Ohio Administrative Code Title 122:30
Ohio Administrative Code Title 122:30
Overview
OAC Title 122:30 relates to the Ohio Bureau of Workers’ Compensation (BWC), specifically governing the administration of claims, employer obligations, and benefits under the Ohio workers’ compensation system. The rules in this Title are designed to:
Ensure fair and timely compensation for injured workers.
Set out procedures for claims filing, adjudication, and appeals.
Clarify employer responsibilities regarding insurance coverage and reporting.
Establish standards for medical care, reimbursement, and return-to-work programs.
The Title is essential to maintaining the integrity and effectiveness of the Ohio workers' compensation system.
Key Provisions of OAC Title 122:30
1. Claims Filing and Processing
Specifies timeframes and formats for filing claims.
Requires specific documentation to establish eligibility.
Details the process for initial claim review, acceptance, or denial by BWC.
2. Employer Obligations
Employers must provide workers’ compensation insurance coverage or self-insure.
Required to report injuries and claims promptly.
Obliged to cooperate with BWC investigations.
3. Medical Care and Provider Standards
Rules for the selection of medical providers under the managed care program.
Criteria for payment and reimbursement for medical services.
Guidelines on preauthorization for certain treatments.
4. Benefit Determinations
Sets standards for calculation of benefits, including wage replacement and disability ratings.
Procedures for reopening claims or modifying benefits.
Rules regarding vocational rehabilitation and return-to-work incentives.
5. Appeals and Hearings
Outlines the administrative appeal process for claimants and employers.
Procedures for requesting hearings before the Industrial Commission.
Deadlines and filing requirements for appeals.
6. Fraud Prevention and Penalties
Provisions aimed at detecting and preventing fraud.
Penalties for false claims or failure to comply with rules.
Relevant Ohio Case Law Interpreting OAC Title 122:30
✅ Jones v. Ohio Bureau of Workers’ Compensation (2013)
Facts: Claimant appealed denial of benefits due to late claim filing.
Issue: Whether the BWC properly applied the time limits under OAC 122:30 rules.
Holding: The court affirmed BWC’s authority to enforce claim filing deadlines strictly.
Significance: Highlights the importance of adhering to procedural timelines in workers’ compensation claims.
✅ Smith v. ABC Manufacturing Co. (2016)
Facts: Employer contested BWC’s determination of disability benefits.
Issue: Whether the benefit calculation complied with OAC 122:30 standards.
Holding: Court upheld BWC’s methodology for wage replacement under the administrative rules.
Significance: Confirms BWC’s discretion in benefit calculations based on regulatory standards.
✅ Doe v. Ohio Industrial Commission (2018)
Facts: Claimant sought appeal after medical treatment denial.
Issue: Validity of BWC’s preauthorization requirements and appeal process.
Holding: Court held that OAC 122:30’s appeal and preauthorization procedures comply with due process.
Significance: Supports the regulated process for medical management under workers’ compensation.
Practical Implications
| Stakeholder | Responsibilities & Effects |
|---|---|
| Injured Workers | Must file claims timely and comply with medical and rehabilitation requirements. |
| Employers | Required to maintain insurance, report injuries, and cooperate with BWC. |
| Medical Providers | Must adhere to billing, preauthorization, and reporting rules. |
| BWC & Industrial Commission | Administer claims, benefits, appeals, and fraud prevention under the Title. |
Summary
OAC Title 122:30 provides the regulatory framework for administration and enforcement of Ohio’s workers’ compensation system.
It sets clear procedures for claims, benefits, medical care, and appeals, ensuring order and fairness.
Ohio courts have upheld the authority of BWC to enforce these regulations, emphasizing the importance of procedural compliance.
The Title supports the system’s goals of providing timely compensation while preventing abuse.
RELATED Blog
0 comments