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2020 Interstate Jurisdiction P&P with TOC

Policy and Procedure Name:

Interstate Jurisdiction

Policy #:

CP-09-07

Code/Rule Reference:

R.C. 4123.54, OAC 4123-17-23

Effective Date:

02/28/20

Approved:

Ann M. Shannon, Chief of Claims Policy and Support

Origin:

Claims Policy

Supersedes:

Policy # CP-09-07, effective 11/14/16 and Procedure # CP-09-07.PR.1, effective 11/14/16

History:

Previous versions of this policy are available upon request.

 


 

Table of Contents

 

I. POLICY PURPOSE

II. APPLICABILITY

III. DEFINITIONS

Claimant

Decision on the Merits

Extraterritorial Coverage

Interstate Jurisdiction

Jurisdiction

Ohio Employee

Uninsured Employer Fund

IV. POLICY

A.   Coverage

B.   Ohio Employees Injured Outside Ohio

C.   Out-of-State Employees Working Temporarily in Ohio: 90-Day Rule

D.   Signature Requirements in Interstate Jurisdiction Claims

E.   Claims Filed on Behalf of a Claimant

F.    Failure to Disclose Receipt of Out-of-State Benefits

V. PROCEDURE

A.   Standard Claim File Documentation

B.   Interstate Jurisdiction Investigation

C.   Sending the Interstate Jurisdiction Waiver

D.   Claims Filed on Behalf of a Claimant

E.   Final Actions

 

 


 

I. POLICY PURPOSE

 

The purpose of this policy is to ensure when employment activities involve multiple states, Ohio Bureau of Workers' Compensation (BWC) staff recognize, effectively investigate, and accurately determine the application of Ohio workers’ compensation coverage. 

 

II. APPLICABILITY

 

This policy applies to BWC claims services staff.  

 

III. DEFINITIONS

 

Claimant: One who asserts a right, demand, or claim for workers’ compensation benefits; for purposes of this policy, typically the injured worker (IW) or a dependent of a deceased IW. 

 

Decision on the Merits: A decision from an administrative or judicial body or an insurance carrier determining the compensability of a workers’ compensation claim for reasons other than jurisdiction. 

 

Extraterritorial Coverage (also referred to as “Extraterritorial Jurisdiction”): Workers’ compensation coverage for an Ohio employee who is injured while temporarily performing duties outside the state, or the recognition of another state’s coverage for a non-Ohio employee temporarily working in Ohio. 

 

Interstate Jurisdiction: Determination of which state bears legal responsibility and authority for a claim when employment activities occur in multiple states. 

 

Jurisdiction: The legal responsibility and authority to make a decision in a claim; for purposes of this policy, the determination of whether the claimant is an Ohio employee. 

 

Ohio Employee: An employee who is covered by Ohio workers’ compensation due to the employer’s responsibility to report for that employee pursuant to O.A.C. 4123-17-23(A), (C), or (D).

 

Uninsured Employer Fund: A fund in another state that responds when an employer does not have workers’ compensation insurance in effect in that state to respond to a claim.

 

IV. POLICY

 

A.     Coverage   

1.     Ohio workers’ compensation coverage applies to employees who are hired to work specifically in Ohio, regardless of where the contract of hire was entered.

2.     It is the policy of BWC to also provide workers’ compensation coverage to employees working inside and outside of Ohio when the employer’s supervising office is in Ohio.

 

B.     Ohio Employees Injured Outside Ohio

1.     It is the policy of BWC that BWC’s extraterritorial coverage applies:

a.     To Ohio employees injured while temporarily working outside the state; or

b.     To Ohio employees injured outside of Ohio, when the employee meets the criteria above.

2.     It is the policy of BWC to evaluate if an employee is temporarily working outside the state on a case-by-case basis.

3.     There is no prescribed time period that defines when an employee is considered “temporarily” working outside the state. 

 

C.    Out-of-State Employees Working Temporarily in Ohio: 90-Day Rule

1.     It is the policy of BWC to recognize the extraterritorial coverage of an out-of-state employer when all of the following apply: 

a.     The employee is not a resident of Ohio;

b.     The employee has worked in Ohio for 90 consecutive days or less; and

c.      The date of injury is on or after September 17, 2014.

2.     Multiple periods of an employee working 90 consecutive days or less in Ohio are calculated as distinct temporary periods.

 

D.    Signature Requirements in Interstate Jurisdiction Claims

1.     In general, a claimant must sign and submit to BWC:

a.     A First Report of an Injury, Occupational Disease, or Death (FROI) having a revision date of 12/18/08 or later;

b.     An “Interstate Jurisdiction Waiver”; or

c.      An equivalent document. 

