Ohio Administrative Code › Title 4121 - Industrial Commission › Chapter 4121-3 - Claims Procedures › Section 4121-3-13 - Disputed self-insuring employers' claims

Current through all regulations passed and filed through July 1, 2024
(A) In the event there is a dispute or
			 disagreement between the injured worker or an eligible applicant and the
			 self-insuring employer that concerns a contested claims matter, the claim shall
			 be referred to the commission for hearing.
(B) Upon receipt of a notice of a dispute or
			 disagreement that concerns a contested claims matter, the bureau of workers'
			 compensation shall immediately notify the parties of the existence of the dispute or disagreement, and
			 shall within seven days refer the matter to the commission as a disputed claims
			 matter.
(C) In the event that the
			 self-insuring employer fails to respond to a request for compensation
			 
								or
			 benefits made by an injured worker within thirty days of such a request, or
			 pursuant to paragraph (B) of this rule the self-insuring employer disputes an
			 application for compensation or benefits, the commission shall schedule the
			 contested claims matter for hearing.
(D) Prior to the hearing in a contested
			 claims matter the parties or their authorized representatives shall file the
			 information necessary to comply with the provisions of paragraph (A)(1) and
			 (A)(2) of rule
			 4121-3-09 of the Administrative
			 Code. Such information shall include, but not be limited to, medical reports
			 received by the parties or their authorized representatives from the treating
			 physician and physicians who have seen the injured worker in consultation for
			 the  injury
			 
								,
			 occupational disease, or death for which the
			 claim has been filed.
(E)
			 Notwithstanding paragraph (D) of this rule, a self-insuring employer, or its
			 authorized representative, shall provide to the commission and to the injured
			 worker, or the injured worker's representative in claims where the injured
			 worker is represented, the following information in writing, prior to the date
			 of hearing of a contested claims matter:
(1) A
			 copy of the first report of injury, occupational disease, or death, or an
			 equivalent document; and
(2) A
			 statement listing the specific conditions that are recognized in the claim by
			 the self-insuring employer, including conditions that were originally
			 recognized as related to the injury or occupational disease for which the claim
			 has been filed, as well as any conditions that are subsequently recognized by
			 the self-insuring employer as being related to the injury or occupational
			 disease; and
(3) Where the
			 contested claims matter concerns a dispute as to the full weekly wage or
			 average weekly wage, the information used to calculate the full weekly wage or
			 average weekly wage, depending on which is at issue, shall be submitted unless
			 the full weekly wage or average weekly wage had been previously established by
			 a final order of the commission; and
(4)
									Where the
			 employer intends to raise the issue of the statute of limitations pursuant to
			 section 4123.52 of the Revised Code, the
			 employer must provide a statement setting forth the date of last payment of
			 compensation and also must provide, for claims arising prior to July 1, 2020,
			 the last payment of a medical bill or, for claims arising on or after July 1,
			 2020, the date of last medical service rendered.
(5) A statement setting forth the date of
			 last payment of a medical bill where the contested claims matter concerns a
			 dispute over entitlement to, or extent of, medical benefits.
(6) A statement setting forth the date of
			 last payment of compensation where the contested claims matter concerns
			 entitlement to compensation.