Policy and Procedure Name:	Multiple Claims Event
Policy #:	CP-03-05
Code/Rule Reference:	R.C. 4123.511; R.C. 4121.121(B)(3)
Industrial Commission (IC) Resolution/Memo	None
Effective Date:	08/25/2023
Approved:	Shawn Crosby, Chief Operating Officer
Origin:	Claims Policy
Supersedes:	Policy # CP-03-05, effective 09/08/2020
History:	Previous versions of this policy are available upon request

 

Table of Contents

 

I. POLICY PURPOSE

II. APPLICABILITY

III. DEFINITIONS

Multiple Claims Event

IV. POLICY

A.         General Policy Statement

B.         Multiple Claims Event Management

V. PROCEDURE

A.         General Claim Note and Documentation Requirements

B.         Identification of a Multiple Claims Event

C.         Claim Assignment

D.         Multiple Claims Event Management

 

 

I. POLICY PURPOSE

 

The purpose of this policy is to ensure that multiple claim events are properly identified, and to ensure consistent claims determination and management.

 

II. APPLICABILITY

 

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

 

III. DEFINITIONS

 

Multiple Claims Event: An event where at least two workers are injured or exposed, resulting in multiple claim filings. The nature of the event could involve medical only claims, death claims, long-term treatment, the inability to return to work, psychological issues, or exposure to harmful substance(s) and/or disease. Examples of a multiple claims event may include (but are not limited to): factory explosions, automobile accidents, workplace violence, or illness.

 

IV. POLICY

 

A.      Multiple Claim Event Identification

1.      It is the policy of BWC to determine if an incident meets the multiple claims event criteria set forth in the definition of this policy.

2.      BWC will evaluate reports of potential multiple claims events to ensure that such incidents are properly identified and managed.

 

B.      Multiple Claims Event Management

1.      When a multiple claims event is identified, it is the policy of BWC to utilize one team to manage the claims to facilitate services for the injured worker(s) and employer(s).

2.      The team is responsible for managing claims throughout the life of the claim.

3.      Self-insured claims involved in the event will be tracked but not managed by the team.

 

V. PROCEDURE

 

A.      General Claim Note and Documentation Requirements

1.      BWC staff must refer to the Standard Claim File Documentation and Altered Documents policy and procedure for claim note and documentation requirements; and

2.      Must follow any other specific instructions for claim notes and documentation included in this procedure.

 

B.      Identification of a Multiple Claims Event

1.      Upon becoming aware of a potential multiple claims event, claims services and MCO staff must report the incident by sending an e-mail to BWCMultipleClaimsEvent@bwc.state.oh.us. Claims services and MCO staff must:

a.      Title the e-mail “Potential Multiple Claims Event;” and

b.      Include any pertinent information, including the claim number, number of known injured workers, nature of event, extent of injuries, etc., in the e-mail.

2.      Claims services management will run a daily report to identify any potential multiple claims event(s) for a single employer.

 

C.      Claim Assignment

1.      A claims services supervisor will assign the claims for investigation and management.

2.      Claims will remain with the team for the life of the claim.

 

D.     Multiple Claims Event Management

1.      The assigned claims services specialist must:

a.      Review the claim(s);

b.      Make contact with the parties;

c.       Complete an investigation;

d.      If necessary, staff with a supervisor for further assistance; and

e.      Once the investigation is complete, make a claim determination.

2.      If the claims require additional assistance from the policy or legal department, the claims will be presented in the multi-disciplinary staffing for review.