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(A) Within seven days after receipt of any claim under this chapter,
the bureau of workers' compensation shall notify the claimant and the employer of the
claimant of the receipt of the claim and of the facts alleged therein. If the bureau
receives from a person other than the claimant written or telecommunicated information
indicating that an injury or occupational disease has occurred or been contracted with
may be compensable under this chapter, the bureau shall notify the employee and the
employer of the information. If the information is provided by any method of
telecommunication, the person providing the information shall provide written
verification of the information to the bureau according to division (E) of section
4123.84 of the Revised Code. The receipt of the information in writing, or if by a
method of telecommunications, the written verification, and the notice by the bureau
shall be considered an application for compensation under section 4123.84 or 4123.85
of the Revised Code provided that the conditions of division (E) of section 4123.84 of
the Revised Code apply to information provided by a method of telecommunication.
Upon receipt of a claim, the bureau shall advise the claimant of the claim number
assigned and the claimant's right to representation in the processing of a claim or to
elect no representation. If the bureau determines that a claim is determined to be a
compensable lost-time claim, the bureau shall notify the claimant and the employer of
the availability of rehabilitation services. No bureau or industrial commission
employee shall directly or indirectly convey any information in derogation of this
right. This section shall in no way abrogate the bureau's responsibility to aid and
assist a claimant in the filing of a claim and to advise the claimant of the claimant's
rights under the law. The administrator of workers' compensation shall assign all
claims and investigations to the bureau service office from which investigation and
determination may be made most expeditiously. The bureau shall investigate the facts
concerning an injury or occupational disease and ascertain such facts in whatever
manner is most appropriate and may obtain statements of the employee, employer,
attending physician, and witnesses in whatever manner is most appropriate.
(B)(1) Except as provided in division (B)(2) of this section, in
claims other than those in which the employer is a self-insuring employer, if the
administrator determines under division (A) of this section that a claimant is or
is not entitled to an award of compensation or benefits, the administrator shall
issue an order no later than twenty-eight days after the sending of the notice
under division (A) of this section, granting or denying the payment of the
compensation or benefits, or both as is appropriate to the claimant. Notwithstanding
the time limitation specified in this division for the issuance of an order, if a
medical examination of the claimant is required by statute, the administrator
promptly shall schedule the claimant for that examination and shall issue an order
no later than twenty-eight days after receipt of the report of the examination. The
administrator shall notify the claimant and the employer of the claimant and their
respective representatives in writing of the nature of the order and the amounts of
compensation and benefit payments involved. The employer or claimant may appeal the
order pursuant to division (C) of this section within fourteen days after the date
of the receipt of the order. The employer and claimant may waive, in writing, their
rights to an appeal under this division.
(2) Notwithstanding the time limitation specified in division (B)(1) of
this section for the issuance of an order, if the employer certifies a claim for
payment of compensation or benefits, or both, to a claimant, and the administrator
has completed the investigation of the claim, the payment of benefits or compensation,
or both, as is appropriate, shall commence upon the later of the date of the
certification or completion of the investigation and issuance of the order by the
administrator, provided that the administrator shall issue the order no later than
the time limitation specified in division (B)(1) of this section.
(3) If an appeal is made under division (B)(1) or (2) of this section, the
administrator shall forward the claim file to the appropriate district hearing officer
within seven days of the appeal. In contested claims other than state fund claims, the
administrator shall forward the claim within seven days of the administrator's
receipt of the claim to the commission, which shall refer the claim to an
appropriate district hearing officer for a hearing in accordance with division (C)
of this section.
(C) If an employer or claimant timely appeals the order of the
administrator issued under division (B) of this section or in the case of other
contested claims other than state fund claims, the commission shall refer the claim
to an appropriate district hearing officer according to rules the commission adopts
under section 4121.36 of the Revised Code. The district hearing officer shall notify
the parties and their respective representatives of the time and place of the hearing.
The district hearing officer shall hold a hearing on a disputed issue or claim within
forty-five days after the filing of the appeal under this division and issue a decision
within seven days after holding the hearing. The district hearing officer shall notify
the parties and their respective representatives in writing of the order. Any party
may appeal an order issued under this division pursuant to division (D) of this section
within fourteen days after receipt of the order under this division.
(D) Upon the timely filing of an appeal of the order of the district
hearing officer issued under division (C) of this section, the commission shall refer
the claim file to an appropriate staff hearing officer according to its rules adopted
under section 4121.36 of the Revised Code. The staff hearing officer shall hold a
hearing within forty-five days after the filing of an appeal under this division and
issue a decision within seven days after holding the hearing under this division. The
staff hearing officer shall notify the parties and their respective representatives
in writing of the staff hearing officer's order. Any party may appeal an order issued
under this division pursuant to division (E) of this section within fourteen days
after receipt of the order under this division.
(E) Upon the filing of a timely appeal of the order of the staff
hearing officer issued under division (D) of this section, the commission or a
designated staff hearing officer, on behalf of the commission, shall determine whether
the commission will hear the appeal. If the commission or the designated staff hearing
officer decides to hear the appeal, the commission or the designated staff hearing
officer shall notify the parties and their respective representatives in writing of
the time and place of the hearing. The commission shall hold the hearing within
forty-five days after the filing of the notice of appeal and, within seven days after
the conclusion of the hearing, the commission shall issue its order affirming,
modifying, or reversing the order issued under division (D) of this section. The
commission shall notify the parties and their respective representatives in writing
of the order. If the commission or the designated staff hearing officer determines
not to hear the appeal, within fourteen days after the filing of the notice of appeal,
the commission or the designated staff hearing officer shall issue an order to that
effect and notify the parties and their respective representatives in writing of that
order. Except as otherwise provided in this chapter and Chapters 4121., 4127., and
4131. of the Revised Code, any party may appeal an order issued under this division
to the court pursuant to section 4123.512 of the Revised Code within sixty days after
receipt of the order, subject to the limitations contained in that section.
