OhioBWC - Basics: (Policy library) - File

Policy and Procedure Name:

Facial Disfigurement

Policy #:

CP-06-02

Code/Rule Reference:

R.C. 4123.57 (B)

Effective Date:

10/22/2021

Approved:

Ann M. Shannon, Chief of Claims Policy and Support

Origin:

Claims Policy

Supersedes:

Policy # CP-06-02, effective 05/24/2017 and Procedure # CP-06-02, effective 05/24/2017

History:

Previous versions of this policy are available upon request


 

Table of Contents

 

I. POLICY PURPOSE

II. APPLICABILITY

III. DEFINITIONS

Facial Disfigurement

Facial Disfigurement Award

IV. POLICY

A.          General Policy

B.          Eligibility for a Facial Disfigurement Award

C.          Facial Disfigurement Award Maximum

V. PROCEDURE

A.          General Claim Note and Documentation Requirements

B.          Review and Evaluation of Eligibility of a Facial Disfigurement Award

C.          Evaluating Degree of Impairment of a Facial Disfigurement

D.          Decision and Payment of a Facial Disfigurement Award

 

 


 

I. POLICY PURPOSE

 

The purpose of this policy is to ensure that an award for a facial disfigurement is made in compliance with the law.

 

II. APPLICABILITY

 

This policy applies to all BWC claims services staff and legal staff.

 

III. DEFINITIONS

 

Facial Disfigurement: A visible, serious deformity, mark or scar to the face or head. Slight scarring or discoloration is not necessarily a facial disfigurement.

 

Facial Disfigurement Award: An award granted to an injured worker for an injury or occupational disease that results in serious facial or head disfigurement which either impairs or may in the future impair the opportunities to secure or retain employment.

 

 

IV. POLICY

 

A.    General Policy

1.    It is the policy of BWC that upon receipt of a motion (C-86) or its equivalent, to determine eligibility for a facial disfigurement award and evaluate the degree of impairment.

2.    BWC may pay a facial disfigurement award in addition to any other partial disability compensation award(s).

3.    A facial disfigurement award is paid in a lump sum.

 

B.    Eligibility for a Facial Disfigurement Award

1.    To be eligible for a facial disfigurement award, the facial disfigurement must:

a.    Be a direct result from the injured worker’s compensable injury or occupational disease; and

b.    Be visible on the injured worker’s face or head; and

c.     Impair or have the potential to impair the injured worker’s opportunities to secure or retain employment.

2.    It is the policy of BWC to make a facial disfigurement award determination only after the facial disfigurement has stabilized.

3.    The injured worker’s employment status is not a factor in determining eligibility for a facial disfigurement award.

 

C.   Facial Disfigurement Award Maximum

1.    The maximum award for a compensable injury or occupational disease occurring on or after June 30, 2006, is $10,000.

2.    The maximum award for a compensable injury or occupational disease occurring on or before June 29, 2006, is $5,000.

 

 

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 and documentation included in this procedure.

 

B.    Review and Evaluation of Eligibility of a Facial Disfigurement Award

1.    Claims services staff shall do a timely review of a motion (C-86) or its equivalent requesting a facial disfigurement award.

2.    To provide notice to the employer or employer representative, claims services staff shall:

a.    Make a telephone call to the employer or employer’s representative.

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

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

b.    If there is no response or a returned call, claims services staff shall send notice by letter (Insured Due Process) via fax, email or mail to the applicable parties:

i.      Document action taken in claim notes for each 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.

c.     After sufficient notice to the employer or employer representative is provided or when the work item(s) has expired with no response, claims services staff shall continue to process the facial disfigurement award request.

3.    Claims services staff shall ensure the facial disfigurement has medically stabilized and will not likely require additional medical treatment or surgeries.

4.    When the facial disfigurement is stabilized, claim services staff and BWC attorney shall determine if the facial disfigurement:

a.    Is a direct result of the injured worker’s compensable injury or occupational disease;

b.    Is visible on the injured worker’s face or head; and

c.     Impairs or has the potential to impair the injured worker’s ability to secure or retain employment.

5.    Claims services staff and BWC attorney shall base decisions for eligibility using medical, psychological, and/or vocational evidence.

 

C.   Evaluating Degree of Impairment of a Facial Disfigurement

1.    When evaluating the degree of impairment and impact of a facial disfigurement to determine the amount of the award, claims services staff and BWC attorney shall consider:

a.    The impacts of the facial disfigurement on the injured worker’s ability to retain or secure employment; and

b.    The severity of the facial disfigurement, including but not limited to:

i.      Shape, color, anatomic location and any evidence of ulceration;

ii.     Depression or elevation;

iii.    Texture (soft and pliable, hard, thin, smooth or rough);

iv.   Attachment or detachment, if any to underlying bone, joint, or muscles or other tissue;

v.     Whether there are disfigurements based on peripheral nerve dysfunction or loss of range of motion;

vi.   Whether the disfigurement can be made less visible or concealed; and

vii.  Whether it is likely to change appearance over time.

2.    Claims services staff may gather any other relevant information prior to staffing with the supervisor and BWC attorney in evaluating the impact of the facial disfigurement such as:

a.    Medical evaluations;

b.    History of the medical condition;

c.     Results of the most recent medical evaluation;

d.    Assessment of medical status, prognosis, diagnosis and treatment plan;

e.    Photographic, video graphic or other visual evidence of the disfigurement;

f.      Present and planned educational level;

g.    Prior or planned vocational training;

h.    Description of present or planned employment;

i.      Summary of specific vocational assessment;

j.      Psychological exam/evaluation;

k.     History of psychological condition;

l.      Results of the most recent psychological evaluation.

3.    Claim services staff and BWC attorney may consider a maximum facial disfigurement award for the following:

a.    “Full thickness” injuries resulting in the removal of multiple layers of flesh on the face or head or possible skin grafting;

b.    Any facial disfigurement, which is so severe that there is massive distortion of the normal facial or head structure; and

c.     Only severe facial injuries qualify for the maximum award. The majority of facial disfigurements do not qualify for the maximum award.

4.    Claims services staff must staff with their supervisor and BWC attorney when determining the amount of the award and prior to publishing the order. Claims services staff may also include other areas when discussing these requests (e.g., Nurse, Rehab) as warranted.

 

D.   Decision and Payment of a Facial Disfigurement Award

1.    Claims services staff shall publish the decision using the subsequent order and selecting “facial disfigurement.”

2.    Claims services staff shall use the receipt date of the request (i.e., Motion (C-86) or its equivalent) to pay the facial disfigurement award in the claims management system.

3.    Claims services staff shall notify a BWC attorney of an appeal filed on our facial disfigurement award order and request BWC attorney attendance.