OhioBWC - Basics: (Policy library) - File

Policy and Procedure Name:

Scheduled Loss Compensation

Policy #:

CP-19-01

Code/Rule Reference:

R.C. 4123.57 (B)

O.A.C. 4123-3-09; 4123-3-15 (C); 4123-3-16 and 4123-3-37

Effective Date:

March 16, 2021

Approved:

Ann M. Shannon, Chief of Claims Policy and Support

Origin:

Claims Policy

Supersedes:

Policy # CP-19-01, effective 10/02/2015 and Procedure # CP-19-01.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

Amputation

Ankylosis

Claimant

Corrective eye surgery

Dependent

Enucleation

Loss of hearing

Loss of use

Loss of vision

IV. POLICY

A.          General Information for Scheduled Loss Compensation

B.          Eligibility for Scheduled Loss Compensation

C.         Amputations

D.         Loss of Use, including Ankylosis

E.          Loss of Vision

F.          Loss of Hearing

G.         Payment of Scheduled Loss Compensation Award

H.         Death of an Injured Worker

V. PROCEDURE

A.          General Claim Note and Documentation Requirements

B.          Scheduled Loss Compensation

C.         Reviewing and Processing the Scheduled Loss Compensation Request

D.         Physician File Review (PFR) or Independent Medical Examination (IME)

E.          Issuing a Decision for Scheduled Loss Compensation

F.          Payment of Scheduled Loss Compensation Award

G.         Ohio Industrial Commission Orders on Scheduled Loss Compensation

H.         Self-Insured Claims

 

 


 

I. POLICY PURPOSE

 

The purpose of this policy is to ensure that BWC processes an application for scheduled loss compensation and pays the allowed award in weekly installments, according to the schedule provided in R.C. 4123.57(B).

 

II. APPLICABILITY

 

This policy applies to Claims Services and Legal Division staff.

 

III. DEFINITIONS

 

Amputation: To cut or remove a limb or body part from the body.

 

Ankylosis: Total stiffness of or contractures due to scars or injuries that may cause joints to be useless because they cannot move.

 

Claimant: One who asserts a right, demand or claim for workers’ compensation benefits. For purposes of this policy a “claimant” is usually the injured worker, but in the case of the injured worker’s death it may also be the surviving spouse or other dependents, or one making a claim related to accrued compensation of loss of use benefits.

 

Corrective eye surgery: For purposes of this policy, addresses the visual problems, but not a wholly equal substitute for the natural lens. In addition, corrective eye surgery is not necessarily a permanent solution as there can be future problems with the implant. (e.g., corneal lens implants.)

 

Dependent: A member of the family of the decedent, for example a surviving spouse or a blood relative, such as child, stepchild, parent or other blood relative who relied on the decedent, in whole or in part, for financial support as provided by law. A dependent is not a fiancé(e), live-in significant other, or a foster child, etc.

 

Enucleation: To remove the eye without removing the muscles that control the eye.

 

Loss of hearing: For purposes of this policy, a permanent and total incapability of receiving auditory input (sound).

 

Loss of use: When a body part is rendered useless for all practical intents and purposes, whether due to severance, or due to injury or occupational disease.

 

Loss of vision: For the purposes of this policy, the loss of uncorrected vision which is the percentage of vision acuity actually lost as a result of the injury or occupational disease.

 

 

IV. POLICY

 

A.     General Information for Scheduled Loss Compensation

1.     A scheduled loss compensation award may also be called Permanent Partial (PP) or a Paragraph B award because it is filed under RC 4123.57(B). To be consistent, BWC shall use the language “scheduled loss compensation.”

2.     It is the policy of BWC that an injured worker is not entitled to receive a scheduled loss compensation award and a percentage of permanent partial disability compensation (%PP) award for the same part of body without applying an offset between the two awards.

3.     It is the policy of BWC to deduct a previously paid %PP award granted for the same part of body for which a scheduled loss compensation award will be granted. State ex rel. Maurer v. Industrial Commission of Ohio (1989), 47 Ohio St.3d 62.

