Definitions

 

A.     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.

B.     Eligibility Criteria: The requirements an employer must meet to gain entry into a program or qualify for certain treatment under BWC employer policies. Eligibility criteria are specified in each BWC program-specific policy.

C.    Extenuating circumstance: A substantial reason, or mitigating factor, that justifies granting the employer’s request for relief.

D.    Program 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.

IV.   Policy

A.     Investigation of Complaint: BWC staff must investigate the employer’s complaint prior to issuing a decision to ascertain:

1.     The relief that the employer is requesting to resolve the complaint.

2.     The reason the employer is requesting relief.

3.     Whether the employer has met eligibility criteria and program requirements related to the applicable program or policy.

4.     Whether the employer meets the criteria for granting relief under an extenuating circumstance in this policy or an extenuating circumstance that is program-specific.

5.     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 4123-14-06(A)(2)).

B.     Guidelines for Granting Relief.

1.     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.

2.     Relief should be granted for the missing of a filing or report deadline only if an extenuating circumstance can be verified through documentation.

3.     The following do not qualify as extenuating circumstances for any BWC employer program or policy:

a.     Changes in the management staff within the organization.

b.     Change in personnel or CPA organization (other than the scenarios described in section D.4 and D.5 below).

c.      Bookkeeper or CPA error.

d.     Confusion over Ohio workers’ compensation laws or rules.

e.     Implementation of a new computer system.

C.    Extenuating Circumstances 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:

1.     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.

2.     Examples of supporting documentation are provided for each of the circumstances, but appropriate documentation is not limited to the documentation listed below.

3.     An extenuating 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.

D.    Circumstances that Qualify as Extenuating Circumstances.

1.     BWC or Ohio Attorney General Office (AGO) Error.

a.     Extenuating Circumstance: 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:

i.       BWC credited the wrong employer’s policy.

ii.      Technical difficulties make www.bwc.ohio.gov unavailable, preventing an employer from completing a required task on BWC’s website.

b.     Supporting documentation:

i.       BWC records to validate error.

ii.      Screen of error messages encountered by employer.

2.     Fraud or Gross Negligence by Employer’s Staff or Agent.

a.     Extenuating Circumstance: 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 or agent.

b.     Supporting documentation: 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.

i.       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.

ii.      For gross 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.

3.     Unpredictable Significant Events.

a.     Extenuating Circumstance: An unpredictable event that was outside of the employer’s control that prevented the employer from filing appropriate paperwork in a timely manner. Examples:

i.       Acts of nature such as a tornado or flood.

ii.      Significant loss events such as water line break or fire.

iii.     Terrorist activities.

iv.    Violence in workplace.

v.      Outages such as network failure of an internet service provider (ISP) or power outage.

b.     Supporting documentation:

i.       News report, police report, or insurance claim related to a natural disaster or significant event.

ii.      Statement from ISP provider or power company verifying date(s) and times of outages.

4.     Serious Illness, Injury or Death of Essential Personnel.

a.     Extenuating Circumstance: Essential personnel within the organization, such as the owner, Chief Operating Officer, or Chief Financial Officer, suffers a serious illness, injury or death that prevents the employer from filing appropriate paperwork or documentation in a timely manner.

b.     Supporting documentation:

i.       For serious illness or injury: A physician’s verification must accompany the request. Such verification should not include specific medical reasons for the absence, but must include the dates the essential personnel missed work due to serious illness or injury.

ii.      For death: A death certificate.

iii.     For both of the above scenarios documentation regarding essential personnel’s responsibilities that relate to the employer’s request.

5.     Essential Personnel Called to Active Military Duty

a.     Extenuating Circumstance: 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.

b.     Supporting documentation: Military order/call to active duty notice and documentation regarding essential personnel’s responsibilities that relate to the employer’s request.

E.     Program-Specific Extenuating 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.

F.     Management Approval of Recommendations.

1.     BWC staff must obtain management level sign-off on each recommendation to approve or deny an employer’s request for relief.

2.     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.


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