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Policy and Procedure Name:
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Interstate Jurisdiction
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Policy #:
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CP-09-07
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Code/Rule Reference:
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R.C. 4123.54, OAC 4123-17-23
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Effective Date:
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02/28/20
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Approved:
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Ann M. 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-09-07, effective 11/14/16 and Procedure # CP-09-07.PR.1,
effective 11/14/16
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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
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
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.
This policy applies to BWC claims services staff.
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.
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.
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.
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.
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.
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.
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 temporarily 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.
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.
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.
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.