OhioBWC - Basics: (Policy library) - File

Policy Name:

Subrogation

Policy #:

CP-19-04

Code/Rule Reference:

R.C. 4123.93, 4123.931

Effective Date:

12/21/2017

Approved:

Kevin R. Abrams, Chief Operating Officer

Origin:

Claims Policy

Supersedes:

All Injury Management policies, directives and memos regarding subrogation claims that predate the effective date of this policy

History:

New 11/05/12; Rev. 12/21/17

 

 

I. POLICY PURPOSE

 

The purpose of this policy is to ensure that claims services staff can identify potential subrogation issues and make referrals to the Subrogation Department so that BWC may recover the cost of applicable workers’compensation benefits from a third party, in accordance with Ohio law.  

 

II. APPLICABILITY

 

This policy applies to BWC Claims Services staff, BWC Legal Division’s Subrogation Department, and BWC Actuarial Division.

 

III. DEFINITIONS

 

Administrative designee process:  an alternative dispute resolution process for pre-litigation settlements which have reached an impasse during negotiations.

 

Index system: a data bank that contains bodily injury claims information on automobile, workers’ compensation, homeowner, general liability, product liability and disability insurance injury claims for the last ten years. Also referred to as ISO.

 

Subrogation:  the legal right for BWC to recover from a third party or person the costs paid to or on behalf of an injured worker directly attributable to a third party’s negligence, which was proven to be a contributory factor in or the cause of the accident.

 

Third party:  for subrogation purposes, an individual, political entity (state or county agency, etc.), or entity that creates conditions or takes actions which result in an injury to an employee.  Third party does not include an employer or co-worker, except when a co-worker participates in horseplay which directly results in an injury to an employee, or if the injured worker can prove an intentional tort claim against the employer.     

IV. POLICY

 

A.    It is the policy of BWC to actively pursue recoupment of claims costs directly caused by a third party by identifying subrogation indicators and pursuing legal recourse as outlined in R. C. 4123.93, et al.   The third party’s negligence must be the cause or a contributing factor in the accident or injury, and compensation benefits must have been paid in the claim.

 

B.    BWC has the following subrogation rights:

1.    May initiate subrogation action without injured worker involvement;

2.    May collect for past and future compensation and medical benefits; and

3.    May apply subrogation rights to any claim with a date of injury on or after April 9, 2003.

 

BWC staff may refer to the corresponding procedure for this policy entitled “Subrogation” for further guidance.