|
Policy and Procedure Name:
|
FIREFIGHTERS WITH CANCER
OCCUPATIONAL DISEASE CLAIMS
|
|
Policy #:
|
CP-06-06
|
|
Code/Rule Reference:
|
O.R.C.
4123.68 (X); 5 CFR § 550.902, as amended
|
|
Effective Date:
|
11/05/2021
|
|
Approved:
|
Ann M. Shannon, Chief of Claims Policy and Support
|
|
Origin:
|
Claims Policy
|
|
Supersedes:
|
Policy #CP-06-06, effective 09/29/2017 and Procedure #CP-06-06.PR1,
effective 09/29/2017
|
|
History:
|
Previous versions of this policy are available upon
request
|
Firefighters with
Cancer Occupational Disease Claims
I. POLICY PURPOSE
II. APPLICABILITY
III. DEFINITIONS
Hazardous Duty
IV. POLICY
A. Cancer Contracted by a
Firefighter
B. Limited Compensation
Benefits
V. PROCEDURE
A. General Claim Note and Documentation
Requirements
B. Investigation for
Firefighter with Cancer Claim
C. Limited Compensation
and Benefits
The purpose of this policy is to ensure that BWC determines
and manages a claim for a firefighter with cancer as an occupational disease in
compliance with applicable laws.
This policy applies to Claims Services staff and Legal
staff.
Hazardous
Duty: duty performed under circumstances in which an accident could
result in serious injury or death.
A. Cancer
Contracted by a Firefighter
1. It is the policy
of BWC that the claimant has the burden of proof and shall submit:
a. Evidence to
establish the presumption of causation is met; and
b. BWC’s Presumption
of Causation for Firefighter Cancer (C-265) form
or its equivalent; and
c. First
Report of Injury (FROI-1) form or its equivalent.
2. It is the policy
of BWC to presume that a firefighter’s cancer was contracted in the course of
and arising out of the firefighter’s employment when the following criteria are
met:
a. Worked as a
firefighter;
b. Worked hazardous
duty as a firefighter for a minimum of six years;
c. Exposed to
an agent classified by the International Agency for Research on Cancer (IARC)
as a Group 1 or Group 2A carcinogen while working as a firefighter;
d. A written
narrative cancer diagnosis from a physician; and
e. The firefighter,
due to the cancer, on or after April 6, 2017 was:
i. First
diagnosed,
ii. First
received treatment;
iii. First quit work:
or
iv. Died due to the cancer.
v. If the
firefighter was first diagnosed or first received treatment prior to April 6,
2017 but has not yet quit work due to the disease, the claim is eligible for
consideration under the presumption.
3. BWC shall consider
the presumption of causation rebutted when any of the following applies:
a.
The
firefighter is 70 years of age or older;
b.
The
firefighter was last assigned to hazardous duty as a firefighter more than 15
years ago.
c.
The
firefighter was exposed to cigarettes, tobacco products or other conditions
that present an extremely high risk for the development of the cancer alleged,
and such exposure was probably a significant factor in the cause or progression
of the cancer;
d.
There
is evidence that shows, by a preponderance of competent scientific evidence,
that exposure to the type of carcinogen alleged did not or could not have
caused the cancer being alleged;
e.
There
is evidence that the firefighter was not exposed to an agent classified by the
International Agency for Research on Cancer (IARC) as a Group 1 or Group 2A
carcinogen while working as firefighter;
f.
There
is evidence that the firefighter incurred the type of cancer alleged prior to
becoming a firefighter.
4. It is the policy
of BWC to allow a claim when the claimant has met the requirements in sections IV.A.1. and IV.A.2.
and a rebuttal of the presumption of causation is not received.
5. BWC may obtain
an independent physician file review or medical examination for an alleged
firefighter with cancer occupational disease claim.
6. When the
presumption of causation is not met, in accordance with this policy, BWC may
process the claim under the general Occupational
Disease Claims policy and procedure.
1. For a
firefighter with cancer occupational disease claim that is presumptively
allowed under R.C. 4123.68(X), compensation shall be limited to:
a. Temporary Total
Disability compensation;
b. Working wage
loss compensation;
c. Permanent
Total Disability compensation;
d. Death Benefits.
2. For claims filed
on 04/06/2017 through 09/28/2017, a firefighter with cancer occupational
disease claim that is presumptively allowed under R.C. 4123.68(X) is not
eligible for to receive working wage loss compensation.
3. BWC shall follow
all other applicable policies for processing benefits for a firefighter with
cancer occupational disease claim that is presumptively allowed under the law.
1. BWC staff shall
refer to the Standard
Claim File Documentation and Altered Documents policy and procedure for
claim note and documentation requirements; and
2. Shall follow any
other specific instructions for claim notes and documentation included in this
procedure.
1. Claims services
staff shall ensure the claim is timely filed and refer to the Jurisdiction
(Statute of Limitations, Statutory Life of a Claim) policy for additional
information.
2. In addition to
the requirements of this policy and procedure, claims services staff shall
follow the:
a. General
investigative requirements of the Initial
Claim Determination policy and procedure, such as, initial contacts;
and
b. Elements of compensability
requirements of the Compensable
Injuries policy and procedure.
3. During the
investigation, claims services staff shall:
a. Ensure the C-265
form or its equivalent and FROI form are completed in its entirety and if information
is missing, contact the party to secure the information;
b. Establish the
date of disease with latest date available in accordance with section IV.A.2.e.;
c. Review the
claim to see if there is evidence to rebut the presumption of causation in
accordance with section IV.A.3.
4. Claims services
staff shall send an email to the BWC Legal Director of Hearing
Services/Field Support to evaluate the claim and to:
a. Determine if the firefighter’s cancer was contracted in the
course of and arising out of the firefighter’s employment and the claim meets
the presumption;
b. Determine
whether evidence is sufficient to rebut the presumption, if applicable;
c. Address any issue(s) identified or questions from the claim’s
services staff, for example:
i. IW is over 70 years old; or
ii. There is confusion over the date of disability (e.g., first
treatment date is 11/21/2020 and diagnosed on 11/30/2020; therefore, the date
of disease/occurrence we are applying is 11/30/2020 -would legal concur?)
5. With approval
from the supervisor and BWC staff attorney, claims services staff may obtain a
physician file review or independent medical examination.
6. When BWC Legal
responds to claims services email and:
a. The conditions
to establish the presumption have been met, claims services staff shall issue a
BWC Initial Allowance order in the claim.
b. The presumption
is not met, or the presumption is rebutted, claims services staff shall refer
to the Occupational
Disease Claims policy to evaluate the claim under standard occupational
disease criteria.
C. Limited Compensation
and Benefits
1. Claims services
staff shall only consider and pay the following types of compensation
for a firefighter with cancer claim presumptively
allowed under the law:
a. Temporary total
disability compensation;
b. Working Wage Loss
Compensation for claims filed on or after 09/29/2017;
c. Permanent
total disability compensation;
d. Death.
2. Claims services
staff shall review a compensation request with a BWC staff attorney when it is
not for a compensation listed in section IV.C.1.a.-d.
in order to determine the next steps and, when applicable issue a notice of
referral to the Industrial Commission.
3. Claims services
staff shall follow any other applicable policy for processing benefits once BWC
has presumptively allowed a firefighter with cancer claim.