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OhioBWC - Basics: (Policy library) - File

Policy Name:

Death Claims

Policy #:

CP-04-04

Code/Rule Reference:

R.C. 4127.03; R.C. 4123.031; R.C. 4123.032; R.C. 4123.59; R.C. 4123.60; R.C. 4123.66; O.A.C. 4123-3-07; 4123-5-13.

Effective Date:

09/29/17

Approved:

Kevin R. Abrams, Chief Operating Officer

Origin:

Claims Policy

Supersedes:

Policy CP-04-04, effective 03/21/16

History:

New 07/01/13; Rev; 12/11/14; 01/05/16; 03/21/16

 

 

I. POLICY PURPOSE

 

The purpose of this policy is to ensure that BWC processes notices of death of an injured worker (“decedent”) and requests for death benefits and/or payment of medical and funeral expenses consistently, appropriately and in compliance with law to dependents and those who rendered services pertaining to an injured worker’s (the decedent’s) death.

 

II. APPLICABILITY

 

This policy applies to BWC Field Operations staff.

 

III. DEFINITIONS

 

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).

 

Common Law Marriage: A marriage relationship created by agreement and cohabitation rather than by ceremony. Ohio law recognizes these marriages only if

established in Ohio prior to October 10, 1991, or if established after that date in another state or nation that recognizes the validity of common law marriages, consistent with the laws of that state or nation.

 

Death Benefits: Benefits payable pursuant to R.C. 4123.59 and R.C. 4123.60 to a dependent of an injured worker who has died as a result of an injury or occupational disease received in the course of, and arising out of, the injured worker’s employment.

 

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, in whole or in part, for financial support.

 

Emergency Management Worker: An individual who has registered for service pursuant to R.C. 5502.34, in connection with the development, maintenance, and operation of any state or local emergency management agency authorized by law, and who has met the minimum requirements of R.C. 4123.031 to 4123.037, or who has been registered as an emergency management worker pursuant to R.C. 5502.34 during a disaster or emergency.

 

Guardian: A person lawfully vested with the power, and charged with the duty,

of taking care of and/or managing the property and rights of another because the person is of minor age, has a defect of understanding or self-control, or is considered incapable of administering his or her own affairs.

 

Natural Parent: For BWC purposes, the legally recognized parent of a child, whether biological or adoptive.

 

Partial Dependent: A dependent who has received some financial support from the decedent, such as the payment of rent or mortgage, medical bills, groceries or utilities.

 

Prospective Dependent: A surviving spouse, lineal descendant, ancestor, or brother or sister, not found to be a whole or partial dependent, but whose circumstances clearly indicate a need for financial support and there is evidence of an intention or commitment of the decedent to provide such financial support.

 

Special Handling Claims: Has the same definition as Memo 4.21 – “COEMP and Special Handling Claims” found in the BWC Employee Handbook/Workplace Policies. 

 

Whole Dependent: A dependent that is presumed or found to have relied on the decedent for financial support, to a greater degree than a partial or prospective dependent (e.g., a surviving spouse and/or minor children are presumed wholly dependent).

 

IV. POLICY

 

A.      It is the policy of BWC to ensure death benefits are properly awarded to a dependent(s) when a decedent dies as the result of a work-related injury or occupational disease.

 

B.      Filing Applications for Death Benefits

1.       A dependent of the decedent may file an application for death benefits.

2.       Applications for death benefits may be initiated via:

a.       A First Report of Injury, Occupational Disease or Death (FROI);

b.       An Application for Death Benefits and/or Funeral Expenses (C-5);

c.       An Application for Additional Award for Violation of Specific Safety Requirement in a Workers’ Compensation Claim (IC-8/9);

d.       A Motion (C-86);

e.       Telephone notification ( to be followed up with a written request);

f.        In person notification (to be followed up with a written request);

g.       Online through the BWC website;

h.       Email notification; or

i.         Any other written communication requesting benefits.

