OhioBWC - Basics: (Policy library) - File

Accrued Compensation

Policy and Procedure Name:

Accrued Compensation

Policy #:

CP-01-04

Code/Rule Reference:

O.R.C. 4123.60; 4123.57; O.A.C. 4123-3-08

Effective Date:

10/21/2020

Approved:

Ann M. Shannon, Chief of Claims Policy and Support

Origin:

Claims Policy

Supersedes:

Policy # CP-01-04, effective 08/07/2018

History:

Previous versions of this policy are available upon request

  


 

Table of Contents

 

I. POLICY PURPOSE

II. APPLICABILITY

III. DEFINITIONS

Accrued Compensation

Claimant

Dependent

IV. POLICY

A.          Eligibility

B.          Timeframe for Filing

C.         Determination

D.         Miscellaneous

E.          Death of a Claimant

V. PROCEDURE

A.          General Claim Note and Documentation Requirements

B.          Accrued Compensation Assignment

C.         Processing the Accrued Compensation Request

D.         Accrued Compensation Determination

E.          Paying Accrued Compensation

 

 


 

I. POLICY PURPOSE

 

The purpose of this policy is to ensure BWC properly identifies and pays accrued compensation to a dependent, a provider or individual that rendered or paid for services related to the injured worker’s (hereafter the “decedent”) death or to the estate of the decedent consistent with applicable rules and statutes.

 

II. APPLICABILITY

 

This policy applies to claims services staff.

 

III. DEFINITIONS

 

Accrued Compensation: The unpaid portion of an award of compensation in an allowed claim due to the decedent at the time of his or her death, regardless of whether the death was the result of an allowed injury or occupational disease claim.

 

Claimant: One who asserts a right, demand or claim for workers’ compensation benefits. For purposes of this policy, “claimant” typically refers to the surviving spouse, other dependents or a provider that is seeking reimbursement or payment for services pertaining to the decedent’s death (e.g., a funeral home).

 

Dependent: A member of the family of the decedent, for example a surviving spouse or a blood relative, such as child, stepchild, parent or other blood relative who relied on the decedent, in whole or in part, for financial support as provided by law.  A dependent is not a fiancé(e), live-in significant other, or a foster child, etc.

 

IV. POLICY

 

A.     Eligibility

1.     It is the policy of BWC to pay accrued compensation benefits, when it meets the eligibility and timeframe for filing requirements outlined in this policy, for the following:

a.     Temporary total compensation;

b.     Permanent partial compensation, including;

i.       Percentage of permanent partial disability;

ii.      Scheduled Loss compensation;

iii.     Facial Disfigurements.

c.      Permanent total compensation.

2.     It is the policy of BWC to pay accrued compensation benefits the decedent was entitled, up to and including the date of death, to the following:

a.     The decedent’s dependent(s); or

b.     If there is no dependent(s), BWC shall pay accrued compensation benefits to a provider or individual that rendered or paid for services related to the decedent’s death.

i.       BWC shall only pay a provider or individual up to the amount of the cost of the services rendered or paid, and no more than what is accrued.

ii.      For example:

a)     If the cost of services rendered or paid were $500.00, but the accrued compensation benefits were $1,000.00, the provider or individual would only be entitled to $500.00.

b)     If the cost of services rendered or paid were $1,500.00, but the accrued compensation benefits were $600.00, the provider or individual would only be entitled to $600.00.

c.      If there is no dependent(s) or provider or individual that rendered or paid services related to the decedent’s death, BWC shall pay accrued compensation benefits to the estate of the decedent.

3.     The decedent’s dependent(s), a provider or individual that rendered or paid for services related to the decedent’s death, or the estate, shall make an application in writing by submitting an Application for Accrued Compensation (C-6) form or its equivalent.

a.     The C-6 is completed in its entirety or the equivalent request contains all the same information as the C-6; and

b.     The application or request has a signature of the person requesting the accrued compensation.

4.     Supporting documentation must be submitted in accordance with the instructions on the C-6 form and the Death Claims policy and procedure.

5.     A claimant shall be determined a dependent in accordance with the Death Claims policy and procedure.

 

B.     Timeframe for Filing

1.     A dependent, a provider or individual that rendered services pertaining to the decedent’s death or the estate has one (1) year from the date of the decedent’s death to file an application for payment of accrued compensation from a benefit that was awarded to the decedent prior to death.

2.     An application for accrued compensation from an application abated due to decedent’s death or a benefit that the decedent was lawfully entitled to have applied for at the time of his or her death must be filed within one (1) year from the date of decedent’s death.

 

C.    Determination

1.     It is the policy of BWC to make a determination on accrued compensation no later than 28 calendar days from receipt of the application.