4.     It is the policy of BWC that an injured worker may receive a %PP award and a scheduled loss compensation award concurrently in the same claim or different claims only when the parts of body are different.

5.     It is the policy of BWC that if the loss of use of a body part produces a residual impairment beyond the scheduled loss, an injured worker may receive a %PP for the additional residual impairment.

6.     It is the policy of BWC to deduct a previously paid Temporary Partial compensation award granted for the same part of body for which a scheduled loss compensation award will be granted.

7.     It is the policy of BWC that it may consider a Lump Sum Advancement (LSA) request on a scheduled loss compensation award for an injured worker but not for any other claimant, including a dependent in a claim for death benefits.

8.     For claims with a date of injury prior to August 25, 2006, statutory permanent total disability (PTD) may be awarded when an injured worker has a total loss of, or a loss of use of, an entire limb. State ex rel. Thomas v. Industrial Commission of Ohio (2002), 97 Ohio St.3d 37.

 

B.     Eligibility for Scheduled Loss Compensation

1.     An application for scheduled loss compensation may be made any time during the life of a claim.

2.     The injured worker or claimant shall provide supporting medical documentation from a physician that demonstrates that the loss is:

a.     Permanent; and

b.     The result of a work-related injury.

3.     The application for scheduled loss compensation shall be made on a Motion (C-86), or its equivalent, and include:

a.     Specific part of body, type and extent of loss (e.g., severance, ankylosis, or how for all practical intents and purposes there is a loss of use that is being requested); and

b.     Specific supporting medical evidence documenting the part of body, type and extent of loss, with additional information as follows:

i.       For an amputation, the physician must provide a clear and accurate description of the point of amputation.

ii.      For loss of vision:

a)     The medical documentation is from an ophthalmologist, except when the loss of vision is based on psychiatric factors;

b)     The medical documentation supports the loss of vision in one or both eyes;

c)     Includes the injured worker’s pre-injury uncorrected vision;

d)     Includes the injured worker’s post-injury uncorrected vision;

e)     The medical documentation must demonstrate at least a twenty-five percent loss of uncorrected vision post-injury.

iii.     For loss of hearing:

a)     The medical documentation is from an ear, nose, and throat (ENT) physician (otolaryngologist) except when the loss of hearing is based on psychiatric factors; and

b)     The medical documentation demonstrates that the loss of hearing in one or both ears is total.

4.     BWC may request additional medical evidence as necessary.

 

C.    Amputations

1.   An injured worker is entitled to a scheduled loss compensation award when they sustain a loss of a body part that is the result of severance, and reattachment of the same body part has not been successful (functional).

a.     If the same severed body part is reattached, an award will not be given when medical documentation supports that the reattachment was successful (functional). State ex rel. Welker v. Industrial Commission of Ohio (2001), 91 Ohio St.3d 98.

b.     The injured worker may request an amputation award if the reattachment subsequently becomes unsuccessful and has to be removed.

2.     An injured worker may be entitled to a scheduled loss compensation award even if they receive a prosthetic device to replace the amputated body part. However, the use of an orthotic device may not necessarily equate to a functional loss of use.

3.     When there is an increase in the scheduled loss compensation due to an additional amputation (below knee amputation revised to above knee amputation), the scheduled loss compensation award is paid but the previously paid award is deducted from the amount.

4.     Fingers, hands, and/or arms

a.     The loss of one-third or distal phalange of any finger other than the first finger (i.e., the thumb) is considered equal to the loss of one-third of the finger. The amputation must be at or near the joint. The loss of the finger near the proximal interphalangeal (PIP) joint is equal to the loss of two-thirds of the finger.

b.     The loss of a second, or distal, phalange of the thumb is considered equal to the loss of one-half of such thumb; the loss of more than one-half of the thumb is considered equal to the loss of the whole thumb.

c.      The scheduled loss compensation award for the loss of two or more fingers by amputation or ankylosis cannot exceed the amount for the loss of a hand. The injured worker cannot combine the loss of parts of four fingers to equal the total loss of two fingers, for purposes of qualifying for a total loss of hand award. State ex rel. Honda of America MFG., Inc. v. Industrial Commission of Ohio, 183 Ohio App.3d 732 (2009).

