OhioBWC - Basics: (Policy library) - File

Policy and Procedure Name:

Accrued Compensation

Policy #:

CP-01-04

Code/Rule Reference:

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

Effective Date:

08/07/2018

Approved:

Kevin R. Abrams, Chief Operating Officer

Origin:

Claims Policy

Supersedes:

Policy #CP-01-04, effective 07/12/17 and Procedure #CP-01-04.PR1, effective 07/12/17

History:

Policy #

CP-01-04

Rev. 08/07/18; 07/12/17; 03/21/16; 01/05/16; New 07/01/13

Procedure #CP-01-04.PR1

Rev. 08/07/18; 07/12/17; 11/14/16; 03/21/16; 01/05/16; New 07/01/13

 

 

 

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 pertaining 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.

 

Dependent: A member of the family of the decedent, or bears to the decedent the relation of surviving spouse, lineal descendant, ancestor, or brother or sister who relied on the decedent for financial support.

 

Claimant: One who asserts a right, demand or claim for workers’ compensation benefits.

 

IV.  POLICY

 

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

1.    To a dependent; or

2.    To a provider or individual that rendered or paid for services pertaining to the decedent’s death; or

3.    To the estate of the decedent, if there is no eligible dependent or provider or individual that rendered services pertaining to the decedent’s death.

 

B.    The dependent, a provider or individual that rendered or paid for services pertaining to the decedent’s death, or the estate, shall make an application to BWC to receive accrued compensation by submitting an Application for Accrued Compensation (C-6) form, available on the BWC website, or an equivalent form.

 

C.   Timeframes:

1.    A dependent, a provider or individual that rendered services pertaining to the decedent’s death or the estate has two (2) years 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.    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.

 

D.   Percentage of Permanent Partial Disability and Scheduled Loss Compensation

1.    Award prior to the decedent’s death

a.    When an award for a percentage of permanent partial disability or scheduled loss compensation is made pursuant to R.C. 4123.57 prior to the death of the decedent, BWC will pay unpaid installments accrued or to accrue under the provisions of the award to:

                                i.    The surviving spouse, or if there is no surviving spouse;

                               ii.    The dependent children of the decedent, and if there are no dependent children surviving;

                              iii.    Other dependents as determined by BWC.

b.    Bfollow the percentage of permanent partial disability policy for processing.ent'ion award to a suriviving spouse or other depenWC recognizes that an estate is entitled to accrued compensation of a scheduled loss compensation award but is not entitled to the unpaid balance of the scheduled loss compensation award.  Estates are not entitled to the ongoing remainder of the balance because an estate cannot be a dependent.  State ex rel. Liposchak v. Indus. Comm., 90 Ohio St.3d 276, 2000-Ohio-73; State ex rel. Estate of Sziraki v. Admr., Bur. of Workers’ Comp., 137 Ohio St.3d 201, 2013-Ohio-4007.

2.    Award after the decedent’s death

a.    When a scheduled loss compensation award is filed after the decedent’s death, BWC shall follow the Scheduled Loss Compensation policy for processing.

b.    When a percentage of permanent partial award is filed after the decedent’s death, BWC shall follow the Percentage of Permanent Partial Disability policy for processing.

c.     BWC shall pay an unpaid award granted and for the period after the decedent’s death in biweekly payments only to:

                                i.    Surviving spouse, if one exists; or

                               ii.    Other dependent, if no surviving spouse exists.

 

E.    Lump Sum Settlement: Lump sum settlements will be handled consistent with the Lump Sum Settlement policy.

 

F.    Existing Overpayment and Accrued Compensation

Any overpayment existing at the time of the decedent’s death will be recouped from accrued compensation consistent with the Overpayment of Compensation policy.

 

G.   A claimant may designate and authorize a representative by filing a Claimant Authorized Representative (R-2) form, consistent with the Authorized Representatives policy. An authorization made by the decedent does not carry-over and apply to a new claimant.

 

H.   Orders, Appeals, and Payment

1.    An order shall be used to issue a decision on an application(s) for accrued compensation.

2.    A party to the claim may appeal an order consistent with the Orders, Waivers, Appeals and Hearings policy.

3.    Any awarded accrued compensation shall be paid at the expiration of the appeal period if an appeal has not been filed unless a waiver is received from all parties.

 

V.   Procedure

 

A.    BWC staff shall refer to the Standard Claim File Documentation and Altered Documents policy and procedure for claim-note requirements and shall follow any other specific instructions included in this procedure.

 

B.    When claims services staff receive notice of the death of a claimant, claims services staff shall verify the death through:

1.    A social security cross match;

2.    A Death certificate;

3.    A Published obituary;

4.    A Police report; or

5.    Some other reliable means.

 

C.   Reviewing and Processing a Request for Accrued Compensation

1.    Accrued Compensation from an Award Granted Prior to Decedent’s Death

a.    If claims services staff receive a request for the accrued compensation from a benefit awarded prior to decedent’s death, claims services staff shall:

i.      Ensure a written application/request for the accrued compensation is in the claim prior to any payment;

ii.     When a request for accrued compensation is made verbally:

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

b)      Provide the claimant with an Application for Accrued Compensation (C-6), 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 will suffice).

c)       Claims services staff shall process, upon receipt of, the Application for Accrued Compensation (C-6) form or an equivalent form from the:

i)        Dependent;

ii)       Provider or individual that rendered or paid for services pertaining to the decedent’s death;

iii)     Estate.

iii.    Ensure the request for accrued compensation has been made within two (2) years from the date of the decedent’s death;

b.    Claims services staff shall investigate and secure the following documentation necessary to verify the eligibility of the claimant for the accrued compensation:

i.      Proof of dependency, if applicant is a dependent, in accordance with the Death Claims policy and procedure.

