(A) For purposes of this
rule:
(1) "Allowed
physical condition" - means a physical condition diagnosed by an approved
physician that arises from an injury inflicted by a ward. It is also a physical
condition resulting from substantial aggravation of a pre-existing condition,
if such aggravation arises from an injury inflicted by a ward.
(2) "Approved
physician" - means a psychologist, psychiatrist, or physician from the
approved physician list. In the event an injury requires emergency room
treatment, the emergency room physician will be considered an approved
physician for purposes of the initial diagnosis and evaluation of the allowed
physical or psychological condition.
(3) "Allowed
psychological condition" - means a psychological condition, diagnosed by
an approved psychiatrist or psychologist from the approved physician list that
develops after, and is related to, the allowed physical condition.
(4) "Date of
injury" - means the date the event triggering the claim
occurred.
(5) "Disabled"
- means the employee is unable to perform the essential functions of their job
due to an injury while on-duty.
(6) "Inflicted by a
ward" - means injured by a ward of the state in one or more of the
following ways: (a) an attempt to subdue, control or restrain a ward's
inappropriate behavior; (b) as the result of being physically harmed in the
course of the employee's duty, as long as the injury was not accidental in
nature or caused by the employee's own misconduct or negligence; or (c)
during the pursuit of a ward in such circumstances where a ward attempts to
flee following the inappropriate behavior listed in this
paragraph.
(7) "Ward" -
Means an inmate, patient, resident, client, youth or student.
(B) Eligibility.
(1) Occupational injury
leave benefits (OIL). Each permanent employee employed by an agency listed in
section 124.381 of the Revised Code who sustains an allowed physical condition
or an allowed psychological condition filed on or after February 1, 2010 shall,
pursuant to this rule and with the approval of the director of the department
of administrative services (DAS), receive OIL. Any subsequent injury that is
determined to be an aggravation of a previous injury for which OIL was approved
shall not be considered an independent injury. It is the employee's
responsibility to prove that the allowed physical condition or an allowed
psychological condition was inflicted by a ward.
(2) Salary continuation
benefits. All permanent employees, including employees not eligible for OIL as
described in paragraph (B)(1) of this rule, who sustain physical injuries or
other disabilities in the performance of and arising out of state employment on
or after February 1, 2010 may apply for salary continuation benefits for each
independent injury sustained.
(3) If the
employee's OIL claim is denied and the workers' compensation claim is
still pending, the employee may apply for salary continuation
benefits.
(C) Application. In order to receive OIL
or salary continuation benefits, the injured employee shall, within twenty days
from the date of the injury, complete and submit the employee's portion of
the claim application to the employee's appointing authority. If the
employee is physically unable to complete the application, someone acting on
the employee's behalf may complete and submit the
application.
(D) Amount and length of
benefit.
(1) OIL benefits. In no
case shall the payment of OIL exceed nine hundred sixty hours per independent
injury. A part-time employee's OIL benefits shall be based on the average
number of hours worked during the six weeks immediately preceding the related
injury, up to forty hours per week.
(2) Salary continuation
benefits. In no case shall the payment of salary continuation benefits exceed
four hundred eighty hours per independent injury. Any leave provisionally
granted under OIL shall count towards the four hundred eighty hour maximum for
salary continuation benefits.
(3) Payment. Payment of
OIL or salary continuation benefits will begin immediately upon the
employee's filing of an application, retroactive to the date the employee
became disabled, and will be paid at the employee's total rate of
pay.
(E) Other benefits. OIL and salary
continuation benefits are in lieu of any other employer-paid leave or
workers' compensation benefits. Employees receiving OIL or salary
continuation benefits are in active pay status and shall continue to accrue
sick leave and personal leave. During the time an employee is receiving OIL or
salary continuation benefits under this rule, the employee shall be exempt from
receiving vacation leave. OIL and salary continuation benefits shall not be
charged against the employee's accumulated sick leave
balance.