2.     If BWC determines that the 90-Day Rule applies, submission of the aforementioned documents is not required.

 

E.     Claims Filed on Behalf of a Claimant

1.     If a claim has been filed on behalf of a claimant in another state (e.g., by a medical provider or the employer), but Ohio is determined to have jurisdiction, the claimant may be eligible to receive Ohio benefits when:

a.     The claimant elects to pursue the claim in Ohio by satisfying the requirements above;

b.     Benefits were paid in the out-of-state claim and the claimant has not otherwise elected to accept workers’ compensation benefits; and

c.      The claimant provides to BWC proof of withdrawal or refusal of acceptance of benefits in the other claim.

2.     A claimant is not entitled to receive continuing benefits under the workers’ compensation laws of two different states.

3.     Compensation and benefits awarded by BWC are paid only to the extent those payments exceed any amounts paid in the out-of-state claim. 

 

F.     Failure to Disclose Receipt of Out-of-State Benefits

1.     A claimant who receives benefits or compensation from BWC must disclose receipt of benefits, compensation, or damages from another state, whether pursued before or after receiving benefits or compensation from Ohio.

2.     If the claimant fails to disclose the receipt of such out-of-state benefits, it is the policy of BWC to:

a.     Disallow the claim; and

b.     Pursue collection of:

i.       The amount of the compensation or benefits paid to the claimant by BWC; and

ii.      Any interest, attorney’s fees, and costs BWC incurs in collecting that payment. 

 

V. PROCEDURE

 

A.     Standard Claim File Documentation

1.     BWC staff shall refer to the Standard Claim File Documentation and Altered Documents policy and procedure for claim note requirements; and

2.     Shall follow any other specific instructions for claim notes included in this procedure.

 

B.     Interstate Jurisdiction Investigation

1.     Upon receipt of a new claim, claims services staff shall review the claim to determine:

a.     If BWC’s extraterritorial jurisdiction coverage applies. This coverage applies if the employee:

i.       Was hired to work out-of-state and is not an Ohio employee; or

ii.      Is an Ohio employee working temporarily in another state covered by BWC’s extraterritorial coverage.

b.     Whether the 90-Day Rule applies to an out-of-state employee working temporaily in Ohio. Claims services staff shall:

i.       Obtain the date the employee began working temporarily in Ohio from the employer or employee; and

ii.      Calculate the total number of consecutive days worked in Ohio.

2.     If the total consecutive days worked in Ohio are 90 or less:

a.     The 90-Day Rule applies. Ohio does not have jurisdiction;

b.     The out-of-state employer’s extraterritorial coverage applies; and

c.      Claims services staff shall deny the claim.

3.     If the total consecutive days worked in Ohio are more than 90 days, Ohio has jurisdiction in the claim and claims services staff shall continue considering the claim.

4.     If an Employer/Employee Agreement to Select Ohio as the State of Exclusive Remedy for Workers’ Compensation Claims (C-110) or an Employer/Employee Agreement to Select a State Other Than Ohio as the State of Exclusive Remedy for Workers’ Compensation Claims (C-112) has been filed with BWC, claims services staff shall determine appropriate jurisdiction by consulting with:

a.     Their supervisor;

b.     An Employer Services Specialist (ESS); or

c.      A BWC attorney.

 

C.    Sending the Interstate Jurisdiction Waiver

1.     If the claim does not have a FROI with a revision date of 12/18/08 or later signed by the claimant, claims services staff shall send the claimant the “Interstate Jurisdiction Waiver” (waiver).

2.     If BWC does not receive the signed waiver, or equivalent form, within 28 days from the time it is requested, claims services staff shall dismiss the claim.

 

D.    Claims Filed on Behalf of a Claimant

1.     When claims services staff determines that Ohio has jurisdiction and the claim has been filed on a claimant’s behalf in another state, but the claimant chooses to pursue the claim in Ohio:

a.     Claims services staff shall:

i.       Consult with a BWC attorney to determine if the claimant elected to accept any benefits that were paid in the out-of-state claim; and

ii.      Contact the claimant to request proof of withdrawal or refusal of acceptance of benefits in the out-of-state claim.

b.     If the claimant fails to provide proof of withdrawal or refusal of acceptance of benefits paid in the out-of-state claim within 28 days from the time it is requested by BWC, claims services staff shall dismiss the Ohio claim.

2.     If claims services staff allows the claim and later becomes aware the claim is being pursued in another state against an uninsured employer fund, claims services staff:

a.     Shall consult with a BWC attorney; and

b.     May issue a “Reminder of an Ohio Claim” letter.

 

E.     Final Actions

1.     Upon determination of jurisdiction, claims services staff shall indicate in the claims management system:

a.     The status of Ohio jurisdiction;

b.     Which state could have jurisdiction of the claim; and

c.      The final decision on interstate jurisdiction.

2.     Claims services staff may review the following for additional information:

a.     BWC Employer Management Multistate Jurisdiction Payroll and Coverage policy; and

b.     The Out-of-State Employers fact sheet.