Ohio Administrative Code Search

...(A) Requests for subsequent actions when a state fund claim has not had activity or a request for further action within a period of time in excess of twenty-four months. (1) The bureau shall consider a request for subsequent action in a claim in the following situations: (a) Where the employee requests that the bureau or commission modify or alter an award of compensation or benefits that has ...

...(A) Requests for subsequent actions when a state fund claim has not had activity or a request for further action within a period of time in excess of twenty-four months. (1) The bureau shall consider a request for subsequent action in a claim in the following situations: (a) Where the employee requests that the bureau or commission modify or alter an award of compensation or benefits that has ...

...(A) This paragraph of this rule applies to any employee's application for a determination of the percentage of permanent partial disability or for an increase of permanent partial disability filed on or after September 29, 2017. (1) If an employee who files an application for a determination of percentage of permanent partial disability or for an increase of permanent partial disability fails to ...

...(A) This paragraph of this rule applies to any employee's application for a determination of the percentage of permanent partial disability or for an increase of permanent partial disability filed on or after September 29, 2017. (1) If an employee who files an application for a determination of percentage of permanent partial disability or for an increase of permanent partial disability fails to ...

...(A) Form C-86 motion shall be used to request action from the bureau or commission. (B) A motion may be submitted by the employee or the employer to seek a determination by the bureau or the commission on any matter not otherwise provided for in this chapter. It is appropriate to file a motion in order to secure allowance of a disability or condition not previously considered in a claim. A motio...

...(A) Form C-86 motion or its equivalent shall be used to request action from the bureau or commission. (B) A motion may be submitted by the employee or the employer to seek a determination by the bureau or the commission on any matter not otherwise provided for in this chapter. It is appropriate to file a motion in order to secure allowance of a disability or condition not previously considered i...

...(A) Administrative appeals. (1) The right of an administrative appeal is limited to the claimant, the dependents of a deceased worker, the employer, and the administrator, where the administrator or the administrator's representative appeals on behalf of the state insurance fund and/or the surplus fund. (2) The named eligible appellants may appeal decisions of the district hearing officers, or s...

...(A) Administrative appeals. (1) The right of an administrative appeal is limited to the claimant, the dependents of a deceased worker, the employer, and the administrator, where the administrator or the administrator's representative appeals on behalf of the state insurance fund and/or the surplus fund. (2) The named eligible appellants may appeal decisions of the district hearing officers, or staff hearing officer...

...(A) Administrative appeals. (1) The right of an administrative appeal is limited to the claimant, the dependents of a deceased worker, the employer, and the administrator, where the administrator or the administrator's representative appeals on behalf of the state insurance fund or the surplus fund. (2) The named eligible appellants may appeal decisions of district hearing officers or staff hear...

...(A) For the purposes of handicap reimbursement under section 4123.343 of the Revised Code, a "handicapped employee" means an employee who is defined as having one or more of the conditions listed in division (A) of section 4123.343 of the Revised Code. (1) With respect to the handicap condition defined in division (A)(4) of section 4123.343 of the Revised Code, degenerative disc disease, spon...

...(A) For the purposes of disability relief under section 4123.343 of the Revised Code, an "employee with a disability" means an employee who is defined as having one or more of the conditions listed in division (A) of section 4123.343 of the Revised Code. (1) With respect to the condition defined in division (A)(4) of section 4123.343 of the Revised Code, degenerative disc disease, spondylosis...

...(A) Pursuant to section 4123.932 of the Revised Code and when an employer satisfies all of the requirements of this rule, the bureau shall charge to the surplus fund created under division (B) of section 4123.34 of the Revised Code any compensation and benefits related to a compensable workers' compensation claim based on a motor vehicle accident involving a third party. This rule applies only to ...

...(A) Pursuant to section 4123.932 of the Revised Code and when an employer satisfies all of the requirements of this rule, the bureau shall charge to the surplus fund created under division (B) of section 4123.34 of the Revised Code any compensation and benefits related to a compensable workers' compensation claim based on a motor vehicle accident involving a third party. This rule applies only to ...

