Ohio Administrative Code › Title 4123 - Bureau of Workers' Compensation › Chapter 4123-17 - General Rating for the State Insurance Fund › Section 4123-17-59 - Fifteen thousand dollar medical-only program

Current through all regulations passed and filed through July 1, 2024
(A)
			 Any employer who is paying premiums to the state insurance fund and whose
			 coverage is in force may elect to participate in the fifteen thousand dollar
			 medical-only program as provided in section
			 4123.29 of the Revised Code. No
			 formal application is required; however, an employer must elect to participate
			 . Once an employer
			 has elected to participate in the program, the employer will be responsible for
			 all bills in all medical-only claims with a date of injury the same or later
			 than the election date, and the employer agrees
			 to pay bills within thirty days of receipt of the bill, unless the employer
			 notifies the bureau of workers' compensation
			 within fourteen days of receipt of the notification of a claim being filed that
			 it does not wish to pay the bills in that claim, or the employer notifies the
			 bureau that the fifteen thousand dollar maximum has been paid, or the employer
			 notifies the bureau of the last day of service on which it will be responsible
			 for the bills in a particular medical-only claim.
(B) Employers may pay bills only on any
			 alleged medical-only injury. The provisions of this program and rule shall not
			 apply to claims in which an employer with knowledge of a claimed compensable
			 injury or occupational disease, has paid wages in lieu of compensation or total
			 disability. Payment of a bill by an employer does not waive the bureau's right
			 to adjudicate the claim, nor does it waive the employer's right to contest the
			 claim should a claim be filed.
(C)
			 This program in no way supersedes the right of any injured worker to file a
			 workers' compensation claim with the bureau.
(D) An employer or its agent may elect to pay
			 to the injured worker, or the provider on behalf
			 of the injured worker, the first fifteen thousand
			 dollars of a medical-only claim. Employers may elect which medical-only claims
			 they do not wish to cover under this program.
(1) An employer electing to pay bills in its
			 employees' medical-only claims is responsible for all bills in a claim until
			 the fifteen thousand dollar maximum is reached and the employer provides notice
			 to the bureau that the employer has paid the first fifteen thousand dollars of
			 the bills in the claim by providing the bureau the date of service of the bill
			 which reached the fifteen thousand dollar maximum, or the employer provides
			 notice to the bureau that it no longer wishes to be responsible for the bills
			 in a particular claim by providing the bureau the last date of service that it
			 will pay. The bureau will process all related bills received after the
			 withdrawal notification date.
(2)
			 If the fifteen thousand dollar maximum has not been reached and the payment of
			 a bill will exceed the fifteen thousand dollar maximum, the employer should pay
			 that portion of the bill that will bring the payment to the fifteen thousand
			 dollar maximum and inform the provider to bill the bureau for the remainder of
			 the bill. The employer should then notify the bureau that the first fifteen
			 thousand dollars has been paid, and provide proof of such payment and copies of
			 all bills paid, in the proper billing format, to the bureau. The bureau will
			 then be responsible for processing all future bills.
(3) The employer cannot elect to pay only
			 certain bills for a claim and submit other bills in that claim to the bureau
			 for payment.
(4) Once an employer
			 has elected to pay bills in medical-only claims under this program, the
			 employer must pay all bills under this program within thirty days of receipt of
			 the bill. The employer shall provide copies of the bills paid in the claim, in
			 the proper billing format, to the bureau and the injured worker or the injured
			 worker's representative upon request. Upon written request from the bureau, the
			 employer shall provide documentation to the bureau of all medical-only bills
			 that they are paying directly. Such requests from the bureau may not be made
			 more frequently than on a semiannual basis. Failure to provide such
			 documentation to the bureau within thirty days of receipt of the request may
			 result in the employer's forfeiture of participation in the program for such
			 injury.