Contract for Coverage of State Agency or Political
Ohio Revised Codes (ORC) 4123.03 and 4123.01
January 11, 2016
U-69 Workers’ Compensation Contract Coverage of the
State and Political Subdivisions Policy issued on February 1, 2008.
New policy issued February 1, 2008; revised January 11,
January 11, 2021
The state or a political
subdivision may contract with the Ohio Bureau of Workers’ Compensation (BWC) to
provide workers’ compensation coverage for individuals who are not considered
employees according to ORC 4123.01.
policy applies to state agencies and institutions, political subdivisions,
authorized representatives, and BWC Policy Processing.
B. This policy
does NOT apply to:
employers. ORC 4123.03 is
limited to public employers.
public employers. Employers who elect to cover volunteers and probationers
performing service for the political subdivision as employees must include
those employees under the self-insurance policy, as set forth in Ohio
Administrative Code (OAC) 4123-19-03(N).
Works Relief Employees. These individuals perform services in exchange for
welfare benefits. Welfare recipients are covered under each county’s welfare
program and wages are reported to that county’s Public Works Relief Employee
policy number, as set forth in ORC 4127.01.
An individual convicted of a criminal offense and serving a sentence in
confinement. Other terms used to describe these individuals include
prisoner, offender, and resident. This term may also pertain to a pre-trial detainee.
B. Inmate worker
program: A program in which an inmate is allowed to leave confinement for
community service work or work in or about the jail.
An individual under age eighteen (18) controlled by the jurisdiction of the
Juvenile Division of Common Pleas Court.
volunteer: An individual who chooses freely to perform community service
work and usually does not receive wages or remuneration for services
rendered. For the purpose of this policy, non-emergency volunteer will be referred
to as volunteer. Examples of volunteers are individuals picking up trash
in parks, clearing walk trails, or planting flowers. Volunteer does not mean
members of volunteer auxiliary police or patrolmen and fire departments,
including emergency medical technicians.
subdivision: A public employer within the state, usually referred to as
public employer taxing district (PEC). These employers consist of the
counties and every taxing district within the county such as cities, villages,
townships, local school districts, public libraries, public hospitals, public
transit authorities and special taxing districts, which includes port
authorities and joint vocational schools.
An individual convicted of a criminal offense and serving any portion of the
sentence by performing community service.
employer: The state, including state hospitals, each county, municipal
corporation, township, school district, and hospital owned by a political
subdivision or subdivisions other than the state. (ORC 4123.01(B)(1))
An official action of a political subdivision that authorizes the execution of
a contract for workers’ compensation coverage with BWC. The resolution
specifically defines all categories of individuals for which the contract
A verifiable list including the names, addresses and types of work performed or
position descriptions of all individuals qualifying for the extension of
workers’ compensation benefits by reason of services rendered. The roster also
must document the period of time over which the services are rendered and when
the services are terminated.
Referred to as state agency in this policy, is any institution or agency of the
state of Ohio, usually referred to as public employer state (PES). These
include, but are not limited to, the Ohio Department of Jobs and Family
Services, Ohio Bureau of Workers’ Compensation, University of Akron, and the
Ohio State University Hospitals.
for Coverage of State Agency or Political Subdivision (U-69): A
BWC form which becomes a contract between a state agency or political
subdivision and BWC.
public employers may contract with BWC to provide workers’ compensation
coverage for individuals who are not considered employees according to ORC
initiate contract coverage, an institution or agency administrator, director or
other top official, who is authorized to execute contracts on behalf of the
institution or agency, shall sign and date the U-69 contract.
state agency must provide a list of specific categories of individuals (see IV.B.4.a
through e below) the contract covers.
A copy of the U-69 contract shall be submitted to BWC.
initiate contract coverage, a U-69 contract shall be signed and dated by the
employer’s appointing authority must pass a resolution authorizing the political
subdivision to enter into a contract for workers’ compensation coverage with BWC. The
resolution must identify specific categories of individuals the contract
A copy of the resolution and U-69 contract shall be submitted to BWC.
employer must mail the U-69 contract (PES and PEC), resolution (PEC only), and the
specific categories of individuals the contract covers to:
contract must be signed by the BWC Administrator before coverage can take
effect. The contract shall be in effect from and after the date BWC receives
the contract. The employer will only have active coverage for the categories
specified under the individual contract, which may include the following:
performing court ordered community service.
