Chapter 4123-9 General Policy of the Bureau and General Organization of Bureau Offices

(A) The main functions of the bureau of workers’ compensation are of the following:

(1) Prompt payment of compensation and benefits, in accordance with the statutes and rules of the bureau and the industrial commission, for death, injuries, or occupational diseases received in the course of and arising out of employment. Each party shall receive fair, impartial, and equal service.

(2) Maintaining an ongoing program to identify employers subject to the Ohio Workers’ Compensation Act and to audit employers to ensure proper premium and assessment payment.

(3) Establishing workers’ compensation coverage for employers under the state insurance fund and collecting premium from employers subject to the Ohio Workers’ Compensation Act.

(4) Granting qualifying employers the privilege of self-insurance, and auditing and monitoring the programs conducted by self-insuring employers to ensure compliance with the workers’ compensation statutes and rules.

(B) The administrator of workers’ compensation may organize the work of the bureau, its divisions, sections, departments, and offices, to the extent necessary to achieve the most efficient performance of the functions of the bureau.

Replaces: 4123-9-01

R.C. 119.032 review dates: 07/06/2004 and 03/01/2008

Promulgated Under: 119.03

Statutory Authority: 4121.12, 4121.30, 4121.31

Rule Amplifies: 4121.121, 4121.31

Prior Effective Dates: 1/1/78, 9/1/96

The duties of the legal division of the bureau shall include, but will not be limited to, the following:

(A) Providing legal advice and assistance to the administrator and the bureau on issues affecting the administration of the workers’ compensation act and the operation of the bureau of workers’ compensation;

(B) Assisting the administrator in the filing of administrative appeals and representation of the interest of the state insurance fund, the statutory surplus fund, and other funds administered by the bureau;

(C) Assisting the administrator in the investigation of all potential acts of internal and external fraud committed against the bureau.

(D) Assisting the administrator in security concerns;

(E) Assisting the administrator by independently reviewing the systems of internal control and recommending improvement when appropriate;

(F) Conducting investigations of alleged safety violations pursuant to workers’ compensation claims.

(G) Assisting the administrator in the investment and management of the surplus and/or reserves in accordance with the investment philosophy of the workers’ compensation oversight commission;

(H) Monitoring federal and state EEO compliance.

Effective: 06/01/2005

R.C. 119.032 review dates: 03/01/2008

Promulgated Under: 119.03

Statutory Authority: 4121.12, 4121.121, 4121.30, 4121.31

Rule Amplifies: 4121.121, 4121.31

Prior Effective Dates: 9/1/96, 9/20/04

The duties of the finance division of the bureau shall include, but will not be limited to, the following:

(A) Assisting the administrator in maintaining the solvency of the state insurance fund;

(B) Maintaining accurate records of losses incurred by employers on account of injuries, establishing proper reserves as a factor in the rate calculation process, establishing a merit rating system of employer, and other functions to assist the administrator in the rate making process;

(C) Assisting the administrator in receiving and disbursing funds from the state insurance fund and other applicable funds in accordance with state and federal laws, rules and regulations;

(D) Assisting the administrator in preparing the bureau’s budget by allocating, auditing, and adjusting appropriations and expenses.

Effective: 06/01/2005

R.C. 119.032 review dates: 03/01/2008

Promulgated Under: 119.03

Statutory Authority: 4121.12, 4121.121, 4121.30, 4121.31

Rule Amplifies: 4121.121, 4121.31

Prior Effective Dates: 9/1/96, 9/20/04

The duties of the information technology division of the bureau shall include, but will not be limited to the following:

(A) Continually improving the business reliability of the bureau through technical improvement and automation;

(B) Increasing and enabling flexibility and responsiveness to changing business requirements;

(C) Providing electronic data and technical system support for each of the bureau’s divisions.

