OhioBWC - Basics: (Policy library) - File

Policy and Procedure Name:

Handicap Reimbursement

Policy #:

CP-08-01

Code/Rule Reference:

R.C. 4123.343 and 4123.63; O.A.C. 4123-3-35

Effective Date:

02/16/22

Approved:

Ann M. Shannon, Chief of Claims Policy and Support

Origin:

Claims Policy

Supersedes:

Policy # CP-08-01, effective 01/01/16; Procedure #CP-08-01.PR1, effective 05/06/2019

History:

Previous versions of this policy are available upon request


 

Table of Contents

 

I. POLICY PURPOSE

II. APPLICABILITY

III. DEFINITIONS

Handicapped Employee

IV. POLICY

A.          General Statement

B.          Handicapped Diseases and Conditions

C.         Eligible vs Non-Eligible Employers

D.         Eligible Employer and Employer’s Representative Application Filing

E.          CHP-4A

F.          Benefits and Compensation

G.         Employers Have Several Rights with Respect to This Policy

H.         Claims Eligible for Handicap Reimbursement

V. PROCEDURE

A.          General Claim Note and Documentation Requirements

B.          Processing a Handicap Reimbursement Application

 

 


 

I. POLICY PURPOSE

 

The purpose of this policy is to ensure BWC reduces costs to an employer’s risk by charging a percentage of the qualifying claim’s costs to the statutory surplus fund instead of to the employer’s experience when an employer hires and retains employees with a qualifying pre-existing condition, disease, or military service handicap.

 

II. APPLICABILITY

 

This policy applies to BWC Claim Services staff, Legal, and Employer Services staff.

 

III. DEFINITIONS

 

Handicapped Employee: For the purpose of this policy, an employee who has a pre-existing physical or mental impairment, or both, whether congenital or due to an injury or disease, such that the impairment constitutes a disability that interferes with obtaining employment or reemployment and whose disability is due to any of the diseases or conditions listed in IV (B)(1)-(25).

 

IV. POLICY

 

A.     General Statement

1. - It is the policy of BWC to charge a percentage of a qualifying claim’s costs to the statutory surplus fund instead of to the employer’s experience, upon application of the employer, when a handicapped employee as defined in R.C. 4123.343 or R.C. 4123.63 is injured, disabled or dies as a result of an injury or occupational disease sustained in the course of, or arising out of, their employment, and BWC finds either that the injury, occupational disease, or death was the result of the pre-existng condition delayed recovery or th pre-existing condition delayed or increased the costs of treating the allowed injury. In addition, a handicap reimbursement award is not evidence to support a substantial aggravation of that qualifying condition.

 

B.   Handicapped Diseases and Conditions

2. - It is the policy of BWC to recognize handicap reimbursement for an injured worker (IW), who has any of the qualifying pre-existing conditions, as set forth below:

1.   Epilepsy;

2.   Diabetes;

3.     Cardiac disease;

4.     Arthritis;

5.     Amputated foot, leg, arm or hand;

6.     Loss of sight of one or both eyes or partial loss of uncorrected vision of more than seventy-five percent (75%) bilaterally;

7.     Residual disability from poliomyelitis;

8.     Cerebral palsy;

9.     Multiple sclerosis;

10.  Parkinson’s disease;

11.  Cerebral vascular accident (stroke);

12.  Tuberculosis;

13.  Silicosis;

14.  Psycho-neurotic disability following treatment in a recognized medical or mental institution;

15.  Hemophilia;

16.  Chronic osteomyelitis;

17.  Ankylosis of joints;

18.  Hyperinsulinism;

19.  Muscular dystrophies;

20.  Arteriosclerosis;

21.  Thrombophlebitis;

22.  Varicose veins;

23.  Cardiovascular pulmonary or respiratory diseases of firefighters or police officers employed by a municipal corporation or township as a regular member of a lawfully constituted police or fire department;

24.  Coal miner’s pneumoconiosis (black lung disease); or

25.  Disability with respect to an individual who has completed a rehabilitation program conducted pursuant to sections R.C. 4121.61 through R.C. 4129.69.

 

C.  Eligible vs Non-Eligible Employers

 

1.   Eligible employers include:

a.   Public employer taxing districts;

b.   Private state-fund employers; 

d.   Any employer who has been granted a previous handicap reimbursement; or

e.   Certain bankrupt employers as determined on a case-by-case basis.

2.   Ineligible employers include:

a.   Non-complying and/or out-of-business employers;

b.   Self-insuring employers; or

c.   State agencies and universities.

 

D.  Eligible Employer and Employer’s Representative Application Filing

26. - It is the policy of BWC, that when an employee with an eligible handicap condition files an allowed workers’ compensation claim, the eligible employer or the employer’s representative may file an Application for Handicap Reimbursement (CHP-4A) form with supporting medical evidence to BWC.

 

E.   CHP-4A

27. - The CHP-4A must be filed while the claim is within the employer’s experience, as outlined in in Section V.B.2.a-b, of the procedures in this document.

 

F.   Benefits and Compensation

28. - An employer's application for handicap reimbursement does not affect the rights of the IW to receive any benefits or compensation, and the employee is not required to provide information to an employer about any pre-existing conditions.

 

G.  Employers Have Several Rights with Respect to This Policy

29. 

1.   An employer may request an informal conference be conducted regarding the application for handicap reimbursement. Informal conference may be  in person, by phone, or via any other remote technolgy as circumstances dicitate or as agreed by the parties.

2.   An employer may request withdrawal of the application at anytime, either in writing or verbally.

3.   Claims settlement does not affect the employer’s right to have a handicap reimbursement application considered.

4.   Pursuant to R.C. 4123.511, the employer may appeal a BWC Order on handicap reimbursement to the Ohio Industrial Commission (IC).