3.       If the dependent has an authorized representative (e.g., legal counsel), the dependent must file an appropriate authorization with BWC.

a.       Any authorization made by the decedent expires upon his or her death and is not applicable to the dependent.

b.       See the Authorized Representatives policy for further information.

4.       Statute of Limitations for Applying for Death Benefits With a Date of Injury Prior to 09/29/2017::

a.       Applications for death benefits for all workers, except emergency management workers, that die due to a work-related injury or occupational disease must be filed within two (2) years from the date of death.

b.       An application for death benefits for an emergency management worker employed by the state or a political subdivision, who dies in the performance of his or her duties as an emergency management worker, must be filed:

i.         Within one (1) year of the date of the death; or

ii.       If the emergency management worker filed an injury claim within one year of an injury, and the emergency management worker subsequently dies from that injury, within six (6) months after the date of death.

5.       Statute of Limitations for Applying for Death Benefits With a Date of Death On or After 09/29/2017:

a.       Applications for death benefits for all workers, including emergency management workers, employed by the state or a political subdivision, who die due to a work-related injury must be filed within one year from the date of death.

b.       If the emergency management worker filed an injury claim within one year of an injury, and the emergency management worker subsequently dies from that injury, the application for death benefits must be filed within six (6) months after the date of death.

c.       For information on the statute of limitations for deaths due to occupational disease, see the Jurisdiction policy.

 

C.      Eligibility for Death Benefits

1.       To be eligible for death benefits:

a.       The applicant must be a dependent;

b.       Application must be made within the required time frames per section IV.B.4; and

c.       The death must have occurred in the course of and arising out of the decedent’s employment.

2.       The status of the decedent as an undocumented worker or public work-relief employee does not by itself, negate the decedent’s dependents from eligibility for death benefits.

 

D.      Whole, Partial and Prospective Dependents

1.       BWC will, based on the evidence in the claim, identify a dependency level as whole, partial or prospective.

2.       The following are presumed to be wholly dependent:

a.       The surviving spouse:

i.         Living with the decedent at the time of death; or

ii.       Living separately from the decedent due to the decedent’s aggression;

b.       A child of the decedent living with the decedent at the time of death and for whom the decedent was contributing more than 50% of the child’s financial support, or for whose maintenance the decedent was legally responsible; and the child is:

i.         Under the age of 18;

ii.       Eighteen (18) years old but less than twenty-five (25) years old and pursuing a full-time educational program while enrolled in an accredited educational institution and program; or

iii.     Eighteen (18) years old or older and physically or mentally incapacitated from earning.

3.       Partial dependency may be demonstrated by producing evidence that the decedent was paying a portion of the dependent’s living expenses.

4.       Prospective dependency may be demonstrated by producing evidence that the decedent paid a portion of the dependent’s living expenses in the past or had made a commitment to pay future living expenses.

a.       A surviving natural parent(s) with whom the decedent was living at the time of death, if not determined to be a whole or partial dependent(s), shall be presumed to be a prospective dependent and entitled to a minimum award of $3,000.

b.       A surviving spouse separated from the decedent for reasons other than aggression is not presumed to be a whole dependent, but may otherwise be determined to be a whole, partial, or prospective dependent if adequate evidence is provided showing the surviving spouse received financial support from the decedent.

5.       There may be a combination of whole, partial and prospective dependents in a claim.

 

E.       Death Benefit Rates and Apportionment

1.       The weekly rate for a whole dependent is 66 2/3% of the decedent’s average weekly wage (AWW); but:

a.       The weekly rate shall not exceed the statewide average weekly wage for the year of death; and

b.       The weekly rate shall not be less than 50% of the statewide average weekly wage (SAWW) for the year of death.

2.       The weekly rate for a partial dependent is 66 2/3% of the decedent’s AWW; but:

a.       The weekly rate shall not exceed the SAWW for the year of death; and

b.       There is no minimum weekly rate.

3.       The benefit for a prospective dependent is based on the amount of support that was received or expected to be received from the decedent; and

a.       The award for all prospective dependents (excluding natural parents deemed prospective dependents) shall not exceed a total amount of $3,000.

b.       Natural parents determined to be prospective dependents shall receive a minimum total award of $3,000.

