Ohio Admin. Code 4123-3-34 - Settlement of state fund claims
(A) The procedures of this rule shall apply
to the settlement of state fund injury and occupational disease
claims.
(B) The employer or the
claimant shall file an application for approval of settlement agreement on the
appropriate form with the administrator of workers' compensation. Each
application shall include the signature of the claimant and the employer, or
their authorized legal representative, except as follows:
(1) A claimant may file an application
without an employer's signature in the following situations:
(a) The employer is no longer doing business
in Ohio;
(b) The claim no longer is
in the employer's industrial accident or occupational disease experience as
provided in division (B) of section
4123.34
of the Revised Code and the claimant no longer is employed with that employer;
or,
(c) The employer has failed to
comply with section
4123.35
of the Revised Code.
(2)
If a claimant files an application without an employer's signature, and the
employer still is doing business in this state, the bureau shall send written
notice of the application to the employer immediately upon receipt of the
application. If the employer fails to respond to the notice within thirty days
after the notice is sent, the application need not contain the employer's
signature.
(C) Each
settlement application shall:
(1) Include a
list of the claim numbers and body parts affected in all claims filed by the
claimant with the administrator of workers' compensation or the industrial
commission.
(2) Set forth the
reason the proposed full and final settlement is deemed desirable by the
claimant and state the amount of the requested settlement.
(D) Settlement may be requested for a portion
of a claim, one or more claims, or a combination of claims, provided that the
claimant is not required to enter into a settlement agreement for every claim
that has been filed with the bureau by the claimant.
(E) The administrator shall utilize whatever
methods the administrator determines to be appropriate, consistent with general
insurance principles, to evaluate a claim for settlement. When a settlement
agreement has been approved by the administrator, a notice of approval shall be
sent to the claimant, the employer, and their representatives, informing them
of their rights to withdraw consent to the settlement agreement within thirty
days. An employer shall not deny or withdraw consent to
a settlement application filed under this paragraph if both of the following
apply to the claim that is the subject of the application: the claim is no
longer within the date of impact pursuant to the employer's industrial accident
or occupational disease experience as provided in division (B) of section
4123.34
of the Revised Code; and, the employee named in the application is no longer
employed by the employer. Supporting evidence indicating that the claim remains
within in the date of impact or that the claimant continues to be employed with
the employer may be filed with the employer's withdrawal of consent. If
written notice of the withdrawal of consent is not filed within the thirty day
period, the settlement agreement is final. A claimant's refusal to endorse a
settlement check issued as a result of an agreement reached pursuant to these
procedures does not alter the finality of the settlement. The administrator may
reopen a settled claim for purposes of conducting a fraud
investigation.
(F) The
administrator shall also send the notice of approval to the industrial
commission within five days from the date of the bureau order of approval. The
staff hearing officer shall determine, within the time set forth in paragraph
(E) of this rule, whether the settlement agreement is or is not a gross
miscarriage of justice. If the staff hearing officer determines within that
time period that the settlement agreement is clearly unfair, the staff hearing
officer shall issue an order disapproving the settlement agreement. If the
staff hearing officer determines that the settlement agreement is not clearly
unfair, or fails to act within the time limits, the settlement agreement is
approved.
(G) The effective date of
the settlement is the date the notice of approval of settlement agreement is
mailed. Once the thirty day waiting period has passed as set forth in
paragraphs (E) and (F) of this rule, the agreed settlement shall be final and
cannot be appealed to the industrial commission or to court.
(H) When a settlement application is filed in
a claim in which an application for violation of specific safety requirement
has been granted or is pending, the administrator shall refer the claim to the
industrial commission for disposition of the application for violation of the
specific safety requirement. If the application for the specific safety
requirement has been granted and the employer is no longer doing business, or
is otherwise not making the payments required by any award for violation of any
specific safety requirement, the administrator may approve a final settlement
without referring the claim to the industrial commission, provided the
administrator identifies any settlement amounts that may be attributed to the
award for violation of specific safety requirement. The administrator need not
refer to the industrial commission any claim in which the claimant has
voluntarily withdrawn an application for violation of a specific safety
requirement, provided no portion of the settlement amount is attributed to any
violation of a specific safety requirement.
(I) The administrator may offset settlement
amounts due the claimant by overpayments owed by the claimant or, where the
claimant is also an employer, unpaid premiums owed by a claimant, as the
administrator determines appropriate.
(J) The representative's signature for either
the claimant or the employer satisfies the requirements for paragraphs (B) and
(C) of this rule.
(K) A settled
claim may be used as a defense to a claim for the same or similar conditions. A
self-insuring employer shall not settle disabled workers' relief fund liability
in state fund claims without the administrator's approval.
(L) An employer or claimant who files a
notice of intent to settle authorized under section
4123.512 of the
Revised Code shall file on the appropriate form with the administrator of
workers' compensation prior to filing an application for approval of settlement
agreement. If the opposing party does not object within fourteen days of
receipt of the notice, the administrator will proceed with the settlement
process under this rule.
Notes
Promulgated Under: 119.03
Statutory Authority: 4123.52, 4123.65
Rule Amplifies: 4121.30, 4121.31, 4123.05
Prior Effective Dates: 07/12/1999, 02/16/2007, 04/01/2014, 07/01/2019
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