d.     If a loss of the arm is payable, the injured worker is not entitled to an additional award for loss of the hand. The award for the arm includes the award for the hand.

e.     If the injured worker’s thumb is amputated and replaced with the great toe, BWC will only pay for the amputation of the toe. There is no award for the loss of the thumb. State ex rel. Mast v. Indus. Comm., 193 Ohio App.3d 650, 2011-Ohio-2865.

f.       Amputation of the hand and arm below the elbow joint is considered equal to the loss of the hand. If the amputation is at the elbow, a determination must be made regarding the functionality of the elbow before determining if the injured worker is eligible for the loss of the hand or loss of the entire arm.

g.     Amputation above the elbow will result in an award for the loss of the arm. A scheduled loss compensation award cannot be granted for partial loss of the arm.

5.     Toes, feet, and/or legs

a.     Loss of the great toe up to the interphalangeal joint is equal to one-half loss of the great toe; loss beyond the interphalangeal joint is equal to the loss of the great toe. For other toes, a loss of two-thirds of the toe is required for a scheduled loss compensation award to be granted. No partial loss award is granted for toes other than the great toe.

b.     When there is an increase in the scheduled loss compensation due to an additional amputation, the amputation is paid less the previously paid amount.

c.      If a loss of the leg is payable, the injured worker is not entitled to an additional award for loss of the foot. The award for the leg includes the award for the foot.

d.     Amputation above the ankle, but below the knee, an injured worker should receive a loss of the foot. Amputation above the knee an injured worker should receive a loss of the leg. State ex rel. McLean v. Industrial Commission of Ohio (1986), 25 Ohio St.3d 90.

 

D.    Loss of Use, Including Ankylosis

1.   Permanent impairment of a body part without severance may entitle the injured worker to an award.

2.   First finger (i.e., thumb) and other fingers

a.     First finger may have a:

                                          i.     Loss of use for 1/2 of the first finger; or

                                         ii.     Total loss of use for entire first finger.

b.     Due to the uniqueness of the first finger, the loss of use of the interphalangeal joint, (the joint between the distal and proximal phalanges) is considered equal to the loss of one-half of the first finger. State ex rel. Riter v. Industrial Commission of Ohio (2001), 91 Ohio St.3d 89. Riter v IC does not apply to amputations of the first finger unless ankylosis of the first finger accompanies the first finger amputation.

c.      Loss of use of the metacarpophalangeal joint between the proximal phalanx and metacarpal bone is usually considered equal to the total loss of use of the whole first finger.

d.     Other fingers, second through fifth, may have a loss of use for:

                                          i.     1/3 of the finger; or

                                         ii.     2/3 of the finger; or

                                        iii.     Total loss of use for entire finger.

3.   The loss of more than the distal and middle phalanges (including loss of the PIP joint) is equal to total loss of the finger. Awards shall not exceed 175 weeks, which is the number of weeks payable for the total loss of the hand.

4.   When there is an increase in the scheduled loss compensation due to an additional loss of use, the loss of use is paid less the previously paid award for the same body part.

 

E.     Loss of Vision

1.     A loss of vision award is based on the injured worker’s post injury vision prior to correction by glasses, contacts, corneal transplants, or surgical intervention. Kroger v. Stover (1987), 31 Ohio St.3d 229.

a.     If an injured worker has an eye injury that will heal without surgery, the scheduled loss compensation award will not be determined until the healing process is completed.

b.     If an injured worker requires corrective surgery as a result of the injury, the scheduled loss compensation award is determined based on the condition prior to surgical correction and healing.

2.     The minimum award for each eye is twenty-five percent loss of uncorrected vision. Although at least a twenty-five percent loss of uncorrected vision is required to receive a loss of vision scheduled loss compensation award, the injured worker may have loss of vision of less than twenty-five percent granted as an allowed condition in the claim.

3.     The percentage needed for loss of vision is the percent of vision loss, not the percentage of whole person impairment (WPI).

