Skip Navigation Links.
Online Support available
Monday through Friday
7:30 a.m. - 5:30 p.m.
Click here to get help!
OhioBWC - Basics: (Policy library) - File

Policy Name:

Adjustment of Overpaid Compensation

Policy #:

CP-01-08

Code/Rule Reference:

R.C. 4123.511(K), 4123.512

Other Reference:  Industrial Commission of Ohio (IC)/Ohio Bureau of Workers’ Compensation (BWC) Joint Resolution R89-3-27

Effective Date:

11/13/15

Approved:

Rick Percy, Chief of Operational Policy, Analytics and Compliance (Signature on File)

Origin:

Claims Policy

Supersedes:

All Injury Management policies, directives and memos regarding adjustment of overpaid compensation that predate the effective date of this policy

History:

New

 

 

I. POLICY PURPOSE

 

The purpose of this policy is to ensure that compensation is entered and adjusted correctly in the claims management system when compensation is overpaid, and overpayments are collected according to Ohio law and applicable case law.

 

II. APPLICABILITY

 

This policy applies to BWC Field Operations staff.

 

III. DEFINITIONS

 

Claimant: The individual seeking workers’ compensation benefits, typically the injured worker (IW) or a dependent of a deceased IW.

Good faithFor purposes of this policy, when the claimant, including IW, employer, and BWC take action on a compensation decision in the claim based on the belief that all relevant and necessary information was available at the time the decision was made, and all parties were acting reasonably and with an honest belief that compensation was lawfully due.

 

 

IV. POLICY

A.     It is BWC’s policy to adjust compensation when:

1.       A claimant’s full weekly wage (FWW) and/or average weekly wage (AWW) are reset (refer to the Wages policy for more information regarding FWW and AWW); or

2.       A claimant receives compensation that he/she is no longer entitled to receive.  

 

B.     It is BWC’s policy to adjust payment of compensation and, if applicable, collect an overpayment from any past, present, or future workers’ compensation claims according to Ohio law, unless:

1.      The claim meets the criteria for non-collection, as outlined in this policy;  

2.      The overpayment is waived in a lump sum settlement agreement; or

3.      The IC has directed otherwise.

 

C.     BWC may not collect an overpayment when field staff, in consultation with a BWC attorney, determines that the claimant, employer and BWC all believed, in good faith, at the time the payments were made, that compensation was lawfully due. 

 

D.     Collecting Overpayments

1.      When an overpayment is created by some means other than a reversal, upon appeal, of a decision to pay compensation (e.g., duplicate payment, wage adjustment, etc.), BWC is not bound by R.C. 4123.511(K); however, it is BWC’s policy to recoup the overpayment according to R.C. 4123.511(K) as this recoupment method is reasonable to recover overpaid funds.  

2.      It is BWC’s policy to collect:

a.       An overpayment from any amount of compensation the claimant may receive in any past, present, or future claim in accordance with Ohio law, even if the claimant has arranged to make payments to BWC’s Collection Department to reduce the overpayment; and

b.      Overpayments according to the percentages listed in the chart on www.bwc.ohio.gov titled “Absorption Rates for Overpayments.” 

i.        Internal and external customers may refer to BWC Library/About BWC/Tools for Authorized Reps/Resources to locate the chart on www.bwc.ohio.gov.   

ii.      Internal customers will find the chart on Claims Online Resources (COR)/Adjustment of Overpaid Compensation/Tips and Tools.   

3.      BWC will not absorb an overpayment from the first 12 weeks of payment of temporary total compensation (TT), except when the overpayment is due to a finding of fraud, but will absorb the overpayment following payment of the first 12 weeks of TT.

4.      Refer to the Overpayment of Compensation policy on www.bwc.ohio.gov for more information regarding overpayments.

 

 

E.      Appeals to Court

1.      When the Court of Common Pleas issues a decision that reverses a previous BWC or IC claim allowance or compensation payment decision, it is BWC’s policy to seek recovery of any compensation paid (set the IW up overpaid).

2.      When an appeal on the allowance of the claim or payment of compensation is filed and the Court of Appeals or the Supreme Court reverses the appealed decision, BWC will not seek recovery of any compensation paid (IW is not set up overpaid), except for claims assigned to a public employer-state (PES).    

a.       The employer’s risk will be adjusted, if compensation has been paid; and

b.      Any overpayment that occurs due to the reversal of the claim allowance or compensation payment will be charged to the Surplus Fund.

c.       For claims assigned to a PES employer:

i.        The employer’s risk will not be adjusted; and

ii.      Any overpayment that occurs due to the reversal of the claim allowance or compensation payment will not be charged to the Surplus Fund.

3.      Refer to the Orders, Waivers, Appeals and Hearings policy on www.bwc.ohio.gov for more information regarding appeals to court. 

 

F.      It is BWC’s policy to send periodic notice to the claimant when a subsequent reduction is made to a declared overpaid balance due to the receipt of a personal check, returned warrant, or issuance of an award for a new period of compensation.

 

G.     Reimbursement of travel expenses is a reimbursement of previously paid expenses, not a form of compensation; therefore, BWC will not collect compensation overpayments from travel expense reimbursement. Refer to the Travel Reimbursement policy and procedure for more information regarding reimbursement of travel expenses. 

 

H.     The claimant may contact BWC’s Collections Department to set up a schedule of payments to reduce the overpayment.

1.      The claimant may send payments for non-fraud collections to:

Ohio Bureau of Workers’ Compensation

P. O. Box 89492

Cleveland, OH  44101-6492.

2.      Fraud collections are to be sent to:

Ohio Bureau of Workers’ Compensation

Attn:  Fraud Collections

P.O. Box 15187

Columbus, OH  43215.

3.      When sending a payment overnight or express mail or a signature is required for delivery, send payment to the following address:

Ohio Bureau of Workers’ Compensation

ATTN:  Lockbox 89492

4910 Tiedeman Road

Cleveland, OH  44144.

4.      A check(s) or money order(s) must be payable to Ohio Bureau of Workers’ Compensation or BWC. 

 

BWC staff may refer to the corresponding procedure for this policy entitled “Adjustment of Overpaid Compensation” for further guidance.

 

 

 


Resources