Ohio Administrative Code › Title 4123 - Bureau of Workers' Compensation › Chapter 4123-3 - Claims Procedure › Section 4123-3-10 - Awards

Current through all regulations passed and filed through July 1, 2024
(A) Compensation
			 check issuance, delivery and endorsement.
(1)
			 Definition of claimant.
As used in this rule the word "claimant" shall apply to an
				employee who sustained an injury or contracted an occupational disease in the
				course of and arising out of employment, to the dependent of a deceased
				employee, as well as to any person who was awarded compensation under the Ohio
				Workers' Compensation Act.
(2) Time limit for issuance.
(a) Any order, finding or decision of the
			 bureau, the industrial commission, or its hearing officers wherein payment of
			 compensation is to be made shall be promptly forwarded to the appropriate
			 department of the bureau charged with the duty of making the payment, or in the
			 case of a selfinsuring employer to the personnel of such employer charged with
			 the disbursement of funds in industrial claims.
(b) The initial payment of the bureau in
			 payment of compensation under an order shall be issued within the time limits
			 set forth in division (H) of section
			 4123.511
			 of the Revised Code. The payment will include compensation accrued and due the
			 claimant at that time. Further payment of compensation due under that order
			 shall be made by the bureau in biweekly installments. In self-insuring
			 employers' claims payment will be made in accordance with applicable laws and
			 rules.
(3) To whom paid.
(a) Awards of compensation shall be made
			 payable only to the claimant as defined in paragraph (A)(1) of this rule,
			 except in cases of lump sum advancements, or where the claimant is an
			 incompetent person or is a minor awarded a lump sum of compensation, or in the
			 case of attorneys fees as provided in paragraph (A)(7) of this rule.
(b) If the claimant is an incompetent person,
			 payment shall be issued payable and shall be mailed to the claimant's legally
			 appointed guardian upon the receipt of documentary proof establishing the
			 existence of such guardianship.
(c)
			 If the claimant is a minor and was awarded a lump sum of compensation, such sum
			 shall be paid to the claimant's legally appointed guardian or in accordance
			 with section
			 2111.05
			 of the Revised Code.
(d) If the
			 bureau or the industrial commission determines that it is to the best interest
			 of the claimant that a guardian of the property be appointed to receive the
			 benefits payable, payment shall be withheld until such guardian is
			 appointed.
(4) Delivery
			 of the bureau's payment to claimant and exceptions.
The standard method of delivering payment to a claimant or
				benefit recipient shall be by electronic fund transfer, as provided in
				paragraph (D) of this rule. Where the bureau issues a check, the bureau's
				checks payable to a claimant shall be mailed to the claimant's address, as
				officially recorded in the claim file, except as provided in this
				paragraph:
(a) The mailing of the
			 bureau's compensation check to a place requested by the claimant in an
			 authorization to receive workers' compensation payment or equivalent, executed
			 in accordance with paragraph (A)(5) of this rule, must be approved by the
			 administrator or the administrator's designee, or by the industrial commission
			 or designee.
(b) Checks for lump
			 sum settlements or lump sum advancements shall be disbursed in accordance with
			 instructions of the bureau or industrial commission, as indicated in the order
			 approving such advancements.
(c) In
			 cases of advancements made by the employer during a period of disability, the
			 bureau's checks shall be delivered in accordance with rule
			 4123-5-20
			 of the Administrative Code.
(5) Personal pick-up of the bureau's checks
			 by a claimant and/or by parties other than a claimant.
(a) Provided approval has been given by a
			 member of the industrial commission or designee, the administrator of the
			 bureau of workers' compensation or the administrator's designee, or a hearing
			 officer, a claimant, an attorney for a claimant, or any other person authorized
			 by a claimant, may pickup a compensation check issued by the bureau.
(b) When a claimant authorizes another person
			 to pick up the claimant's compensation check, the authorization shall be an
			 authorization to receive workers' compensation payment or equivalent. On all
			 types of compensation, other than percentage of permanent partial compensation,
			 the authorization must be filed prior to or at the hearing, or prior to the
			 date of payment of the award of compensation, whether the award of compensation
			 was made at a hearing or without a hearing. For authorization to receive
			 compensation checks in connection with permanent partial disability
			 applications and applications for increases thereof, the authorization must be
			 filed with the application, with the agreement of permanent partial disability,
			 with the election, or with the industrial commission at formal hearing or not
			 later than prior to the date of mailing of the findings resulting from the
			 formal hearing.
(c) The warrant
			 will be made payable to the claimant and sent in care of the
			 attorney/representative identified on the authorization to receive workers'
			 compensation payment or equivalent. The warrant shall be mailed to the address
			 that the claimant indicated on the request, or at a place designated by the
			 administrator.
(d) A person
			 authorized to pick-up the check at the bureau shall furnish adequate
			 identification and sign a dated receipt verifying acceptance of the
			 check.