4.     When the injured worker has permanently lost an eye due to enucleation, they are entitled to total loss of vision for that eye.

5.     The loss of vision for traumatic cataract is based on the injured worker’s post injury vision prior to correction by glasses, contacts, or surgical intervention.

a.     Cataracts that develop due to prolonged usage of medications, advancing age or other conditions are not considered traumatic.

b.     Cataracts that develop due to prolonged usage of medication may be considered for additional allowance as a flow-through condition as a known side effect of treatment for another allowed condition. It is important that the treatment for the other condition must be generally accepted as causing or associated with the development of cataracts.

 

F.     Loss of Hearing

1.     Scheduled loss compensation for loss of hearing shall be awarded only when the injured worker has permanent and total loss of hearing in one or both ears as a result of a work-related injury.

2.     An injured worker may have loss of hearing allowed in a claim, but not be eligible for a scheduled loss compensation award if the loss of hearing is partial.

 

G.    Payment of Scheduled Loss Compensation Award

1.     It is BWCs policy to pay multiple scheduled loss compensation awards for multiple body parts consecutively, not concurrently. This is consistent with case law. State ex rel. Swallow v. Industrial Commission of Ohio (1988), 36 Ohio St.3d 55.

2.     It is BWCs policy when paying a scheduled loss award in a lump sum to reduce it to net present value. Refer to the Lump Sum Advancement policy.

3.     For claims with a date of injury:

a.     Prior to November 3, 1989, the injured worker is paid at sixty-six and two-thirds percent of his/her average weekly wage (AWW) at the time of the injury multiplied by the number of weeks, not to exceed the statewide average weekly wage (SAWW) for the date of injury.

b.     On or after November 3, 1989, compensation payable per week to the injured worker is one hundred percent of the SAWW according to R.C. 4123.62(C).

 

H.    Death of an Injured Worker

1.     When a scheduled loss compensation award(s) is granted and/or paying but there remains an amount unpaid prior to the injured worker’s date of death, BWC shall:

a.     Pay scheduled loss compensation payable through the date of death, in accordance with the Accrued Compensation policy and procedure.

b.     Pay in this order:

i.       The surviving spouse, if one exists; or

ii.      Other dependent; or

iii.     If no surviving spouse or other dependent exists, the estate of the IW; or

iv.    If no estate exists, another person, including an adult child of the IW, who shows proof of payment of medical bills or funeral expenses for the IW, up to the amount of the bill provided but not to exceed the accrued compensation amount payable.

v.      Accrued compensation may be apportioned between the surviving spouse and other dependents, when appropriate.

2.     When scheduled loss compensation award is granted before or after death, and there is scheduled loss compensation payable after the date of death, BWC:

a.     May grant a scheduled loss compensation award as accrued compensation when an injured worker’s surviving spouse or other dependent files an application for an amputation or loss of use.

b.     Shall pay, upon application, an unpaid scheduled loss compensation award for the period after the injured worker’s date of death in biweekly payments to the surviving spouse or other dependent.

c.      Shall pay, if granted:

i.       To the surviving spouse if one exists; or 

ii.      If no surviving spouse exists, to another dependent.

d.     Shall not grant a lump sum advancement against an unpaid scheduled loss compensation payment to a surviving spouse or other dependent.

3.     BWC recognizes that an estate is entitled to the accrued compensation of a scheduled loss compensation award but is not entitled to the unpaid balance or ongoing payments into the future of the scheduled loss compensation award. Estates are not entitled to the ongoing remainder of the balance because an estate cannot be a dependent. State ex rel. Liposchak v. Indus. Comm., 90 Ohio St.3d 276, 2000-Ohio-73; State ex rel. Estate of Sziraki v. Admr., Bur. of Workers’ Comp., 137 Ohio St.3d 201, 2013-Ohio-4007.

4.     BWC shall not pay a scheduled loss compensation award after the death of the decedent’s surviving spouse or dependent.

 

 

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 included in this procedure.

