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Policy
and Procedure Name:
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Change
of Occupation
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Policy
#:
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CP-03-02
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Code/Rule
Reference:
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R.C. 4123.57 (D) and (E); 4123.68 (W) (Y) (Z) and (BB)
O.A.C. 4123-3-25; 4121-3-25; and 4123-3-16
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Effective
Date:
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09/30/20
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Approved:
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Ann
Shannon, Chief of Claims Policy and Support
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Origin:
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Claims
Policy
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Supersedes:
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Policy
# CP-03-02, effective 05/24/17
and
Procedure # CP-03-02.PR1, effective 05/24/17
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History:
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Previous
versions of this policy are available upon request
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Table
of Contents
I. POLICY PURPOSE
II.
APPLICABILITY
III.
DEFINITIONS
None
IV. POLICY
A. General Policy
Statement
B. Eligibility for
Change of Occupation
C. Payment for a
Change of Occupation Award
V. PROCEDURE
A. General Claim
Note and Documentation Requirements
B. Processing a
Change of Occupation Request
C. NOR
D. How to Pay a
Change of Occupation Award
E. Change of
Occupation and Other Types of Compensation
The
purpose of this policy is to ensure that BWC allows a change of occupation
award to an injured worker who is entitled to the award by statute.
This
policy applies to Claims Services staff.
None
1. It is the
policy of BWC to make an appropriate determination on a change of occupation
award for the purpose of substantially reducing an injured worker’s exposure to
a harmful agent. This includes when an injured worker:
a. Has contracted,
in the course of employment, silicosis, coal miners’ pneumoconiosis, or
asbestosis. The award is payable up to a maximum of 130 weeks.
b. Has any
dust-induced occupational diseases. The award is payable up to a maximum of 130
weeks.
c. Specific to
firefighters or police officers, have contracted, in the course of employment,
cardiovascular, pulmonary, or respiratory disease. The award is payable up to a
maximum of 105 weeks.
2. It is the
policy of BWC that a change of occupation is only payable:
a. When a fire
fighter (paid or volunteer) or a police officer have contracted any of the
following conditions:
i.
Cardiovascular;
ii. Pulmonary; or
iii. Respiratory, in
the course of employment.
b. When an injured
worker, other than a fire fighter or police officer, has contracted any of the
following conditions in
the course of employment:
i.
Silicosis;
ii. Coal miners’ pneumoconiosis
(black lung);
iii. Asbestosis; or
iv. Any
dust-induced occupational disease.
3. It is the
policy of BWC that if an injured worker has received a change of occupation
award or has one of the occupational diseases in section IV.A.2. a. and b.,
that any requests for compensation, except for temporary total compensation,
permanent total compensation and death, shall be referred to the Ohio
Industrial Commission (IC).
4. It is the
policy of BWC to not pay a change of occupation award concurrently with:
a. Temporary total
disability; or
b. Permanent total
disability.
5. If the injured
worker has multiple allowed claims, they are entitled to only one change of
occupation award.
6. If the exposure
occurred before January 1, 1967, only the change of occupation award may be
paid to the injured worker. No other types of compensation are payable.
1. A request for change of occupation award must be filed on a Motion
(C-86) with supporting medical evidence.
2. To qualify for
the award and permit BWC to pay the change of occupation award, the injured
worker shall establish by appropriate evidence that:
a. They have contracted
in the course of employment one of the occupational
diseases identified in section IV. A.2.a. and b.;
and
b. They have been
medically advised that a change of occupation is recommended to substantially
decrease further exposure; and
c. They have
changed or shall change occupations to one in which the exposure is
substantially decreased.
3. It is the
policy of BWC, that this award may be made to an injured worker who continues
to work for the same employer as long as the job change substantially decreases
the injured worker’s exposure to the harmful agent.
1. It is the
policy of BWC to pay a change of occupation award to an injured worker meeting
the eligibility requirements listed in section IV.B. of this policy.
2. It is the
policy of BWC, that an injured worker who has established eligibility is
entitled for the first 30 weeks of compensation if they discontinue current
employment or changes employment to a job in which the exposure is
substantially reduced. For subsequent weeks:
a. An injured
worker who has contracted, in the course of employment, silicosis, coal miners’
pneumoconiosis, asbestosis, or any dust-induced occupational disease is only
eligible to receive an additional 100 weeks immediately following the
expiration of the first 30 weeks.
b. A firefighter
or police officer who has contracted, in the course of employment,
cardiovascular, pulmonary, or respiratory disease is only eligible to receive
an additional 75 weeks immediately following the expiration of the first 30
weeks.
c. In both
instances listed above (i.e., IV.C.2.a. and b.), the injured worker must submit
evidence to BWC on a:
i.
Wage
statement that documents the change of employment and loss of wages; or
ii. Wage loss
statement for job search documenting reasonable attempts to secure employment.
3. BWC staff shall
refer to section V.D. of the procedures for details on paying a change of
occupation award to eligible injured workers.
A.
General
Claim Note and Documentation Requirements
1. BWC staff shall
refer to the Standard Claim File Documentation and Altered Documents
policy and procedure for claim note and documentation requirements; and
2. Shall follow
any other specific instructions for claim notes and documentation included in
this procedure.
1. Claims services
staff shall:
a. Receive a
request on a C-86; and
b. Review
supporting documentation to determine if the injured worker has established
eligibility as outlined in the policy.
2. Claims services
staff shall issue a decision in one of two methods:
a. BWC Subsequent
order; or
b. Notice of
Referral (NOR) to the IC.
3. The BWC
Subsequent order shall contain:
a. A starting date
of the award (date injured worker quit/changed employment); and
b. Include the
ending date, if award is only for the first 30 weeks; and
c. An explanation
of the evidence on which the award was based in the add text box.
4. Claims services
staff shall refer to the Orders,
Waivers, Appeals and Hearings policy and procedure for additional
information.
1. Claims services
staff shall send a NOR to the IC when the evidence does not support the payment
of the award as requested.
2. The NOR shall
contain BWC’s recommendation and reason for the objection to the payment of the
award as requested.
3. Claims services
staff shall refer to the Notice
of Referral to the Industrial Commission policy and procedure for
additional information.
1. Claims services
staff shall refer to the Wages
policy and procedure for additional information, if wages need to be
established in the claim.
2. Claims services
staff shall pay the first 30 weeks after the date the employee discontinues or
changes the former job (initiating as of the date of the discontinuance or
change) at 50% of the statewide average weekly wage (SAWW) as of the date of occurrence
(DOO) per week.
3. Claims services
staff shall pay at 66 2/3% of the wage loss resulting directly from the change
of occupation, for the additional number of weeks as outlined in the policy.
This amount cannot be greater than one half of the SAWW as of the DOO.
a. Claims services
staff shall select the following in the claim:
i.
Indemnity
Payments;
ii. Click add; and
iii. Select Benefit
Type of Change of Occupation.
b. Claims services
staff shall enter the following in the claim:
i.
The
start date and number of weeks; and
ii. The manually
calculated rate in the Override Weekly Benefit Rate along with a comment.
1. Claims services
staff shall only pay a change of occupation award to eligible injured workers identified
in section IV.A.2.a. and b.
2. Claims services
staff shall send a NOR to the IC for a request for compensation, except for
temporary total disability, permanent total disability, and death if an injured
worker has received a change of occupation award or has one of the occupational
diseases outlined in section IV.A.1. and 2.