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Policy and Procedure Name:
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Disability Relief
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Policy #:
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CP-08-01
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Code/Rule Reference:
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R.C.
4123.343, R.C. 4123.63;
O.A.C.
4123-3-35
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Industrial Commission (IC) Resolution/Memo
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N/A
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Effective Date:
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02/26/24
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Approved:
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Shawn Crosby, Chief Operating Officer
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Origin:
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Claims Policy
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Supersedes:
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Policy # CP-08-01, effective 02/16/22
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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
Employee With A Disability
IV. POLICY
A. Disability
Relief and Qualifying Pre-Existing Conditions
B. Employer
and Claim Eligibility
C. Application
D. IW
Rights
E. Employer
Rights
V. PROCEDURE
A. General Claim Note and Documentation
Requirements
B. Disability Relief Application Processing
The purpose of this policy is to ensure BWC reduces costs to
an employer’s risk by charging a percentage of the qualifying claim’s costs to
the statutory surplus fund instead of to the employer’s experience when an
employer hires and retains employees with a qualifying pre-existing condition, disease,
or military service disability.
This policy applies to BWC Claims
Services, Legal, and Employer Services staff.
Employee With A Disability: For the purpose of this policy, an employee who has a pre-existing
physical or mental impairment, or both, whether congenital or due to an injury
or disease, such that the impairment constitutes a disability that interferes
with obtaining employment or reemployment and whose disability is due to any of
the diseases or conditions listed in IV.A.2.a-z of this policy.
1.
When an employee with a qualifying pre-existing condition, as defined in
R.C. 4123.343 or R.C. 4123.63, is injured, disabled, or dies as a result of an
injury or occupational disease sustained in the course of, or arising out of,
their employment and the employer believes that the pre-existing condition
delayed recovery or increased the costs of the claim, the employer may file an application
with BWC to have a percentage of a qualifying claim’s costs charged to the
surplus fund instead of to the employer’s experience.
2.
It is the policy of BWC to consider disability relief for an employer
when an injured worker (IW) has any of the following qualifying pre-existing
conditions:
a.
Epilepsy;
b. Diabetes;
c.
Cardiac disease;
d. Arthritis;
e.
Amputated foot, leg, arm or hand;
f.
Loss of sight of one or both eyes or partial loss of uncorrected vision
of more than seventy-five percent (75%) bilaterally;
g.
Residual disability from poliomyelitis;
h. Cerebral
palsy;
i.
Multiple sclerosis;
j.
Parkinson’s disease;
k.
Cerebral vascular accident (stroke);
l.
Tuberculosis;
m. Silicosis;
n. Psycho-neurotic
disability following treatment in a recognized medical or mental institution;
o. Hemophilia;
p. Chronic
osteomyelitis;
q. Ankylosis
of joints;
r.
Hyperinsulinism;
s.
Muscular dystrophies;
t.
Arteriosclerosis;
u. Thrombophlebitis;
v.
Varicose veins;
w. Cardiovascular
pulmonary or respiratory diseases of firefighters or police officers employed
by a municipal corporation or township as a regular member of a lawfully
constituted police or fire department;
x.
Coal miner’s pneumoconiosis (black lung disease);
y.
Disability with respect to an individual who has completed a
rehabilitation program conducted pursuant to sections R.C. 4121.61 through R.C.
4129.69; or
z.
Another qualifying preexisting injury pursuant to 4123.63.
3.
A disability relief award is not evidence to support a substantial
aggravation of that qualifying condition.
1.
Employers that are eligible for disability relief include:
a.
Public employer taxing districts;
b. Private
state-fund employers;
c.
Any employer who has been granted a previous disability relief; or
d. Certain
bankrupt employers as determined on a case-by-case basis.
2.
Employers that are ineligible for disability relief include:
a.
Non-complying and/or out-of-business employers;
b. Self-insuring
employers; or
c.
State agencies and universities.
3.
BWC will only consider an application for disability relief in claims
where the IW has received:
a.
Temporary total (TT) disability (or wages in lieu of TT);
b. Permanent
total disability;
c.
Scheduled loss/loss of use, facial disfigurement, or accrued benefits
paid under 4123.57(B); or
d. Death
benefits.
1.
Eligible employers or employer representatives must file an Application for Disability Relief (CHP-4A) form.
2.
The CHP-4A must be filed:
a.
With supporting medical evidence; and
b. While
the claim is within the employer’s experience, as follows:
i.
For private state-fund employer claims,
the CHP-4A must be filed by June 30th of the year:
a) No
more than six years from the year of the date of injury or occupational disease
if the date of injury (DOI) is between January 1st and June 30th.
b) No
more than seven years from the year of the DOI or occupational disease if the
DOI is between July 1st and December 31st.
ii.