(F) Employee's responsibilities. In
order to receive OIL or salary continuation benefits, the injured employee must
also:
(1) Follow the
agency's accident or injury reporting guidelines;
(2) Be evaluated by an
approved physician to determine if the injury will keep the employee from
performing the essential functions of the employee's position. If the
employee is unable to schedule an appointment with an approved physician within
forty-eight hours of the date of the injury, the employee must contact the
agency's workers' compensation coordinator. The employee must
continue to seek treatment from an approved physician for the duration of the
benefit;
(3) Ensure that an
approved physician completes and returns the DAS designated medical
form;
(4) Demonstrate that any
transitional work program offered by the agency is not appropriate based upon
an approved physician's restrictions;
(5) Apply for
workers' compensation benefits at the time that OIL or salary continuation
is being requested; and.
(6) Receive approval from
the bureau of workers' compensation for an additional injury allowance, in
the case where, after an initial diagnosis, the injury is determined to more
extensive and the employee requests an extension of benefits.
(G) Failure to be evaluated. If the
employee refuses to be evaluated by an approved physician, the application for
OIL or salary continuation benefits will be denied and will be reviewed by the
bureau of workers' compensation as a normal request for workers'
compensation benefits. If the employee has been paid any OIL or salary
continuation benefits, the employee shall substitute sick leave, vacation
leave, personal leave, compensatory time, or reimburse the employer for any
benefits received.
(H) Appointing authority's
responsibilities. The employee's appointing authority or designee must
promptly review the employee's claim and forward the employee's
paperwork to the director or authorized designee within five days of receiving
the employee's application. In the case of OIL, the appointing authority
or designee should also forward any documentation certifying or disputing that
the injury was sustained in the line of duty and was inflicted by a ward. In
the case of salary continuation benefits, the appointing authority should also
forward any documentation certifying or disputing that the injury was sustained
in the line of duty, as well as any witness statements.
(I) Medical treatment and return to work.
It shall be the responsibility of the employee to receive necessary medical
treatment and to return to active work status at the earliest time permitted by
the approved physician.
(J) Termination of benefits. OIL and
salary continuation benefits shall terminate when:
(1) The employee engages
in any activity that adversely affects the employee's
recovery;
(2) The employee engages
in any outside activity for wage or profit if the outside activity is
inconsistent with the employee's medical or psychological
restrictions;
(3) The employee
knowingly makes a false or misleading statement, or alters, falsifies, destroys
or conceals any document in order to receive the benefit;
(4) The approved
physician releases the employee back to work;
(5) The employee is
incarcerated and the incarceration prevents the employee from coming to
work;
(6) The employee's
workers' compensation claim is denied by the bureau of workers'
compensation;
(7) The industrial
commission determines the employee has reached maximum medical
improvement;
(8) The employee is
disqualified from receiving workers' compensation benefits or if the
employee accepts workers' compensation temporary total disability
benefits; or
(9) The employee is no
longer employed by the state.
(K) Denied claims.
(1) If an agency denies
an employee's application for OIL on the basis that the injury was not
inflicted by a ward, OIL shall cease. The employee may appeal the decision to
DAS within twenty days of the postmark on the letter of denial and the decision
of DAS shall be binding. If the employee's claim is approved by DAS, the
agency shall render OIL benefits to the employee back to the time of the
initial agency denial. If the employee's OIL claim is denied by DAS, the
employee may be eligible for salary continuation benefits.
(2) If the bureau of
workers' compensation denies the claim on the basis that the injury was
not an allowed physical or psychological condition, OIL or salary continuation
benefits shall cease. The employee may appeal the decision to the industrial
commission. If the employee's claim is approved by the industrial
commission, the agency shall render OIL or salary continuation benefits on the
employee back to the time of the initial denial by the bureau of workers'
compensation. If the employee's claim is denied by the industrial
commission, the employee shall substitute sick leave, vacation leave, personal
leave, compensatory time, or reimburse the employer for any benefits
received.
(L) Insurance. An employee who receives
OIL or salary continuation benefits is responsible for the employee's
share of health insurance premiums.
(M) Transitional work program. An
employee receiving OIL or salary continuation benefits may participate in a
transitional work program pursuant to rule 123:1-33-07 of the Administrative
Code. If a permanent employee is given a transitional work assignment with less
than the employee's regularly scheduled hours, the employee may use OIL or
salary continuation hours to supplement up to the amount of the employee's
regularly scheduled hours. If an employee does not successfully complete a
transitional work program, the employee may resume OIL or salary continuation
benefits up to the number of hours that remain for the injury.