Inmates performing work or providing services.
performing community service.
payroll for premium purpose.
political subdivisions, payroll for a volunteer is based on the total number of
hours worked times the current Ohio minimum wage, and never less than twenty (20)
hours a week for each volunteer.
state agencies, no payroll is to be reported for a volunteer for premium rate
making purposes due to state agencies rate making methodology that calculates a
rate representing paying dollar-for-dollar for claims costs.
Payroll is based on the total number of hours worked times the current Ohio
minimum wage, and never less than twenty (20) hours a week for each juror. If a
juror’s weekly wages exceed the minimum wage times twenty (20) hours, then
actual wages must be reported.
inmates, and juveniles: Reportable payroll is based on the total number of
hours worked by each probationer, inmate, or juvenile times the current Ohio
Department of Commerce, Division of Labor and Worker Safety, is responsible for
establishing the Ohio minimum wage according
to an amendment, Ohio
Constitution, Article II, Section 34a, which was passed in 2006.
amendment requires the minimum wage rate to increase each year in accordance
with the Consumer Price Index.
Council on Compensation Insurance (NCCI) manual codes.
calculated for the work hours of a volunteer, probationer or inmate worker must
be reported to the National Council on Compensation Insurance (NCCI) manual of
the political subdivision.
NCCI Manual Number
Special Public Universities
Special Vocational Schools
Special Public Institutions
Public Transit Authority
Special Public Authority,
two or more taxing districts involved. (Excluding Transit Authority)
will be no separate policy number for contract coverage.
wage estimates provided by the political subdivision shall be construed as the
minimum premium amount and are therefore nonrefundable, except in the event
that there is an adjustment in the premium rate by BWC.
D. Keeping and
agencies and political subdivisions must create and maintain a roster at the
outset of the contract and update the roster throughout the entire term of the
contract. The roster must list names, addresses, termination dates, and any
other information needed to identify and verify persons covered under the
roster will not be submitted to BWC. The employer must keep the roster at the
employer location as a component of recordkeeping and make the roster available
to BWC upon request.
agencies and political subdivisions must maintain records to support the
reporting of wages, allowances, or any other type of remuneration.
in BWC discount programs.
subdivisions are eligible to participate in BWC discount
programs. Employers must comply with all program laws, rules and
agencies are not eligible for BWC discount programs.
party may terminate the contract.
intent to terminate the contract must be in writing and sent by certified mail.
The termination shall take effect on the date in the written notification, but
not less than thirty (30) days after the mailing of the notification.
termination, the rights, duties, and liabilities of the state agency or political
subdivision and BWC shall cease except as to injuries occurring before the date
of termination and as premiums accrued prior to the date of termination.
must mail the terminating notification to:
performed community service.
political subdivision initiated U-69 workers’ compensation contract coverage. A
completed U-69 contract was on file at BWC. A resolution, which authorized
extending workers’ compensation coverage for juveniles and probationers
performing community service as assigned to the Alternative Community Outreach
Program, was on file at BWC. Juvenile Center administration recorded juvenile
community service work hours and communicated those hours to Juvenile Court. Juvenile
Court Employer maintained an electronic record of work hours and roster of
juveniles’ names, types of work being done and hours worked. In case of a
juvenile’s work related injury or illness, the Court verified that the specific
juvenile was on the roster.
An eleven (11)
year old juvenile, confined in a Juvenile Center, was ordered by the Court to
complete seventy-five (75) hours of community service in the public employer’s
Alternative Community Outreach Program. On one occasion, the juvenile performed
community service under supervision by pulling weeds and picking up trash in a
park. The juvenile inadvertently stepped in a hole, fell and fractured a wrist.
the juvenile covered under the U-69 contract for coverage? Yes. Workers’
compensation coverage was active as a result of the public employer
appropriately completing contract coverage initiation procedures.
performed community service. (Different fact pattern)
political subdivision believed a U-69 contract and resolution, which authorized
extended workers’ compensation coverage for inmates performing work, has been
filed with BWC. Juvenile Court, the employer that maintained an appropriate
roster, ordered five juveniles, ages fourteen (14) to seventeen (17) years old,
to individually complete one hundred (100) hours of community service. The
juveniles were confined to the Juvenile Center and would be released under
Juvenile Center staff supervision to do community service work.
community service work by sweeping sidewalks and pulling weeds, one juvenile
tripped on the edge of a curb and broke an ankle.
the juvenile covered under the U-69 contract for coverage? It cannot be
determined if the juvenile was covered. This scenario presents two questionable
The employer believed the material was filed with BWC; however, the
employer did not confirm that it had active U-69 coverage.