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

iii.    Proof of executor status, and the estate’s tax identification number if a tax identification number has been obtained for the estate, if the applicant is an executor of the decedent’s estate.

c.     Claims services staff may staff the application with the BWC attorney to ensure any legal issues are addressed.

2.    Accrued Compensation from an Award Not Granted Prior to Decedent’s Death

a.    If claims services staff receive a request for accrued compensation from an award that was not granted prior to the decedent’s death, claims services staff shall advise the claimant to submit the request in writing in the manner appropriate for the type of benefit from which accrued compensation is being sought (typically, via a motion);

b.    The written request for accrued compensation from an award serves as an application for that award, whether the previous application:

i.      Was abated upon the decedent’s death; or

ii.     Is for an award the decedent would have been lawfully entitled to have applied for at the time of death.

c.     Once the written application is received, claims services staff shall review the application and determine:

i.      The status of the claimant (surviving spouse, dependent child, etc.); and

ii.     Whether the application has been filed within one (1) year after the date of the decedent’s death.

d.    Claims services staff shall staff the application with the BWC attorney to ensure any legal issues are addressed.

e.    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; percentage of permanent partial disability).

f.      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.

g.    Example:

i.      An injured worker is receiving temporary total (TT).

ii.     The injured worker dies.

iii.    Within one year of the decedent’s death the claimant files a motion for accrued compensation from SL (or files a motion for SL, with no reference to accrued compensation).

iv.   Claims services staff processes the request for accrued compensation for SL or SL pursuant to the Scheduled Loss Compensation policy and procedure.

 

D.   Determining Eligibility for Accrued Compensation

1.    Accrued Compensation from an Award Granted Prior to Decedent’s Death

a.    Except as provided in section V.D.1.b. (as it relates to percentage of permanent partial disability or scheduled loss compensation), claims services staff shall grant accrued compensation from an award granted prior to the decedent’s death generally to:

i.      The dependent(s) of the decedent.

a)    A dependent will typically be a surviving spouse and/or minor children.

b)    Adult children or other family members are not typically dependents unless they relied on the decedent for financial support.

c)    If there is more than one eligible dependent claims services staff shall determine the most equitable and appropriate distribution of the accrued compensation;

ii.     Eligible providers or individuals that rendered or paid for services pertaining to the decedent’s death; or

iii.    If there are no dependents, or providers or individuals that rendered or paid for services pertaining to the decedent’s death, to the decedent’s estate.

b.    Percentage of Permanent Partial Disability and Scheduled Loss Compensation Awarded before the Death of the Decedent.

i.      Claims services staff shall pay all unpaid installments accrued or to accrue for awards of percentage of permanent partial disability or scheduled loss compensation to:

a)    The surviving spouse; or

b)    If there is no surviving spouse, to the dependent children of the decedent; or

c)    If there is no surviving spouse or dependent children, to other dependents as determined appropriate.

ii.     If the request has not been made by a surviving spouse, dependent child or other dependent, claims services staff shall staff payment of any accrued compensation awarded with the BWC attorney.

2.    Accrued Compensation from an Award Granted After the Decedent’s Death: Claims services staff shall staff eligibility for accrued compensation from a request received after the decedent’s death with the BWC attorney.

 

E.    Issuing the Order: Claims services staff shall issue an order to the claimant, copying any other dependents, awarding or denying the accrued compensation request. (See the Orders, Waivers, Appeals and Hearings procedure).

 

F.    Paying the Accrued Compensation

1.    If 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 procedure).

2.    To pay the 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.F.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.F.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 any awarded on-going Percentage of Permanent Partial Disability and Scheduled Loss Compensation for the period after the decedent’s date of death to the surviving spouse, dependent child or other dependent in biweekly payments.

a.    Lump sum advancements shall not be granted against the scheduled loss payments.

b.    Scheduled loss payments shall not be paid after the death of the surviving spouse, dependent child or other dependent. The estate of a deceased surviving spouse, dependent child or other dependent is not entitled to the ongoing remainder of the scheduled loss compensation.

5.    Claims services staff shall refer to the “Claimant Date of Death” PowerSuite job aid for further information.

 

G.   Authorized Representative in the Claim

1.    A claimant may designate and authorize a representative by filing a Claimant Authorized Representative (R-2) form, consistent with the Authorized Representatives policy.

2.    An authorization made by the decedent does not carry-over and apply to a new claimant, such as the decedent’s surviving spouse or dependent child, even if the new claimant chooses to designate and authorize the same representative to represent them.

3.    For further information refer to the Authorized Representatives policy and procedure.

 

VI.  Special Issues

 

A.    Lump Sum Settlement (LSS): When the decedent is a party to a lump sum settlement, claims services staff shall process the LSS in compliance with the Lump Sum Settlement policy and procedure.

 

B.    Travel Reimbursement: Claims services staff shall treat travel reimbursement as accrued compensation, whether pending and abated at the time of decedent’s death, or filed as a new application in compliance with the Travel Reimbursement policy and procedure.

 

C.   Overpayments

1.    Claims services staff shall deduct any overpayment existing at the time of the decedent’s death in compliance with the Overpayment of Compensation policy and procedure and the “Absorption Rates for Overpayments Chart”, available on COR.

2.    Claims services staff shall use the absorption rate applicable to the type of compensation being paid. 

 

D.   Accrued Compensation and Death of a Dependent

1.    If a dependent is awarded and receiving payments of accrued compensation from a scheduled loss compensation award, pursuant to R.C. 4123.57(B), and the dependent dies, claims services staff shall pay to the estate of the dependent only the accrued compensation payable up to and including the date of the dependent’s death, if no other dependent, as determined by BWC, is eligible.

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