Ohio Administrative Code › Title 4123 - Bureau of Workers' Compensation › Chapter 4123-3 - Claims Procedure › Section 4123-3-08 - Preparation and filing of applications for compensation and/or benefits

Current through all regulations passed and filed through July 1, 2024
(A) Preparation and
			 execution of forms.
(1) The "First Report of
			 Injury" form (FROI-1) or equivalent for applying for payment from the state
			 insurance fund due to an injury, occupational disease, or death may be
			 completed by the employee, employer, medical provider, or other interested
			 party. If someone other than the employee submits a FROI-1 or equivalent, the
			 bureau may contact the employee to attempt to verify that the employee wishes
			 to pursue the application. To accept or deny the validity of the claim, the
			 employer may complete and sign the form at the designated point or may use a
			 separate writing, telephone, or other means of telecommunication.
(2) The FROI-1 for applying for payment from
			 a self-insuring employer shall be completed, signed by the employee, and
			 returned to the self-insuring employer. In situations where there is no
			 prescribed form, a notice in writing shall be given in a manner sufficient to
			 inform that a claim for benefits is being presented.
(3) An injured or disabled employee who is a
			 minor (under eighteen years of age) shall file a claim in his or her own name
			 and right. A report of injury signed by such minor employee shall be sufficient
			 to initiate proceedings for compensation and/or benefits.
(4) In the event the injured or disabled
			 employee is unable to complete the first report of injury by reason of physical
			 or mental disability, the report may be completed and filed by the employee's
			 spouse, next friend, the guardian of the employee, or the employee's employer.
			 In claims for death benefits where the dependents are a spouse and one or more
			 minor children, it shall be sufficient for the spouse to make application for
			 benefits on behalf of the spouse and the minor children. In the event a
			 dependent minor child has a guardian of the person other than the spouse of the
			 deceased, such guardian shall execute the report on behalf of such minor child.
			 If there is no spouse surviving, the report on behalf of the dependent minor
			 children, or children who are mentally or physically incapacitated, may be
			 filed by a guardian or next friend of such children.
(5) It shall be the duty of every employer to
			 assist injured or disabled employees in the preparation and submission of
			 reports for compensation and/or benefits. In the event that the employer
			 refuses, neglects or unduly delays the completion of a report, the report may
			 be filed without the part pertaining to the employer having been completed. The
			 fact of refusal or neglect should be noted upon the report or with it by way of
			 separate letter.
(6) In cases where
			 the death of the employee is not the result of injury or occupational disease,
			 an application for accrued compensation may be made as provided in sections
			 4123.57
			 and
			 4123.60
			 of the Revised Code.
(7)
			 Application for payment of the balance of percentage permanent partial
			 disability compensation, awarded under division (A) of section
			 4123.57
			 of the Revised Code prior to the employee's death, shall be made by the injured
			 employee's dependents. The application may be filed whether the death was
			 related or unrelated to an industrial injury or occupational disease.