This scenario deals with juveniles, not inmates as described in the
resolution. Potential questions include:
a resolution and U-69 contract actually on file with the employer and BWC?
An employer should verify that a resolution and contract are in its
The employer is required to maintain a resolution and U-69 contract as a
component of recordkeeping. The employer also must submit a resolution and U-69
contract to BWC.
representative should confirm that the employer’s resolution and contract are
in BWC files.
stores the resolution and U-69 contract in its electronic file room. A BWC
representative may access the electronic file room and view the materials in
order to verify that a resolution and U-69 contract exist for the specific
employer. Also, the resolution should be reviewed to determine the specific
category of individual under coverage.
a resolution and U-69 contract cannot be found in the electronic file room by a
BWC representative, the employer probably does not have contract coverage. However,
the representative must contact Policy Processing Division to confirm the
employer has no contract coverage. A delay with posting the materials in the
electronic file room may have occurred.
the employer paying premiums on those individuals under contract coverage?
BWC will conduct research and fact finding to answer the question.
Employers are required to maintain payroll reports as a component of
recordkeeping. These reports may be used to verify payment of premiums on
individuals under contract coverage.
an employer fails to comply with U-69 contract requirements, such as keeping
records of payroll reports or paying premiums on individuals under contract
coverage, the contract may be terminated by BWC.
performed community service.
political subdivision had U-69 contract workers’ compensation coverage. A
completed U-69 contract was on file at BWC. A resolution, authorized extending
coverage for probationers performing community service in the Service
Assistance Program, also was on file at BWC. The Court maintained an electronic
roster, which listed probationers’ names, types of work being done and hours
worked. In case of a probationer’s work related injury or illness, the court
verified that the specific probationer was on the roster.
agreed to court ordered community service in lieu of jail confinement and a
fine. Community service was directed through the public employer’s Service
Assistance Program. The probationer did housekeeping, pulling weeds, spreading
mulch, and painting at the public employer’s nursing home and Senior Citizen’s
Community Center. During one workday, the probationer fell from a ladder and
injured the left kneecap while cleaning windows.
the probationer covered under the U-69 contract for coverage? Yes. Workers’
compensation coverage was active as a result of the public employer appropriately
completing contract coverage initiation procedures. The court verified that the
probationer was on the roster.
in Inmate Worker Program.
political subdivision did not provide U-69 workers’ compensation contract
coverage for inmates working in an Inmate Worker Program. The employer
decided to cover inmates in the Inmate Worker Program under its general
serving a six month sentence, participated in an Inmate Worker Program. The
inmate worked in the jail laundry room. The inmate received a lower back injury
from a fall after slipping on a damp floor.
the inmate covered under a U-69 contract for coverage? No. The employer opted
not to provide workers’ compensation contract coverage for inmates in the Inmate
worked for state agency.
state agency employer had workers’ compensation contract coverage. The agency’s
director signed and dated a U-69 contract to extend workers’ compensation
coverage to park volunteers. Extension of workers’ compensation coverage for
volunteers was documented in a memorandum and signed by the director. An
electronic roster of volunteers’ names, addresses, position descriptions, and
services and termination dates was kept and updated on a regular basis. In case
of a volunteer’s work related injury or illness, the employer verified that the
specific volunteer was on the roster.
worked to clear brush, tree limbs and debris from walking trails in a park. One
volunteer received a bee sting which caused a severe adverse health reaction. The
volunteer was hospitalized for 8 days.
the volunteer covered under the U-69 contract for coverage?
Yes. Contract workers’ compensation coverage was active as the result of
a U-69 contract being on file at BWC and the ill volunteer was verified as
being on the roster.
The memorandum specified that volunteers were covered by workers’