(e) In self-insuring
			 employers' claims, the claimant and the employer may agree on check delivery or
			 pick-up, such agreement to be based on the same principles as outlined in this
			 rule.
(6) Endorsement of
			 checks and procedure in the event of claimant's death.
(a)
										 Checks payable to
			 a claimant's guardian must be endorsed by said
			 guardian in the guardian's official capacity.
(b) When a claimant dies prior to endorsing a
			 compensation check or accessing an electronic benefit payment, no one has the
			 right to endorse and cash such check or access the electronic benefit funds.
			 Each check payable to a claimant shall bear on the reverse side, immediately
			 above the point specified for endorsement, the standard printed certification
			 explaining the limitations and penalties for false endorsements, as required by
			 the department of administrative services for state warrants and checks.
Checks that cannot be endorsed because the claimant is deceased
				must be returned to the bureau's benefits payable section, at the address
				designated by the administrator, by the party handling the claimant's affairs,
				notifying the bureau of the date of death, if known. Upon receipt of
				information of claimant's death, payment of compensation shall be terminated
				and proper entry made in the records of the bureau.
(7) Procedure for a lump sum
			 payment and attorney fees where the claimant is an obligor for child support
			 payments.
(a) If a claimant is entitled to a
			 lump sum payment of one hundred and fifty dollars or greater and the claimant
			 is an obligor for child support payments, prior to issuing the lump sum
			 payment, the bureau shall notify the claimant and the claimant's attorney in
			 writing that the claimant is subject to a support order. The bureau shall hold
			 the lump sum payment for thirty days, pending application by the attorney for
			 attorney fees as provided in paragraph (A)(7)(b) of this rule.
(b) The bureau shall instruct the claimant's
			 attorney in writing to file a copy of the fee agreement signed by the claimant,
			 along with an affidavit signed by the attorney setting forth the amount of the
			 attorney's fee with respect to that lump sum payment award to the claimant and
			 the amount of all necessary expenses, along with documentation of those
			 expenses, incurred by the attorney with respect to obtaining that lump sum
			 award. The attorney shall file the fee agreement and affidavit with the bureau
			 within thirty days after the date the bureau sends the notice under paragraph
			 (A)(7)(a) of this rule.
(i) The attorney shall
			 file a copy of the fee agreement that clearly establishes the fee for the lump
			 sum payment in the claim. The attorney's failure to file a copy of the fee
			 agreement shall be a reason for the bureau to reject the application.
(ii) The attorney shall file an affidavit in
			 the form provided by the bureau. The attorney may complete the affidavit on the
			 form provided by the bureau or in an affidavit that contains at least all of
			 the elements of the form established by the bureau. The affidavit shall be
			 notarized. The attorney's failure to file an affidavit in the form proscribed
			 by the bureau or failure to obtain a notary signature shall be a reason for the
			 bureau to reject the application.
(iii) The attorney fee shall be limited to
			 the fee for obtaining the specific lump sum payment that is the subject of the
			 bureau notice provided in paragraph (A)(7)(a) of this rule. The attorney fee
			 shall be limited to the written fee agreement of the initial lump sum payment
			 of the award. The bureau will reject a fee application that includes fees from
			 awards other than the subject lump sum payment or that request a fee from
			 future payments of the award after the lump sum payment.
(iv) If the attorney claims reimbursement for
			 expenses in the affidavit, the expenses shall be limited to the expenses for
			 obtaining the specific lump sum payment that is the subject of the bureau
			 notice provided in paragraph (A)(7)(a) of this rule. The attorney shall provide
			 itemized expenses and documentation to support the expenses. If the attorney
			 fails to provide the required information on expenses, the bureau may reject
			 that portion of the fee application, but shall process the attorney fee portion
			 of the application.
(v) Where the
			 bureau has paid the attorney fee under paragraph (A)(7)(c) of this rule, the
			 bureau will not honor an authorization to receive workers' compensation payment
			 or equivalent for that award under paragraph (A)(5) of this rule, except in
			 cases of court settlement of the workers' compensation claim.
(vi) Before rejecting an attorney fee
			 affidavit or fee agreement due to noncompliance with any part of this rule, the
			 bureau shall notify the attorney of the noncompliance and provide the attorney
			 an opportunity to submit additional information during the thirty day hold
			 period provided in paragraph (A)(7)(a) of this rule.
(c) Upon receipt of the fee agreement and
			 attorney affidavit, the bureau shall review the affidavit as provided in this
			 rule. If the affidavit complies with this rule, the bureau shall deduct from
			 the lump sum payment the amount of the attorney's fee and necessary expenses
			 and pay that amount directly to and solely in the name of the attorney within
			 fourteen days after the fee agreement and attorney affidavit have been filed
			 with the bureau.
(d) After
			 deducting any attorney's fee and necessary expenses, if the lump sum payment is
			 one hundred fifty dollars or more, the bureau shall hold the balance of the
			 lump sum award in accordance with division (A)(11) of section
			 3121.037
			 of the Revised Code.