2.     It is the policy of BWC to ensure that an application for accrued compensation is either allowed by BWC or is referred to the Industrial Commission (IC) for determination.

3.     BWC shall recoup an overpayment pursuant to R.C. 4123.511(K) and the claimant would receive the balance, if a balance exists.

 

D.    Miscellaneous

1.     BWC may treat Disabled Workers’ Relief Fund (DWRF) as accrued compensation, up to and including the date of death, when it meets the eligibility and timeframe for filing requirements of this policy.

2.     BWC may consider travel reimbursement as accrued compensation, whether pending and abated at the time of the decedent’s death or filed as a new application when it meets the eligibility and timeframe for filing requirements of this policy and is completed in compliance with the Travel Reimbursement policy and procedure.

 

E.     Death of a Claimant

1.     When a claimant is awarded and receiving payments from an ongoing scheduled loss compensation award or percentage of permanent partial disability award, pursuant to R.C. 4123.57, and the claimant dies, BWC shall pay to the estate of the claimant only the accrued compensation payable, up to and including the date of the claimant’s death, when no other claimant, as determined by BWC, is eligible.

2.     When death benefits are awarded to a claimant and the claimant dies before the funds are disbursed, BWC shall pay to the claimant’s estate accrued compensation for the period between the decedent’s death and the claimant’s death, when no other claimant, as determined by BWC, is eligible.

 

V. PROCEDURE

 

A.     General Claim Note and Documentation Requirements

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 included in this procedure.

 

B.     Accrued Compensation Assignment

1.     When claims services staff receives a notice of death of an injured worker or a claimant, claims services staff shall verify the death through reliable means, such as:

a.     A social security cross match;

b.     A death certificate;

c.      A published obituary;

d.     A police report; or

e.     Some other reliable means.

2.     When a request for accrued compensation is made verbally, claims services staff shall:

a.     Advise the claimant to submit the request in writing; and

b.     Provide the claimant with an Application for Accrued Compensation (C-6) form or direct the claimant to the BWC website to obtain the form. (Any claimant may use the C-6 to apply for accrued compensation. However, any written request providing equivalent information is sufficient).

c.      Claims services staff assigned to the claim shall process upon receipt the Application for Accrued Compensation (C-6) form or its equivalent from a claimant. 

3.     General assignment guidelines:

a.     The claims services staff assigned the original claim when a C-6 application is filed must process the request for accrued compensation, except when an Application for Death Benefits and/or Funeral Expenses (C-5) form is filed at the same time as the C-6. When a death claim request is filed, claims services staff will reassign the claim to the appropriate team for processing death benefits. 

b.     When an Application for Death Benefits and/or Funeral Expenses (C-5) form is subsequently filed after the C-6 application (i.e., a day later or multiple days later), the supervisor of the team assigned and the supervisor of the appropriate team for processing death benefits shall consult and agree upon a plan to resolve everything pending in a timely and efficient manner.

 

C.    Processing the Accrued Compensation Request

1.     Claims services staff shall:

a.     Upon receipt of an accrued compensation application, provide notice to all known claimants and dependents, including any attorney representative(s) of the application filed.  Notice must also include the employer of record, if applicable. 

b.     Make a telephone call to each applicable dependent(s), claimant(s), representative(s) and if applicable, the employer and employer’s representative.

i.       Document the attempt/contact made in claim notes for each applicable party.

ii.      Set a work item for three business days, not including the date the telephone call was placed.  (e.g., call placed on Thursday, left a message. Set a work item for 3 business days – Friday, Monday, Tuesday – claims staff can continue processing application on Wednesday.)

c.      If there is no response or a returned call, staff shall send notice by letter via fax, email or mail to the applicable party:

i.       Document action taken in claim notes for each applicable party.

ii.      Set a work item as follows:

a)     Three full business days to respond if the letter is sent by fax or email; or

b)     Seven full business days to respond if the letter is sent by mail.

d.     Continue reviewing request after sufficient notice has been provided or when work item(s) has expired with no response.

2.     Claims services staff shall ensure the request meets the eligibility and timeframe for filing requirements of this policy.

3.     Depending on the requestor, claims services staff shall verify:

a.     Proof of dependency, if applicant is a dependent.

b.     An invoice, proof of payment or other credible documentation if the applicant is a provider or individual who rendered or paid for services related to the decedent’s death.

c.      For an estate, proof of executor status (i.e., documentation from the court verifying the claimant’s authority to act on behalf of the estate) and the estate’s tax identification number if a tax identification number has been obtained for the estate; or

4.     If supporting documentation is not on file, claims services staff shall request the applicable supporting documentation necessary to process the application.

