Ohio § 4123.511

§ 4123.511.

(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 facsimile

information or information communicated verbally over the telephone indicating that

an injury or occupational disease has occurred or been contracted which may be compensable

under this chapter, the bureau shall notify the employee and the employer of the information.  If the information is provided verbally over the telephone, 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 facsimile, or if initially by telephone,

the subsequent 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 verbally over the telephone.  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

in whatever manner is most appropriate from any of the following:  employee;  employer;

attending physician, certified nurse-midwife, clinical nurse specialist, or certified

nurse practitioner;  and witnesses. The administrator, with the advice and consent of the bureau of workers' compensation

board of directors, may adopt rules that identify specified medical conditions that

have a historical record of being allowed whenever included in a claim.  The administrator may grant immediate allowance of any medical condition identified

in those rules upon the filing of a claim involving that medical condition and may

make immediate payment of medical bills for any medical condition identified in those

rules that is included in a claim.  If an employer contests the allowance of a claim involving any medical condition

identified in those rules, and the claim is disallowed, payment for the medical condition

included in that claim shall be charged to and paid from the surplus fund created

under section 4123.34 of the Revised Code . (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 industrial

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 expiration of the period in which an appeal

of the order of the staff hearing officer may be filed as provided in division (D)

of this section, 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 (K) 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) Except as otherwise provided in division (B) of section 4123.66 of the Revised Code , payments of medical benefits payable under this chapter or Chapter 4121., 4127.,

or 4131. of the Revised Code shall commence upon 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) The administrator shall charge the compensation payments made in accordance with

division (H) of this section or medical benefits payments made in accordance with

division (I) of this section to an employer's experience immediately after the employer

has exhausted the employer's administrative appeals as provided in this section or

has waived the employer's right to an administrative appeal under division (B) of

this section, subject to the adjustment specified in division (H) of section 4123.512 of the Revised Code . (K) 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. (L) 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. (M) 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. (N) 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. (O) 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.