4.       Apportioning and Reapportioning Death Benefits Among Dependents

a.       When there are two or more whole and/or partial dependents eligible for death benefits, BWC will apportion the amount of the benefit among the whole and or partial dependents equitably, considering the circumstances of each particular case.

i.         If there is at least one whole dependent, the one benefit, as calculated based on the whole dependent, shall be apportioned among the whole and/or partial dependents.

ii.       Payment of benefits to any prospective dependent(s) does not factor into the benefits paid or apportioned among whole and/or partial dependents.

b.       An award to natural parents living with the decedent at the time of death that are determined to be prospective dependents shall be equally apportioned.

c.       If there is more than one prospective dependent (excluding natural parents) the award to the prospective dependents will be apportioned among the prospective dependents as BWC determines equitable.

d.       Death benefits will be reapportioned when:

i.         Benefits were awarded and apportioned to one or more dependents and subsequently an additional dependent is identified and awarded benefits; or

ii.       The eligibility status of a dependent changes. Events that change eligibility status include, but are not limited to:

a)       Remarriage of the surviving spouse;

b)      A child reaches the age of 18;

c)       A child at least 18 years old but less than 25 years old starts or stops attending an accredited educational institution and program full-time;

d)      A child attending an accredited educational institution and program reaches the age of 25;

e)      A dependent dies;

f)        A dependent is incarcerated or released from incarceration in a state or federal correctional institution for a conviction of any state or federal criminal law. See the Incarceration policy for further information.

 

F.       Funeral and Medical Expenses

1.       In addition to the death benefits discussed above, application may be made for reimbursement of, or payment for:

a.       Medical, nurse, hospital services, and medicine related to the decedent’s work-related injury or occupational disease; and

b.       Funeral expenses up to a maximum of $5,500.

2.       The individual or provider that incurred the expense and making the application must provide supporting documentation such as an invoice or receipt.

3.       In addition to funeral expenses, BWC may pay for related exceptional transportation costs; e.g., returning the body of the decedent when the death occurs outside the area where the decedent lived.

 

G.      BWC shall deduct from a dependent’s death benefits any family support that the dependent is ordered to pay, consistent with the Family Support Orders and Attorney Fees Paid Pursuant to Deductions of Child Support from Lump Sum Payments policy.

 

H.      Settlement

1.       A potential dependent may be entitled to death benefits, even if the decedent’s claim was settled.

2.       The dependents of the decedent may seek to settle death benefit claims, consistent with the Lump Sum Settlement policy.

 

I.         Lump Sum Advancement

Requests for lump sum advancements shall be processed consistent with the Lump Sum Advancement policy.

 

J.        Ongoing Documentation and Contact Requirements

1.       All dependents are required to immediately notify BWC when there is any change in his/her dependency status (e.g., surviving spouse remarries, child stops attending a full-time educational program).

2.       BWC shall also verify the continuing eligibility of a dependent through an annual contact letter. All dependents are required to:

a.       Sign the letter acknowledging and verifying the information provided in the letter; and

b.       Return the signed letter and any required documentation to BWC within a stated period of time. A scanned or faxed copy of the signed letter will fulfill the signature requirement.

3.       In addition to an annual contact letter, a dependent/student receiving benefits is required to submit to BWC, every educational period (e.g., semester, quarter):

a.       Proof of continued enrollment in a full-time educational program (e.g., class registration); and

b.       Proof of participation in, and completion of the previous educational period for which benefits were received (e.g., a grade report).

4.       BWC may require additional documentation from a dependent at any time to verify continuing eligibility status, as is reasonably necessary.

5.       The failure of a dependent to respond to an annual contact letter or submit the required documentation, including the documentation required from a student each educational period, may result in the withholding and possible termination of the dependent’s benefits.

 

BWC staff may refer to the corresponding procedure for this policy entitled “Procedure for Death Claims” for further guidance.

 


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