(F) Every notice of an appeal from an order issued under divisions (B),
(C), (D), and (E) of this section shall state the names of the claimant and employer,
the number of the claim, the date of the decision appealed from, and the fact that the
appellant appeals therefrom.
(G) All of the following apply to the proceedings under divisions
(C), (D), and (E) of this section:
(1) The parties shall proceed promptly and without continuances except for
good cause;
(2) The parties, in good faith, shall engage in the free exchange of
information relevant to the claim prior to the conduct of a hearing according to
the rules the commission adopts under section 4121.36 of the Revised Code;
(3) The administrator is a party and may appear and participate at all
administrative proceedings on behalf of the state insurance fund. However, in
cases in which the employer is represented, the administrator shall neither
present arguments nor introduce testimony that is cumulative to that presented or
introduced by the employer or the employer's representative. The administrator
may file an appeal under this section on behalf of the state insurance fund;
however, except in cases arising under section 4123.343 of the Revised Code, the
administrator only may appeal questions of law or issues of fraud when the
employer appears in person or by representative.
(H) Except as provided in section 4121.63 of the Revised Code and
division (J) of this section, payments of compensation to a claimant or on behalf
of a claimant as a result of any order issued under this chapter shall commence
upon the earlier of the following:
(1) Fourteen days after the date the administrator issues an order under
division (B) of this section, unless that order is appealed;
(2) The date when the employer has waived the right to appeal a decision
issued under division (B) of this section;
(3) If no appeal of an order has been filed under this section or to a court
under section 4123.512 of the Revised Code, the expiration of the time
limitations for the filing of an appeal of an order;
(4) The date of receipt by the employer of an order of a district hearing
officer, a staff hearing officer, or the industrial commission issued under
division (C), (D), or (E) of this section.
(I) No medical benefits payable under this chapter or Chapter
4121., 4127., or 4131. of the Revised Code are payable until the earlier of the
following:
(1) The date of the issuance of the staff hearing officer's order under
division (D) of this section;
(2) The date of the final administrative or judicial determination.
(J) Upon the final administrative or judicial determination under
this section or section 4123.512 of the Revised Code of an appeal of an order to
pay compensation, if a claimant is found to have received compensation pursuant
to a prior order which is reversed upon subsequent appeal, the claimant's employer,
if a self-insuring employer, or the bureau, shall withhold from any amount to which
the claimant becomes entitled pursuant to any claim, past, present, or future,
under Chapter 4121., 4123., 4127., or 4131. of the Revised Code, the amount of
previously paid compensation to the claimant which, due to reversal upon appeal,
the claimant is not entitled, pursuant to the following criteria:
(1) No withholding for the first twelve weeks of temporary total disability
compensation pursuant to section 4123.56 of the Revised Code shall be made;
(2) Forty per cent of all awards of compensation paid pursuant to sections
4123.56 and 4123.57 of the Revised Code, until the amount overpaid is refunded;
(3) Twenty-five per cent of any compensation paid pursuant to section 4123.58
of the Revised Code until the amount overpaid is refunded;
(4) If, pursuant to an appeal under section 4123.512 of the Revised Code, the
court of appeals or the supreme court reverses the allowance of the claim, then no
amount of any compensation will be withheld. The administrator and self-insuring
employers, as appropriate, are subject to the repayment schedule of this division
only with respect to an order to pay compensation that was properly paid under a
previous order, but which is subsequently reversed upon an administrative or
judicial appeal. The administrator and self-insuring employers are not subject to,
but may utilize, the repayment schedule of this division, or any other lawful means,
to collect payment of compensation made to a person who was not entitled to the
compensation due to fraud as determined by the administrator or the industrial
commission.
(K) If a staff hearing officer or the commission fails to issue a
decision or the commission fails to refuse to hear an appeal within the time periods
required by this section, payments to a claimant shall cease until the staff hearing
officer or commission issues a decision or hears the appeal, unless the failure was
due to the fault or neglect of the employer or the employer agrees that the payments
should continue for a longer period of time.
(L) Except as otherwise provided in this section or section
4123.522 of the Revised Code, no appeal is timely filed under this section unless
the appeal is filed with the time limits set forth in this section.
(M) No person who is not an employee of the bureau or commission
or who is not by law given access to the contents of a claims file shall have a
file in the person's possession.
(N) Upon application of a party who resides in an area in which an
emergency or disaster is declared, the industrial commission and hearing officers
of the commission may waive the time frame within which claims and appeals of
claims set forth in this section must be filed upon a finding that the applicant
was unable to comply with a filing deadline due to an emergency or a disaster.
As used in this division:
(1) "Emergency" means any occasion or instance for which the
governor of Ohio or the president of the United States publicly declares an
emergency and orders state or federal assistance to save lives and protect
property, the public health and safety, or to lessen or avert the threat of a
catastrophe.
(2) "Disaster" means any natural catastrophe or fire, flood, or
explosion, regardless of the cause, that causes damage of sufficient magnitude
that the governor of Ohio or the President of the United States, through a public
declaration, orders state or federal assistance to alleviate damage, loss,
hardship, or suffering that results from the occurrence.
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