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OhioBWC - Basics: (Policy library) - File

Policy Name:

Overpayment of Compensation

Policy #:

CP-15-04

Code/Rule Reference:

R.C. 4123.511(K); R.C. 4123.56; OAC 4121-3-32(B)(2); OAC 4123-3-34; 4123-3-37

Other resources:  Industrial Commission of Ohio (IC) Joint Resolution R89-3-27; IC Hearing Officer Manual Memo P3 (VSSR Overpayment Due to Court Decision)

Effective Date:

3/21/16

Approved:

Rick Percy, Chief of Operational Policy, Analytics & Compliance (Signature on File)

Origin:

Claims Policy

Supersedes:

All Injury Management policies, directives and memos regarding overpayment of compensation that predate the effective date of this policy.

History:

New

 

 

I. POLICY PURPOSE

 

The purpose of this policy is to ensure that BWC appropriately declares an overpayment when a claimant receives compensation that the claimant is not entitled to receive.

 

II. APPLICABILITY

 

This policy applies to BWC field staff.

 

III. DEFINITIONS

 

Claimant: The individual seeking workers’ compensation benefits, typically the injured worker (IW) or a dependent of a deceased IW.

Overpayment of Compensation:  A final administrative or judicial determination  holding that the claimant received compensation to which he or she was not entitled, and which entitles BWC or a self-insuring employer to withhold a percentage amount of compensation from any claims, past, present or future, to which the IW or claimant becomes entitled.

 

IV. POLICY

A.    An overpayment of compensation may include:

1.    BWC payments paid directly to a claimant;

2.    BWC payments paid to another entity on the claimant’s behalf, including, but not limited to, payments to:

a.    A child support enforcement agency;

b.    The Ohio Department of Job and Family Services.

 

B.    Except as noted in section IV.C. of this policy, BWC shall:

1.    Seek recoupment of an overpayment of compensation until it recovers the total amount of the overpayment, regardless of the amount of overpayment and/or time that has passed since the overpayment occurred. 

2.    Recoup the overpayment from any amount of compensation to which the claimant becomes entitled in a past, present or future claim, except that an overpayment shall not be recouped from:

a.    A lump sum advancement for attorney fees;

b.    Disabled worker relief fund payments; or

c.    Living maintenance payments, but not to include living maintenance wage loss payments.

d.    The first twelve (12) weeks of temporary total compensation.

 

C.   BWC shall not seek recoupment of an overpayment:

1.    If the injured worker received compensation in a claim that is subsequently disallowed by the Court of Appeals or Supreme Court;

2.    When, absent an indication of fraud, existing death-benefit award dependents are overpaid because a new dependent is identified as being eligible for a portion of the previously paid death benefits; 

3.    When the overpayment is caused by a court subsequently overturning an Industrial Commission (IC) violation of specific safety regulation award;

4.    When the statute of limitations on the claim in which the overpayment occurred expired prior to declaration of the overpayment.

 

D.   BWC shall provide notice of its intent to recoup an overpayment via:

1.    A BWC order; or

2.    An “Initial Notification of Industrial Commission Declared Overpayment” letter.

 

 

BWC staff may refer to the corresponding procedure for this policy entitled “Procedure for Overpayment of Compensation” for further guidance.


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