HISTORY: Eff 9-1-96; Replaces 4123-9-04, eff. 9-20-04

Rule promulgated under: RC 119.03

Rule authorized by: RC 4121.12, 4121.30, 4121.31

Rule amplifies: RC 4121.121, 4121.31

R.C. 119.032 review dates: 03/01/2008

The duties of the government and media affairs division of the bureau shall include, but will not be limited to, the following:

(A) Preparing, publishing and distributing news releases, reports, pamphlets, articles, and other publications, print or electronic, relating to the bureau’s operations.

(B) Handling all communications with the media.

(C) Responding to inquiries from the public.

(D) Monitoring state and federal legislation for impact on the bureau and responding to inquiries from members of the state or federal legislatures.

HISTORY: Eff 9-1-96; 9-20-04

Rule promulgated under: RC 119.03

Rule authorized by: RC 4121.12, 4121.30, 4121.31

Rule amplifies: RC 4121.121, 4121.31

R.C. 119.032 review dates: 07/06/2004 and 03/01/2008

The duties of the employer management services division of the bureau, shall include, but will not be limited to the following:

(A) Identifying employers subject to Ohio workers’ compensation act;

(B) Conducting periodic review of manual classifications and payroll reports of state fund employers to ascertain that employer premiums have been properly computed and paid;

(C) Granting, renewing, and revoking the privilege of self-insurance; auditing and monitoring self-insuring employers to ensure compliance with bureau statutes, rules and policies; handling complaints filed against self-insuring employers; managing medical-only and bankrupt self-insuring employer claims;

(D) Auditing and monitoring the safety and hygiene fund;

(E) Assisting the superintendent of the division of safety and hygiene in researching, investigating, and conducting loss prevention programs and courses for employers;

(F) Conducting research and analysis.

HISTORY: Eff 9-1-96; Rescinded and replaced, eff. 9-20-04

Rule promulgated under: RC 119.03

Rule authorized by: RC 4121.12, 4121.30, 4121.31

Rule amplifies: RC 4121.121, 4121.31

R.C. 119.032 review dates: 03/01/2008

The duties of the human resources division of the bureau shall include, but are not limited to, the following:

(A) Administering personnel plans, policies and programs in compliance with state and federal statutes, rules, and regulations;

(B) Providing payroll and benefit services for bureau employees;

(C) Assisting with determining personnel needs of the bureau, posting employment opportunities, and filling position vacancies;

(D) Development of employment policies and monitoring of labor compliance issues;

(E) Providing forms, supplies, and mail service support for each of the bureau’s divisions;

(F) Providing delivery and fleet services to bureau divisions.

Effective: 06/01/2005

R.C. 119.032 review dates: 03/01/2008

Promulgated Under: 119.03

Statutory Authority: 4121.12, 4121.121, 4121.30, 4121.31

Rule Amplifies: 4121.121, 4121.31

Prior Effective Dates: 9/20/04

The duties of the field operations division shall include, but will not be limited to the following:

(A) Managing claims according to bureau statutes, rules and policies, including medical-only claims, claims filed by out-of-state injured workers and employees of the bureau and industrial commission, special claims, including black lung, marine fund, disabled worker relief fund, and public works relief claims;

(B) Adjudicating non-contested claims by issuing an order to approve or deny the payment of compensation or benefits;

(C) Executing orders of the industrial commission;

(D) Issuing adjustment and overpayment orders;

(E) Approving settlements of claims as authorized by the workers’ compensation statutes;

(F) Planning, developing, and implementing relevant employee training programs, including continuing education and the online learning center.

HISTORY: Eff 9-20-04

Rule promulgated under: RC 119.03

Rule authorized by: RC 4121.12, 4121.30, 4121.31

Rule amplifies: RC 4121.121, 4121.31

R.C. 119.032 review dates: 03/01/2008

The duties of the quality assurance division of the bureau shall include, but will not be limited to the following (A) Providing an independent assessment of program activities and functions to evaluate them for effectiveness and compliance, using generally accepted auditing standards;

(1) Assessing program compliance with applicable laws, rules, and policies;

(2) Assessing objectives of new or ongoing programs for relevance;

(3) Determining the extent to which a program achieves the desired results;

(4) Assessing the effectiveness of program components;

(5) Identifying factors inhibiting satisfactory performance;

(6) Determining whether more cost-effective alternatives can be implemented;

(7) Identifying duplication, overlap, or conflicts among related programs;

(8) Assessing the adequacy of controls;

(9) Evaluating whether reported measures of effectiveness are valid and reliable;

(B) Providing written reports and recommendations for improvement.