5.     Accrued compensation from an award granted prior to decedent’s death, claims services staff shall:

a.     Evaluate the request; and

b.     Staff the application with the supervisor and may if necessary, the BWC attorney to address any legal issues.

6.     Accrued compensation from an award not granted prior to decedent’s death

a.     Claims services staff shall staff the request with the supervisor and BWC attorney to ensure any legal issues are addressed.

b.     If it is found the request has been timely filed and any legal issues have been addressed, claims services staff shall process the application in the manner appropriate for the type of benefit for which accrued compensation is being requested (e.g., scheduled loss compensation or percentage of permanent partial disability).

c.      Example:

i.       The injured worker files for a scheduled loss (SL) award.

ii.      The injured worker dies before the SL award is determined.

iii.     Claims services staff abate the application for SL.

iv.    Within one year of the decedent’s death, the claimant files a motion for accrued compensation from the SL.

v.      Claims services staff will resume processing the SL application.

 

D.    Accrued Compensation Determination

1.     Claims services staff shall issue a BWC order to the claimant, copying all other claimant(s), when granting the accrued compensation request.  Claims services staff shall include in the order:

a.     Type of compensation; and

b.     Any overpayment(s), if applicable:

i.       When declared prior to decedent’s death, claims services staff shall:

a)     Use the absorption rate applicable for the type of compensation being paid, and

b)     Attach a copy of the order declaring the overpayment in the claim.

ii.      Claim services staff shall refer to the Overpayment of Compensation policy and procedure when an overpayment was not declared by BWC or IC order prior to the decedent’s death.

2.     Claim services staff shall issue a notice of referral to the Industrial Commission, copying all parties to the claim, when recommending denial.

3.     Claims services staff may request the claimant withdraw the application when no accrued compensation is payable in the claim to prevent sending a notice of referral to the Industrial Commission for denial.

4.     Claims services staff shall adhere to additional requirements in the Orders, Waivers, Appeals and Hearings policy and procedure.

 

E.     Paying Accrued Compensation

1.     When accrued compensation is awarded, claims services staff shall issue payment when the appeal period has expired and no appeal is filed, unless a waiver is received from all parties. (See the Orders, Waivers, Appeals, and Hearings policy and procedure).

2.     To pay accrued compensation through the claims management system claims services staff shall:

a.     Search for and/or add the payee as a customer:

i.       If paying to a provider or an estate, claims services staff shall enter the entity’s tax identification number, provided via a Request for Taxpayer Identification Number and Certification (W-9).  If there is no estate tax identification number, refer to section V.E.3. below.

ii.      A social security number is not required if paying to a person/customer.

b.     Enter the payee as a participant and alternate payee in the claim, if not already attached as an existing participant (e.g., beneficiary or dependent);

c.      If the accrued compensation is awarded to the estate, make payment to “The estate of…”

i.       Claims services staff shall not make payment in the name of, or in the care of, an executor or any other individual.

ii.      Claims services staff shall request the estate’s tax identification number from the person making the request, as well as documentation from the probate court establishing that person’s relationship to the estate.  If there is no estate tax identification number, refer to section V.E.3. below.

d.     Code the accrued compensation by the type of compensation that accrued (e.g., temporary total, permanent total disability);

e.     Schedule the payment; and

f.       Modify the allocation information (defaulted to the claimant) to update the primary payee to reflect payment to the participant as appropriate.

3.     If there is no tax identification number for an estate:

a.     Claims services staff shall email Benefits Payable at eftgroup@bwc.state.oh.us and include the following information in the email:

i.       The claim number;

ii.      The name of the deceased claimant;

iii.     An explanation that there is no tax identification number for the estate, and details regarding the contact made and how this information was obtained;

iv.    That the check should be made payable to “The estate of [deceased claimant’s name]”;

v.      The address the check is to be sent to;

vi.    The amount to be issued;

vii.   The type of payment (i.e., percentage of permanent partial, permanent total disability);

viii. The period of time the payment covers, if applicable; and

ix.    Any pertinent documents (e.g., the BWC order, the application for accrued compensation, any relevant court documents).

b.     Benefits Payable will generate the payment and place a note in the claim file.

4.     Claims services staff shall pay an award for on-going Percentage of Permanent Partial Disability and Scheduled Loss Compensation for the period after the decedent’s date of death in biweekly payments to the surviving spouse, dependent child or other dependent.

a.     Claims services staff shall not process a request for a lump sum advancement against an on-going percentage of permanent partial disability or scheduled loss compensation; and

b.     Refer to the Lump Sum Advancement policy and procedure for additional information.

5.     Claims services staff shall refer to the “Date of Death - Claimant” CoreSuite job aid for further assistance.