For public employer taxing
district claims, the CHP-4A must be filed by December 31st of
the year no more than six years from the year of the DOI or occupational
disease.
iii.
For a claim involving a private state
fund employer or a public employer taxing district employer participating in a
retrospective rating plan, the application must be filed within the time provided
immediately above in Sections IV.C.2.b.i and ii, as applicable.
1.
An employer's application for disability relief does not affect the
rights of the IW to receive any benefits or compensation.
2.
The IW is not required to provide information to an employer about any
pre-existing conditions.
1.
Upon filing the CHP-4A, the employer has the right to an informal
conference with BWC. Informal conferences may be in person, by phone, or
via any other remote technology as circumstances dictate, or as agreed by the
parties.
2.
The employer may request withdrawal of the application at any time,
either in writing or verbally.
3.
Settlement of a claim does not affect the employer’s right to have a
disability relief application considered.
4.
Pursuant to R.C. 4123.511, the employer may appeal a BWC Order on
disability relief to the Ohio Industrial Commission (IC).
1.
BWC staff will refer to the Standard
Claim File Documentation and Altered Documents policy and procedure for
claim note and documentation requirements; and
2.
Must follow any other specific instructions for claim notes and
documentation included in this procedure.
1.
If a CHP-4A is not directly filed with BWC’s Legal Division, any BWC staff
who receives a CHP-4A must immediately, without imaging the document(s) into
the claim, date stamp and forward the CHP-4A with supporting documentation to:
BWC Legal Division
Disability Relief
Unit, L-26
30 W. Spring Street
Columbus, Ohio 43215-2256
2.
Application Review
a.
Legal staff will complete an initial
review of the CHP-4A and supporting evidence to ensure:
i.
The employer is eligible to receive
relief, as described in Section IV.B of this policy;
ii.
The application is filed while the
claim is within the employer’s experience;
iii.
The employer had coverage on the DOI;
b. That BWC has awarded compensation to the IW for:
i.
TT disability (or wages in lieu
of TT);
ii.
Scheduled loss/loss of use, facial disfigurement, or accrued
benefits paid under 4123.57(B);
iii.
Permanent total disability; or
iv.
Death benefits.
c.
The employer has supplied medical
evidence that:
i.
The employee suffered from a qualifying pre-existing condition listed in
Section IV.A.2.a-z of this policy;
ii.
The condition pre-existed the injury, occupational disease, or death
(e.g., evidence that the employee was hospitalized or obtained extensive
medical treatment for the qualifying pre-existing condition);
iii. Supports
the allegation that:
a) The
injury, occupational disease, or death would not have occurred but for the employee’s
qualifying pre-existing condition; or
b) The
injury, occupational disease, or death was caused, in part, through aggravation
of the qualifying pre-existing condition; or
c)
The qualifying pre-existing condition delayed recovery or increased the
cost of treating the allowed conditions in the claim.
d. Legal
staff will review each claim for:
i.
Pending BWC or IC applications;
ii.
Previous award denied or granted by the IC or BWC for the same
disability;
iii. Motions or
appeals; and
iv. If
applicable, other related claims.
e.
Legal staff will deny or dismiss a
CHP-4A for an allowed claim not meeting eligibility criteria outlined in this
policy.
f.
If the IW files for an additional
condition in the claim being reviewed, Legal staff will continue to process the
CHP-4A. The filing of an additional condition does not stay the request for
disability relief.
3.
Disability Relief Conference
a.
Legal staff will schedule an informal
determination conference and serve notice of the upcoming conference
electronically or by mail to the employer and the employer representative, if
applicable, giving a minimum of two weeks notification, unless the employer
waives this requirement.
b.
The BWC legal representative assigned
to hold the conference and the employer and/or the employer representative will
meet in a manner that is mutually agreed upon by all parties to discuss the
merits of the application.
i.
If all parties reach agreement at the
time of the meeting, the employer or the employer representative may sign
a Waiver of Appeal Period (C-108) to have the order processed immediately.
ii.
If the parties do not reach agreement,
BWC may not process the order until after the 14-day appeal period expires.
4.
Determination
a.
Legal Staff Responsibilities
i.
Once legal staff has made a
determination on the disability relief, legal staff will issue an order.
ii.
Legal staff must send a copy of the
order to:
a)
The employer;
b)
The employer’s representative; and
c)
The risk file.
iii.
The disability relief application
packet and order are automatically imaged into the claims management system,
initiating a work item for claims services staff.
b.
Claims services staff will enter the
disability percentage and the condition for which the disability percentage was
awarded in the relevant fields found under the Claim
Details>Occurrence>Profiles tab as follows:
i.
After the IC order is final, if an
appeal is filed;
ii.
At the conclusion of the appeal period,
if no appeal is filed; or
iii.
Immediately, upon receipt of a waiver
of the appeal period.