...(A) Except as provided in paragraph (E) of this rule and paragraph (B)(1)(b) of rule 4123-3-09 of the Administrative Code, no payment of compensation shall be approved by the bureau of workers' compensation in a claim unless supported by a report of a physician duly licensed to render the treatment. (B) When evaluating the sufficiency of medical proof, the following criteria shall be considered:...

...(A) Except as provided in paragraph (E) of this rule and paragraph (B)(1)(b) of rule 4123-3-09 of the Administrative Code, no payment of compensation shall be approved by the bureau of workers' compensation in a claim unless supported by a report of a physician duly licensed to render the treatment. (B) When evaluating the sufficiency of medical proof, the following criteria shall be considered:...

...As used in this chapter: (A) "Authorization" or "prior authorization" means: Notification that a specific treatment, service, or equipment is medically necessary for the diagnosis or treatment of an allowed condition. (B) "Bureau certified provider" means: A provider who is approved by the bureau for participation in the health partnership program (HPP) pursuant to this chapter of Administ...

...(A) The bureau shall establish minimum criteria for provider certification. Providers must meet all licensing, certification, or accreditation requirements necessary to provide services in Ohio. A provider licensed, certified or accredited pursuant to the equivalent law of another state shall qualify as a provider under this rule in that state. However, a provider will be ineligible to participate...

...(A) The bureau will establish minimum criteria for provider certification. Providers must meet all licensing, certification, or accreditation requirements necessary to provide services in Ohio. A provider licensed, certified, or accredited pursuant to the equivalent law of another state qualifies as a provider under this rule in that state. However, a provider is ineligible to participate in the h...

...(A) Except as otherwise provided in paragraph (C) of this rule, the administrator of the bureau of workers' compensation shall follow the procedures set forth in this rule to terminate the enrollment of and decertify a non-facility provider who has failed to comply with a workers' compensation statute or rule. (1) If the bureau determines a provider has committed three or more reported violations...

...(A) Except as otherwise provided in paragraph (C) of this rule, the administrator of the bureau of workers' compensation will follow the procedures set forth in this rule to terminate the enrollment of and decertify a non-facility provider who has failed to comply with a workers' compensation statute or rule. (1) If the bureau determines a provider has committed three or more reported violations ...

...(A) HPP: Within one business day of initial treatment or initial visit of an injured worker, a provider must report the employee's injury or occupational disease in accordance with either paragraph (A)(1) or (A)(2) of this rule. (1) A provider may report an injury to the MCO responsible for medical management of the employee's treatment. When reporting the injury to the MCO, the provider shall do...

...(A) To be eligible for participation in the HPP as an ambulatory surgical center arthroplasty center, an ambulatory surgical center must comply with the following minimum criteria: (1) The facility must be bureau certified as an ambulatory surgical center under paragraph (C) of rule 4123-6-02.2 of the Administrative Code. (2) The facility must have a formal joint replacement program which has be...

...(A) To be eligible for participation in the HPP as an ambulatory surgical center arthroplasty center, an ambulatory surgical center must: (1) Be certified as an ambulatory surgical center under paragraph (C) of rule 4123-6-02.2 of the Administrative Code. (2) Have a formal joint replacement program which has been in place for at least one year prior to the date of application, and have perfo...

...(A) The administrator may refuse to certify or recertify, or may decertify from participation in the HPP, any MCO that: (1) Is owned, directly or indirectly, by an individual or entity that has a felony conviction in any jurisdiction, a conviction under a federal controlled substance act, a misdemeanor conviction for an act involving dishonesty, fraud, or misrepresentation, a conviction for a...

...(A) Upon request by a managed care organization, the bureau shall send the managed care organization an MCO application for certification for the managed care organization to complete and submit to the bureau. (B) The MCO application submitted to the bureau by the managed care organization shall include a list of bureau certified providers in its provider panel and/or bureau certified providers with which the manage...