 

H.  Claims Eligible for Handicap Reimbursement

30. - BWC will only consider an application for handicap reimbursement when one of the following apply:

1.   BWC has awarded compensation to the IW for:

a.   Temporary total disability;

a.     Permanent total disability;

b.     Scheduled loss/ loss of use, facial disfigurement or accrued benefits paid under 4123.57(B); or

c.      Death benefits.

2.   The IW has received wages from the employer in lieu of compensation (e.g., salary continuation.

 

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.     Processing a Handicap Reimbursement Application

1. 

1.   If a CHP-4A is not directly filed with BWC’s Legal Division, any staff who receives a CHP-4A shall immediately, without imaging the document(s) into the claim, date stamp and forward the CHP-4A with supporting documentation to:

BWC Legal Division

Handicap Reimbursement L-26

Attention: Handicap Reimbursement Coordinator

30 W. Spring Street

Columbus, Ohio 43215-2256

2.     The CHP-4A must be filed while the claim is within the employer’s experience, as follows:

a.     For private state-fund employer claims with a date of injury (DOI):

i.       On or before December 31, 2009, the CHP-4A must be filed by June 30th of the year no more than six years from the year of the date of injury or occupational disease.

ii.      On or after January 1, 2010, the CHP-4A must be filed by June 30th of the year:

a)     No more than six years from the year of the date of injury or occupational disease if the DOI is between January 1st and June 30th.

b)     No more than seven years from the year of the DOI or occupational disease if the DOI  is between July 1st and December 31st.

b.     For public employer taxing district claims with a DOI:

i.       On or before December 31, 2009, the CHP-4A must be filed by December 31st of the year no more than five years from the year of the date of the injury or occupational disease.

ii.      On or after January 1, 2010, the CHP-4A must be filed by December 31st of the year no more than six years from the year of the DOI or occupational disease.

c.      For a claim involving a private state fund employer or a public employer taxing district employer participating in a retrospective rating plan, the application shall be filed within the time provided in Section V.B.2.a-b, as applicable.

3.     Predetermination Eligibility Review

a.     Legal staff shall complete an initial review of the CHP-4A to ensure:

i.       It is timely filed while the claim is within the employer’s experience; and

ii.      It meets the following minimum criteria:

a)     The private state-fund employer had coverage on the DOI ;

b)     Presents medical evidence that the employee suffered from a condition listed in Section IV(B)(1)-(25); and

c)     Presents evidence that the handicap condition pre-existed the injury, occupational disease or death, including but not limited to, evidence that prior to the injury, occupational disease or death, the handicap condition caused the employee to be hospitalized or to obtain extensive medical treatment; and

d)     Presents evidence that BWC has awarded compensation to the IW for temporary total disability, disabilities described under R.C. 4123.57 division (B), permanent total disability, or death benefits; or, the IW has received wages from the employer in lieu of compensation (e.g., salary continuation); and

e)     Presents medical reports to support the contention that the injury, disease or death would not have occurred but for the pre-existing disease or eligible condition of the employee, or that the resulting disability or death was caused, in part, through aggravation of the disease or presents evidence that the pre-existing condition delayed recovery or increased cost of treating the allowed conditions.

iii.     Legal staff shall review each claim for:

a)     Pending BWC or IC applications;

b)     Previous award denied or granted by the IC or BWC for the same handicap;

c)     Motions or appeals;

d)     If the employer is participating in the Enhanced Care Program; and

e)     If applicable, other related claims.

b.     Legal staff shall deny or dismiss a CHP-4A for an allowed claim not meeting the criteria listed in Section V.B.3.a.1-2.

c.      If the IW files for an additional condition in the claim being reviewed, Legal staff shall continue to process the CHP-4A. The filing of an additional condition does not stay the request for a handicap reimbursement.

4.     Handicap Reimbursement Conference

a.     Legal staff shall schedule an informal determination conference and serve notice of the upcoming conference electronically or by mail to the employer and the employer representative, if applicable, giving a minimum of two weeks notification, unless the employer waives this requirement.

b.     The BWC legal representative assigned to hold the conference and the employer and/or the employer representative shall meet (i.e., in-person, over-the-phone, virtually) to discuss the merits of the application.

i.       If all parties reach agreement at the time of the meeting, the employer or the employer representative may sign a Waiver of Appeal (C-108) to have the order processed immediately.

ii.      If the parties do not reach agreement, BWC may not process the order until after the fourteen (14) day appeal period expires.

5.     Handicap Reimbursement Processing

a.     Legal staff’s responsibilities

i.       Once legal staff has made a determination on the handicap reimbursement, Legal staff shall issue an order.

ii.      Legal staff shall send a copy of the order to:

a)     The employer;

b)     The employer’s representative; and

c)     The risk file.

iii.     Legal staff shall image the handicap reimbursement application packet and order into the claims management system, initiating a work item for the Claims Services staff; or

iv.    Send the handicap application packet and order to the scan zone for imaging.

b.     BWC Claim Services Staff Responsibilities

i.       If an appeal is filed, BWC Claim Services staff shall not enter the handicap information in the claims management system until the IC issues an order awarding a handicap reimbursement percentage.

ii.      If no appeal is received within the appeal period, BWC Claim Services staff shall enter the handicap percentage and the condition for which the handicap percentage was awarded in the handicap fields found under the Claims Maintenance-Profile tab.

6.     If the appeal period is waived, BWC Claim Services staff can immediately apply the handicap reimbursement percentage under the Claims Maintenance-Profile tab.