HISTORY: Eff 9-20-04

Rule promulgated under: RC 119.03

Rule authorized by: RC 4121.12, 4121.30, 4121.31

Rule amplifies: RC 4121.121, 4121.31

R.C. 119.032 review dates: 03/01/2008

The duties of the injury management division services of the bureau shall include, but will not be limited to, the following:

(A) Implementing the health partnership program (HPP) and qualified health plan (QHP) in accordance with workers’ compensation statutes;

(B) Assessing the compliance of HPP and QHP with workers’ compensation statutes, rules and policies;

(C) Establishing criteria to determine the amount to be paid for medical services, equipment, and supplies;

(D) Authorizing, denying or adjusting provider payments;

(E) Developing programs to provide rehabilitation services to claimants in accordance with workers’ compensation statutes;

(F) Assuring that claimants’ rehabilitation services further return to work objectives;

(G) Developing, implementing and assessing claims, medical and vocational rehabilitation policies and procedures;

(H) Overseeing and consulting for contractual compliance issues regarding managed care organizations;

(I) Enrolling and certifying providers in HPP systems and maintaining disability evaluators panel;

(J) Resolving complaints regarding HPP;

(K) Assisting in provider training;

(L) Recovering medical payments made in excess or in error;

(M) Administering the employee health services for bureau and industrial commission central office employees, as well as the catastrophic nurse advocates program benefiting injured workers who have suffered catastrophic injuries from job-related accidents;

(N) Supporting systems initiatives for management of the bureau’s pharmacy benefits program;

(O) Developing requirements for enhancements and coordinating and testing systems for electronic data interchange transactions, related to claims, providers, network and medical billing processes, and for systems relating to claims;

(P) Providing analytical, statistical, and reporting services to internal and external customers, including but not limited to calculating the employer open enrollment report card, managed care organizations’ incentive payments, managed care organizations’ administrative payment set-offs, and most managed care organizations’ related statistics;

(Q) Coordinating medical, claims, and rehabilitation policies, procedures, and programs;

(R) Responding to local and statewide inquiries regarding claim handling practices and procedures.

HISTORY: Eff 9-20-04

Rule promulgated under: RC 119.03

Rule authorized by: RC 4121.12, 4121.30, 4121.31

Rule amplifies: RC 4121.121, 4121.31

R.C. 119.032 review dates: 03/01/2008

The duties of the customer service division of the bureau shall include, but will not be limited to, the following:

(A) Supporting state and bureau quality initiatives;

(B) Planning, developing, and implementing leadership training;

(C) Planning, developing, and implementing personal development programs.

HISTORY: Eff 9-20-04

Rule promulgated under: RC 119.03

Rule authorized by: RC 4121.12, 4121.30, 4121.31

Rule amplifies: RC 4121.121, 4121.31

R.C. 119.032 review dates: 03/01/2008

The duties of the communications division of the bureau shall include, but will not be limited to, the following:

(A) Preparing, publishing and distributing reports, pamphlets, articles, and other publications, print or electronic, relating to the bureau’s operations;

(B) Coordinating the bureau’s special events;

(C) Producing and editing content for broadcast on public access television station;

(D) Managing the conference center.

HISTORY: Eff 9-20-04

Rule promulgated under: RC 119.03

Rule authorized by: RC 4121.12, 4121.30, 4121.31

Rule amplifies: RC 4121.121, 4121.31

R.C. 119.032 review dates: 03/01/2008