 

B.     Scheduled Loss Compensation

1.     Claims services staff may identify an injured worker who appears to be eligible for a scheduled loss compensation award and may notify the injured worker that they may file for a scheduled loss compensation award, and BWC will process the request. Note: BWC cannot guarantee any particular outcome for the motion as there are complex legal, medical and factual issues that may impact the ultimate eligibility for an award.

2.     Claims services staff shall process a C-86 or its equivalent requesting scheduled loss compensation anytime during the life of a claim for one or more of the following:

a.     Amputation;

b.     Loss of use;

c.      Loss of vision;

d.     Loss of hearing.

 

C.    Reviewing and Processing the Scheduled Loss Compensation Request

1.     Claims services staff shall ensure the C-86 or its equivalent meets the eligibility requirements of this policy.

2.     If claims services staff is unsure the C-86 or its equivalent meets the eligibility requirements the application may be reviewed with the supervisor and a BWC attorney.

3.     Claims services staff shall:

a.     Upon receipt of the scheduled loss compensation request, provide notice to the employer of record or employer representative.

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

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

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

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

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.

4.     Continue reviewing the scheduled loss compensation request after sufficient notice has been provided or when work item(s) has expired with no response.

5.     Claim services staff shall process the scheduled loss compensation request as long as it is feasible that an allowed condition in the claim could result in a scheduled loss.

6.     If medical documentation is insufficient to support the request or additional evidence is necessary, claims services staff must request the applicable evidence from the injured worker, claimant, authorized representative, MCO, or provider.

a.     Make a telephone call to all applicable parties.

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

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

b.     If there is no response or a returned call, staff shall send notice by letter via fax, email or mail to the applicable party.

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.      Continue reviewing request after requesting the insufficient or additional medical documentation or when work item(s) has expired with no response.

7.     Claims services staff shall review the injured workers or claimants’ medical evidence and staff the next course of action with the supervisor and BWC attorney, which may be one of the following:

a.     Evidence supports the request; the CSS shall staff the request with a supervisor and BWC attorney prior to issuing a determination consistent with Section E of this procedure; or

b.     Evidence does not clearly support the request, or the date of loss is not clearly indicated; the CSS shall staff with a supervisor and BWC attorney to determine if a physician file review or independent medical examination is necessary.

c.      Issue a BWC Miscellaneous order to dismiss if there is a lack of evidence on file to support the request.

 

D.    Physician File Review (PFR) or Independent Medical Examination (IME)

1.     Claims services staff does not need to do a PFR or IME if eligibility requirements and sufficient proof of a scheduled loss compensation award is submitted.

2.     Claims services staff may schedule a PFR or IME when there is an outstanding issue(s) but shall first consult with their supervisor and BWC attorney to determine whether a PFR or IME is appropriate.  Examples:

a.     An outstanding issue(s) regarding the request; or

b.     A question on the onset of the date of loss.

3.     If an injured worker has previously been granted a %PP award for the same body part, claims staff shall send for a PFR or IME and use the specific question requesting the DEP physician to explain what portion of the %PP award is encompassed by the scheduled loss and what portion of the %PP might be due to residual effects.

4.     Claims services staff shall discuss with the nurse situations where it is alleged that the loss of vision or loss of hearing is based on psychiatric factors to determine what medical specialty to consult to appropriately address the issue.

5.     For a unique or unusual fact pattern, claims services staff must work with the nurse and BWC attorney to add specific questions to the standard scheduled loss compensation questions.

6.     Claims services staff shall refer to the Independent Medical Exams (IME) and Physician File Reviews (PFR) policy on Claims On-line Resources (COR) for the specific questions to use.

 

E.     Issuing a Decision for Scheduled Loss Compensation

1.     Claims services staff is required to staff all scheduled loss compensation requests with a supervisor and BWC attorney prior to publication of the order addressing the award. Claims services staff must enter a required claim note with the specific note title: SL CSS Staffed with IMS, Legal.

2.     Claims services staff shall use the date of injury, not the date of amputation or actual loss of use, when determining the rate at which the award will be paid.

