Percy, Chief of Operational Policy, Analytics & Compliance (Signature on
policies and procedures, directives or memos regarding catastrophic events
that predate the effective date of this policy.
purpose of this policy is to ensure multiple claims occurrences are properly
identified, and to ensure consistent injury management:
BWC using multiple claims occurrence teams; and,
BWC and the Managed Care Organizations (MCOs) through collaboration.
policy applies to all BWC and MCO staff.
of Daily Living (ADL): a personal or self-care task that enables an
individual to meet basic life needs (e.g., eating, dressing, bathing, toileting,
transferring in and out of a bed/chair and walking).
a claim in which there is a serious injury resulting in limited mobility and/or
cognition related to the allowed conditions in the claim and that severely
limits the ability of the injured worker (IW) to perform activities of daily
an incident resulting in:
At least two workers being severely injured; and,
At least two workers requiring treatment at a medical facility; and
3. The nature of
at least two of the workers’ injuries makes a return to the position held at
the time of injury improbable (e.g., severity of injury or death).
A. It is the policy
of BWC to evaluate reports of potential multiple claim occurrences and to
determine if the event meets the criteria set forth in the multiple claims occurrence
definition in this policy.
B. When BWC has
categorized an event as a multiple claims occurrence, it is the policy of BWC
to proactively assist the IWs and facilitate injury management services through
the multiple claims occurrence teams.
C. BWC maintains
the following regional core multiple claims occurrence teams in service offices
that assist the listed offices and/or areas:
1. Columbus team:
f. Out of state
g. Special Claims/COEMP;
h. Out of state
employer claims; and
i. Death claims
associated with a multiple claims occurrence.
2. Dayton team:
b. Governor’s Hill;
c. Lima; and
3. Youngstown team:
c. Cleveland; and
regional multiple claims occurrence teams are responsible for managing claims
through the initial determination process.
E. The multiple
claims occurrence process is:
1. The initial
reporting of a potential multiple claims occurrence event;
2. Assignment of
the event to a responsible multiple claims occurrence event team;
3. Determination if
the event is a multiple claims occurrence; and
4. If it is a multiple
claims occurrence, the development of an action plan utilized through the
initial determination phase of the involved claims.
F. BWC does not
utilize the multiple claims occurrence process for self-insured claims, unless
the self-insured employer is bankrupt.
for Multiple Claims Occurrence
Percy, Chief of Operational Policy, Analytics & Compliance (Signature on
for Multiple Claims Occurrence CP-03-05.PR1 dated 08/20/13
08 /20/13; Rev. 11/14/16
I. BWC staff shall refer
to the Standard Claim File Documentation policy and procedure for
claim-note requirements and shall follow any other specific instructions
included in this procedure.
II. BWC shall maintain
regional multiple claims occurrence teams whose members participate in
staffings as needed and consist of the following:
A. An injury management
supervisor (IMS) who:
1. Is the team lead;
2. Oversees the efforts
of the team through the closure of the multiple claims occurrence;
3. Assigns tasks to
multiple claims occurrence team members; and
4. Coordinates the
transfer of claims to the responsible regional claims service specialist (CSS)
B. A claims service
specialist (CSS) who:
1. Creates the event in
the Multiple Claim Occurrence screen in the claims management system;
2. Ensures the
information remains current by updating the claims management system according
to staffing outcomes; and,
3. Manages all aspects
of the injury in accordance with all applicable policies and procedures.
C. A medical service specialist (MSS) who
acts as a primary resource for medical issues regarding non-catastrophic
D. A BWC catastrophic nurse advocate (CNA)
who is the primary resource for issues regarding catastrophic claims.
E. An employer
management supervisor (EMS) who:
1. Decides in what
capacity employer services needs to be involved; and,
2. Notifies the Safety
Violation Investigation unit (SVIU) or the Public Employment Risk Reduction
Program unit (PERRP) when a fatality is part of the multiple claims occurrence
F. An MCO catastrophic
claim program coordinator (MCO CAT Coordinator) who:
1. Is the point of
contact for the responsible regional multiple claims occurrence team;
2. Obtains medical
documentation for his/her respective employer(s); and,
information within the MCO as needed.
G. A death benefits coordinator who:
1. Manages death claims
that result from the multiple claims occurrence; and,
2. Makes the initial
confirmation and notification contact to the employer(s).
III. Initial reporting and
investigation of a potential multiple claims occurrence event
A. Reporting an event
1. Upon becoming aware
of a potential multiple claims occurrence, BWC or MCO staff shall report the
incident by sending an email to email@example.com.
2. Staff shall title the
email “Potential Multiple Claims Occurrence” and note the location of the event
in the subject line of the email (e.g., Potential Multiple Claims Occurrence –
3. Staff shall include
all known information in the body of the email (e.g., location of event,
employer(s) involved, number of injured workers (IWs), and extent of injuries).
B. Establishing the
responsible multiple claims occurrence team
1. The IMS of the
identified region in the subject line of the email shall direct a member of the
regional multiple claims occurrence team (generally the CSS) to enter available
information regarding the event into the Multiple Claims Occurrence screen.
2. Multiple claims
occurrence team leads shall then either:
a. Coordinate an initial
staffing with the responsible regional multiple claims occurrence team members
within one business day, notifying the appropriate MCO CAT coordinator(s) of
the event and initial event staffing via email and phone call; or,
b. If the event involves
multiple regions, staff within one business day with the IMS staff and SOMs of
each involved region to determine the responsible multiple claims occurrence
event team and primary region assignment; and,
i. Notify the
responsible multiple claims occurrence team members; and,
ii. Notify appropriate
MCO CAT coordinator(s).
IV. Multiple claims
A. If, after the initial
staffing, BWC has determined that the event does not meet the definition
of a multiple claims occurrence as defined by the Multiple Claims Occurrence
policy, a member of the responsible regional multiple claims occurrence
1. Enter a staffing note
and update the multiple claim occurrence screen;
2. Reassign the claim to
the appropriate regional service office and CSS who shall then process the
claim(s) in accordance with the Initial Determination policy and
procedure in the appropriate service office.
B. If, after the initial
staffing, it is determined that the event does meet the definition of a
multiple claims occurrence, then all claims related to this event, even if previously
filed, shall be reassigned to the regional multiple claims occurrence CSS.
C. Upon determining the event is a
multiple claims occurrence event a member of the responsible regional multiple
claims occurrence team shall:
1. Update the multiple
claim occurrence screen accordingly and create a multiple claims occurrence
action plan: and,
2. Process each claim
associated with the event in accordance with the Initial Determination
policy and procedure.
V. Multiple claims
occurrence action plan
A. A designee of the
responsible regional multiple claims occurrence team shall create an action
plan by using the template located on the Multiple Claim Occurrence
policy page on COR.
B. Multiple claims
occurrence staff shall document each action step in the plan. Staff shall
utilize the action plan to capture tasks and outcomes associated with claims
occurring from a multiple claims occurrence.
C. Staff shall close a CAT event action
plan after an initial determination has been made on all claims in the event and
reassign claims other than death claims to the appropriate regional service
office for further management.
D. The closure of a CAT event action plan
results in closure of the multiple claims occurrence event.
E. Upon closure of the
CAT event action plan, involved claims shall be processed in accordance with
all applicable policies and procedures.