Ohio Administrative Code › Title 4123 - Bureau of Workers' Compensation › Chapter 4123-3 - Claims Procedure › Section 4123-3-11 - Reports of payments by self-insuring employers

Current through all regulations passed and filed through July 1, 2024
(A) During the continuance of temporary total
			 disability, temporary partial disability, or wage loss compensation caused by
			 an injury or occupational disease, the employer shall, at the request of the
			 bureau of workers' compensation or the industrial commission at any time or at
			 the request of the claimant or claimant's representative where the issue of
			 compensation is pending in a workers' compensation hearing or adjudication
			 matter, file a report of compensation payments with the bureau showing the
			 amount and type of compensation paid to such employee during the preceding
			 period. The report shall indicate the date when the first installment of the
			 type of compensation reported was paid.
(B) In the event an injury or occupational
			 disease results in a disability compensable under division (A) or
(B) of section
			 4123.57 of the Revised Code, and
			 an agreement has been entered into between the employee and the employer as to
			 the compensation to be paid for such permanent partial disability, the
			 agreement shall state when the first installment of such compensation is to be
			 paid. Such agreement shall be signed by the employee and employer and shall be
			 filed with the bureau as soon as it has been completed. Such agreement shall be
			 accompanied by a report from the attending physician which shall indicate the
			 extent of the permanent partial disability sustained.
(C) In cases of compensable death claims,
			 where the employer and the dependents or legal representatives of a deceased
			 employee agree that the death is compensable, and there being no question of
			 apportionment of death benefits, they enter into an agreement in writing as to
			 the benefits which are to be paid; such agreement shall be reported by the
			 employer. It shall indicate the date of the first installment of payment, the
			 weekly rate of death benefits, the period of time over which such benefits will
			 be paid (lifetime or specific dates) and the total amount of benefits in cases
			 where it is known. Such agreement shall be signed by the employer and the
			 dependent, dependents, or legal representatives and shall be filed with the
			 bureau within one month of the date of execution of the agreement. Such
			 agreement shall include provision for the payment of appropriate funeral,
			 medical, hospital and other expenses. Subsequent reports of the payment of
			 death benefits shall be filed with the bureau at the request of the bureau or
			 the commission at any time or at the request of the claimant or claimant's
			 representative where the issue of compensation is pending in a workers'
			 compensation hearing or adjudication matter. Should there be a change in death
			 benefits as a result of changes in the dependency status of the recipients,
			 employer's reports shall reflect same. In cases of compensable death claims,
			 where the employer and the dependents or legal representatives of a deceased
			 employee agree that the death is compensable but where there is a question of
			 apportionment, the self-insuring employer may choose to pay death benefits
			 before a hearing at the industrial commission. The first such payment should
			 indicate to the beneficiaries that because there is a question of apportionment
			 among the surviving spouse, dependent children, or other dependents, the
			 commission must issue an order apportioning the payment; therefore, payments
			 until such order issues are subject to an adjustment in accordance with the
			 apportionment ordered by the commission among the beneficiaries at such time as
			 the apportionment order issues. In other death claims approved for payment by
			 the industrial commission or its hearing officers, the employer shall report
			 payments in the same general manner as indicated above.
(D) In all claims, the self-insuring employer
			 shall, upon completion of the payment of compensation and benefits, report that
			 fact to the bureau at the request of the bureau or the commission at any time
			 or at the request of the claimant or claimant's representative where the issue
			 of compensation is pending in a workers' compensation hearing or adjudication
			 matter indicating the dates of the payment of the first and last installments
			 of compensation, and the total amount of each type paid, together with the
			 total amounts expended for benefits other than compensation according to type
			 of benefit.
(1) Such report shall be signed
			 by the employer and the employee or his or her dependents or their legal
			 representatives as the circumstances may require.
(2) Upon receipt of such report by the
			 bureau, it shall be examined to determine whether or not the payments made have
			 been in conformity with the provisions of the workers' compensation law. If it
			 is found that the reported payments do conform to the provisions of the
			 workers' compensation law, the same shall be approved by the bureau and the
			 employer shall be advised thereof. If it is found that the reported payments do
			 not conform, the bureau shall notify the employer of that fact indicating the
			 further payment payments that are to be made. The employer shall make such
			 payments and file a revised report with the bureau.
(3) If, for any reason, it is impossible for
			 the employer to promptly file a report of payments or an agreement as to
			 compensation paid or to be paid, the employer shall immediately report that
			 fact and the reason therefor to the bureau. Failure to do so shall be
			 sufficient reason for the administrator to take such action as may be
			 indicated.
(E) Where
			 compensation has been ordered paid or where the employee and employer have
			 agreed upon the compensation to be paid, request to the bureau may be made by
			 either the employer, the employee, or the employee's dependents for
			 authorization to pay all or part of the unpaid balance of the award in one or
			 more lump sum payments.
(F)
			 Whenever a self-insured employer that is a professional sports franchise
			 domiciled in Ohio makes payment pursuant to the terms of a contract of hire or
			 a collective bargaining agreement during a period of disability resulting from
			 the injury or occupational disease, the self-insurer shall report such payments
			 on the same basis as required in paragraph (A) of this rule. The total amount
			 of such payments, the period of disability for which those payments were made,
			 and the amount such payments exceed the compensation that was due for that
			 period shall be reported. The amount such payments exceed the compensation
			 payable or, in the event no compensation was payable, the total amounts of such
			 payments, shall be considered advanced payments and shall be applied to offset
			 future payments of compensation for disability under sections
			 4123.56 to
			 4123.58 of the Revised Code. The
			 self-insurer shall report these offsets on the same basis as required in
			 paragraph (A) of this rule. Offsets shall be made only in cases where the
			 employee's application for compensation is pending on or after August 22, 1986.