Policy and Procedure Name:
4123.57; O.A.C. 4123-3-08
Ann M. Shannon, Chief of Claims Policy and Support
Policy # CP-01-04, effective 08/07/2018
Previous versions of this policy are available upon
Table of Contents
I. POLICY PURPOSE
B. Timeframe for Filing
E. Death of a Claimant
A. General Claim Note and
B. Accrued Compensation
C. Processing the Accrued
D. Accrued Compensation
E. Paying Accrued
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.
This policy applies to claims services staff.
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
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).
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.
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:
partial compensation, including;
of permanent partial disability;
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:
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.
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.
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
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
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
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
application or request has a signature of the person requesting the accrued
documentation must be submitted in accordance with the instructions on the C-6 form and the
Claims policy and procedure.
5. A claimant
shall be determined a dependent in accordance with the Death
Claims policy and procedure.
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
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
BWC shall recoup an overpayment pursuant to R.C. 4123.511(K) and the claimant
would receive the balance, if a balance exists.
1. BWC may
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
Reimbursement policy and procedure.
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.
1. BWC staff
shall refer to the Standard
Claim File Documentation and Altered Documents policy and procedure for
claim note and documentation requirements; and
follow any other specific instructions for claim notes included in this
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
d. A police report;
e. Some other
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
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).
services staff assigned to the claim shall process upon receipt the Application
for Accrued Compensation (C-6) form or its
equivalent from a claimant.
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
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.
services staff shall:
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
b. Make a
telephone call to each applicable dependent(s), claimant(s), representative(s)
and if applicable, the employer and employer’s representative.
the attempt/contact made in claim notes for each applicable party.
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.)
there is no response or a returned call, staff shall send notice by letter via
fax, email or mail to the applicable party:
action taken in claim notes for each applicable party.
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.
reviewing request after sufficient notice has been provided or when work item(s)
has expired with no response.
services staff shall ensure the request meets the eligibility
and timeframe for filing requirements of this policy.
on the requestor, claims services staff shall verify:
a. Proof of
dependency, if applicant is a dependent.
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
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
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
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
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
injured worker files for a scheduled loss (SL) award.
injured worker dies before the SL award is determined.
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.
services staff will resume processing the SL application.
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
overpayment(s), if applicable:
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.
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.
services staff shall issue a notice of referral to the Industrial Commission,
copying all parties to the claim, when recommending denial.
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.
services staff shall adhere to additional requirements in the Orders,
Waivers, Appeals and Hearings policy and procedure.
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
a. Search for
and/or add the payee as a customer:
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.
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);
the accrued compensation is awarded to the estate, make payment to “The estate
services staff shall not make payment in the name of, or in the care of, an
executor or any other individual.
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);
the payment; and
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:
services staff shall email Benefits Payable at email@example.com and include the
following information in the email:
name of the deceased claimant;
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]”;
address the check is to be sent to;
vi. The amount to be
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).
Payable will generate the payment and place a note in the claim file.
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
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;
b. Refer to
Sum Advancement policy and procedure for additional information.
services staff shall refer to the “Date
of Death - Claimant” CoreSuite job aid for further assistance.