3.     Claims services staff shall use the following dates to begin the scheduled loss compensation award:

a.     The date of amputation or actual loss of use date; or

b.     For loss of use by reason of ankylosis, the date the physician makes the diagnosis of the loss of use; or

c.      The date of the loss as determined by the medical documentation from the physician or the IME report.

4.     Prior to issuing the determination on the scheduled loss compensation request, claims services staff shall build the scheduled loss compensation indemnity benefits plan and use the Scheduled Impairment Awards window, as follows:

a.     For an award in a claim with a date of injury (DOI) prior to November 3, 1989, claims services staff must:

i.       Manually calculate the award using the statutory formula in place at the time of the DOI; and

ii.      Build it as a miscellaneous payment.

iii.     Use the compensation rate chart located on COR Home Page listed under Commonly Used Documents or the schedule in R.C. 4123.57(B) when determining the number of weeks payable for the loss of the applicable body part. Claims services staff shall refer to Section IV.G.2.a for the calculation.

b.     For an award in a claim with a date of injury on or after November 3, 1989, claims services staff must enter in the claims management system as follows:

i.       For amputations, loss of use, and loss of hearing:

a)     Select scheduled loss;

b)     Amputations, loss of use, and loss of hearing are entered as a 100%;

c)     Enter the percentage (%) in the Scheduled Impairment Awards window.

ii.      For loss of vision:

a)     Select scheduled loss –vision;

b)     Enter the percentage (%) of loss cited in the medical documentation in the Scheduled Impairment Awards window.

c.      Claims Services staff shall not schedule the award; just build it in the claims management system so the correct dates and amounts appear in the BWC Order.

5.     Claims services staff shall issue a decision on a scheduled loss compensation request as follows:

a.     A BWC Subsequent order if allowing the request for scheduled loss compensation in its entirety as requested and employer is in agreement or did not respond to notice; or

b.     A BWC Death Subsequent order on a death claim if allowing the request for scheduled loss compensation in its entirety as requested and employer is in agreement or did not respond to notice; or

c.      A notice of referral to the Industrial Commission when there is a conflict, such as:

i.       An employer disagrees with the request for scheduled loss compensation;

ii.      BWC’s recommendation is to deny the request for scheduled loss compensation in its entirety;

iii.     BWC’s recommendation is to allow in part and deny in part the request for scheduled loss compensation.

6.     Claims services staff shall refer to the Notice of Referral to the Industrial Commission policy for additional information.

7.     Claims services staff shall use specific language when issuing a notice of referral to the IC and staff with a BWC attorney for the language to use:

a.     When a loss of use of the interphalangeal joint (the joint between the distal and proximal phalanges) is requested as total loss of the first finger (i.e., the thumb) as discussed in Section IV.D.2.b.

b.     When a request for an amputation award is for a severed body part that was successfully reattached, as discussed in Section IV.C.1.a.

c.      For any unique or unusual fact patterns.

8.     Claims services staff may, as needed, work with a BWC attorney for specific language for a BWC Order or a notice of referral.

9.     Claims services staff shall pay an amputation or loss of use award less the previous paid award when there is an increase in the scheduled loss compensation due to an additional amputation or loss of use to the same area of the body.

a.     Example:  When granting an increase from the loss of fingers to a loss of the hand, the loss of the hand is granted less the weeks previously paid for the individual fingers.

b.     Example:  When granting an increase from the loss of the toes to a loss of the foot, the loss of the foot is granted less the weeks previously paid for the individual toes.

10.  Claims services staff shall use the ‘previous impairment offset worksheet’ located on COR (Claims On-line Resource) to calculate the amount to enter as an offset, under Indemnity Payments > Adjustment tab > Adjustments drop-down > Add Adjustment.

11.  Claims services staff must address when a deduction will occur to the scheduled loss compensation award in the BWC Order or in the notice of referral due to:

a.     A previous %PP award granted for the same part of body for which a scheduled loss compensation award will be granted.

b.     An overpayment.

c.      Family support.

