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Transitional Workgrant EZ Program Agreement TWG-EZ-110 - Ohio
| Transitional Workgrant EZ Program Agreement Form. This is a Ohio form and can be used in Employers Workers Comp . |
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Transitional W orkGRANT$-EZ For small business - Its easy Employer full, legal name (please print or type) Federal tax I.D. number Employer address (city, state, ZIP code) This is an Agreement by and between ____________________________________ ___________________________ (hereinafter, the employer), Employer full, legal name with its principal place of business located at ________________________ __________________ , and the Ohio Bureau of Workers Compensation (hereinafter BWC), having offices at 30 W. Spring St., Columbus, Ohio 43215-2256, entered into the day, month and year set out below. Whereas, the Administrator of BWC, may issue a grant to defray the costs incurred by the employer who elects toparticipate in BWCsTransitional Work Program Development Grants-EZ program, also known as the Transitional WorkGRANT$ (TWG)-EZ program, pursuant to Ohio Revise d Code Section (ORC) 4123.29 and Ohio Administrative Code Rule (OAC) 4 123-17-55 and4123-18-06, wherein the employermay receive grant monies for the development of a transitional work program; now Therefore, for good and valuable consideration, the sufficiency of which is acknowl edged, the parties mutually agree tothe following: CONDITIONS PRECEDENT. Approval of a TWG-EZ grant is contingent upon the following criteria: The employer is eligible for a TWG-EZ grant only one time per policy number. Only state fundemployers or certain public employers are eligible for such a grant. TASK DESCRIPTION. The employer, in consideration of the grant given to it as a participant in the BWC s TWG-EZ program promises to pay the transitional work developer for its work and to implement the program in good faith in accordance with OAC 4123-17-55, as amended, which shall be incorporated as if fully rewritten herein. Where applicable, th e employer participating in the TWG-EZ program in consideration of the grant given to the employer, promises to fully comply with the program requirementsas outlined in t he application,which shall be fully incorporated herein by reference. ELIGIBILITY AND DISTRIBUTION OF GRANT MONIES. The distribution of any TWG-EZ money for the employer participating in BWCs TWG-EZ program is fully dependent upon available resources of BWC. The employer and BWC mutually understand and agree as follows. The employer may request a proposal from the current list of transitional work develo pers from BWC and then solicit proposals from these Developers. BWC shall not reimburse the employer or the transitional work developers for costs associated with preparing and submitting a proposal to the employer. Grant amounts will be based on the complexity of services needed as in dicated in a proposal for transitional work services. Factors which may determine appropriate grant amounts may include the em ployers number of employees, job classifications, job analyses needed, and collective bargaining units. The grant monies shall not exceed the maximum amount to which the employer is eligible, as delineated 2600.00 in the Transitional Work Development Reimbursement Limits document, which shall beincorporate d as if fully rewritten herein. The maximum reimbursable amounts and rates shall be those that are in ef fect on the date of this agreement. The job analysis reimbursement amount per job analysis shall not exceed one hundred sixty dollars ($160.00), which shall be paid for the actual number of job analyses performed. Each job analysis shall con sist of a certain length of observation and a certain length for report completion. The employer shall directly compensatethe transitional work developer for the developerss services. BWC shall not reimburse the employer for costs not deemed eligible.BWC may monitor the employers and the transitional work developers content and implementation of transitional work services. The employer agrees to utilize the grant mon ies soley for the purposes outlined in this Agreement and in OAC 4123- 17-55. If the employer receives the warrant and uses the grant monies fo r some other purpose, it shall immediately return the full amount to BWC, and BWC reserves the right to recover grant money by one or more of the following methods: Billing the employer for grant money received, forwarding to the Ohio Attorney General for collections, set-o ff, recoupment, or other legal remedy. February 2004 American LegalNet, Inc. TWG-EZ-110 www.USCourtForms.com <<<<<<<<<********>>>>>>>>>>>>> 2DISQUALIFICATION . If for any reason the employer participating in the BWCs TWG-EZ program fails to satisfy the requirements of thisprogram in a timely manner, the employer may be disqualified from the TWG-EZ program. BWC reserves the right to conduct an on-siteeview if there is reason to believe the program has not been implemente d in good faith. Sufficient reason shall include an increase in thenumber or overall duration of lost-time claims after implementation of t he program; such a determination maybe made by an investigationor by data warehouse research. Sufficient reason shall also include reas onable suspicion of fraud orcollusion on the part of the employer.The Employer, if disqualified by BWC, shall immediately return all of the monies to BWC, and BWC reserves the right to recover the grantby the following methods: billing the employer, for the grant money received, forwarding to the Ohio Attorney General for recollection,set-off, recoupment or other legal remedy. If the employer fails to implement the program within one (1) year, the grant monies shall beconsidered misappropriated, and the employer shall repay the amount of t he grant immediately, and BWC reserves the right to recovergrant money by one or more of the following methods: billing the Employe r for the grant money received, forwarding to the Ohio AttorneyGeneral for collection, set-off, recoupment, or other legal remedy. PURPOSE AND DISCLAIMER . If implemented correctly by the employer, the goal of the TWG-EZ program is to reduce the incidence oflost-time claims and the duration of such clams by the employees of the employer. In the event of an injury or occupational disease arisingfrom the implementation of the program, the employers and the employees sole and exclusive remedy shall be pursuant to workerscompensation laws of the appropriate jurisdiction. In no event shall BWC be liable for any damages in contract or in tort. MODIFICATIONS . The parties may in writing and by mutual agreement, amend, modify, supplement or rescind the terms o
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