12.  When claims services staff arrive at the dollar amount of the previously paid scheduled loss compensation or %PP compensation that is attributed to the same body part as the scheduled loss compensation award, the amount is entered as an offset, under Indemnity Payments > Adjustment tab > Adjustments drop-down > Add Adjustment.

13.  Claims services staff shall choose the appropriate order insert to describe the situation where there will be a reduction in the amount of scheduled loss compensation paid out due to previous awards granted, such as previous scheduled loss compensation or %PP awarded. The reduction of award shall be noted in the BWC order.

14.  The claims services supervisor is required to review and electronically approve (i.e., respond by email) all correspondence orders granting scheduled loss compensation. Claims services supervisor must enter a required claim note with the specific note title: 

a.     SL IMS Reviewed Order – Approved (if order is correct); or

b.     SL IMS Reviewed Order – Returned (if order needs to be corrected).

 

F.     Payment of Scheduled Loss Compensation Award

1.     Claims services staff shall pay a scheduled loss compensation award at the expiration of the appeal period.

2.     Claims Services staff shall pay all awards of scheduled loss compensation in weekly installments in accordance with the schedule associated with the loss of the applicable body part, unless ordered by the IC to pay differently.

3.     Claims services staff shall honor an Authorization to Receive Workers Compensation Payment (C-230) filed by the injured worker’s representative for payment of a scheduled loss compensation award for the initial accrued lump sum payment (i.e., the first check). Future payments shall be set up on scheduled weekly payments.

4.     Deductions from a scheduled loss compensation award

a.     Family Support

i.       Claims services staff shall apply family support weekly deduction orders to scheduled loss compensation awards that are being paid biweekly.

ii.      Accrued scheduled loss compensation awards are subject to hold for lump sum family support processing. Claims services staff shall refer to the Family Support policy for additional information regarding family support obligations.

b.     Overpayments

i.       Claims services staff may recoup overpayments from a scheduled loss compensation award at forty percent. However, if fraudulent activity is determined, recoupment is one hundred percent.

ii.      Claims services staff shall refer to the Overpayments of Compensation and Adjustment of Overpaid Compensation policies for additional information.

5.     Claims services staff shall pay multiple scheduled loss compensation awards for multiple body parts consecutively, not concurrently, unless otherwise ordered.

6.     Claims services staff may pay a scheduled loss compensation award concurrently with:

a.     Temporary total disability compensation;

b.     Wage loss compensation;

c.      Permanent total disability

d.     Statutory permanent total disability;

e.     Living maintenance;

f.       Living maintenance wage loss;

g.     Facial disfigurement;

h.     %PP;

i.       Disabled workers relief fund;

j.       Death benefits.

7.     Claims services staff may pay a scheduled loss compensation award for periods after the IW’s date of death in biweekly payments to the widow(er) or other dependent unless otherwise ordered.

8.     Claims services staff may consider a lump sum advancement on a scheduled loss compensation award for an injured worker but not for any other claimant or dependent in a death claim. Claims services staff shall refer to the Lump Sum Advancement policy for additional information.

 

G.    Ohio Industrial Commission Orders on Scheduled Loss Compensation

1.     Claims services staff shall timely review an Industrial Commission order and if there is an issue with the decision shall staff the order with the supervisor and BWC attorney.

2.     Claims services staff shall staff all issues of concurrent payments or lump sum payments with BWC Legal.

3.     Claims services staff shall perfect the order consistent with Orders, Waivers, Appeals and Hearings policy unless the BWC attorney has provided other direction.

 

H.    Self-Insured Claims

1.     Claims services staff may receive the Agreement as to Compensation for Permanent Partial Disability (ICGC1) form which is used in a self-insured claim when a self-insuring employer and injured worker have entered into an agreement for compensation of permanent partial disability or scheduled loss compensation.

2.     Claims services staff shall review the ICGC1 to determine if:

a.     The number of weeks being paid corresponds with the medical documentation on file;

b.     The number of weeks payable is in accordance with the rate chart; and

c.      The Waiver of Notice of Hearing and Waiver of Right of Appeal section of the ICGC1 is signed by the self-insuring employer and injured worker with a copy sent to all parties.