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Policy and Procedure Name:
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Salary Continuation
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Policy #:
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CP-19-09
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Code/Rule Reference:
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R.C. 4123.56; O.A.C. 4123-5-20
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Effective Date:
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12/14/22
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Approved:
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Patricia Harris, Chief Operating Officer
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Origin:
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Operational Policy and Support
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Supersedes:
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Policy # CP-19-09, effective 09/28/21 and Procedure #
CP-19-09.PR1, effective 05/06/19
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History:
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Previous versions of this policy are available upon
request
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Table of Contents
I. POLICY PURPOSE
II. APPLICABILITY
III. DEFINITIONS
IV. POLICY
A. Documenting Salary Continuation
B. Notification of Changes
V. PROCEDURE
A. General Claim Note and
Documentation Requirements
B. Identifying Payment of Salary
Continuation
C. Verifying and Acknowledging
Payment of Salary Continuation
D. Building the Salary
Continuation Plan
E. Requesting TT When Salary
Continuation Has Been Paid
The purpose of this policy is to
ensure BWC properly identifies and records payment of
salary continuation by the employer of record (EOR) to ensure that the EOR’s
reserves are accurately calculated when they choose to pay salary continuation.
This policy applies to claims
services staff.
Parties
to the Claim: Injured Worker (IW), IW
representative, employer, employer representative and BWC.
Regular
full wages: Earnings (e.g.,
salary/wages) and any benefit (e.g., accrual of vacation leave, holiday pay,
and scheduled pay increases) the IW would have received had they continued to
work for the EOR.
Salary continuation (SC): Regular full wages paid to the IW by the EOR.
This includes any kind of paid leave (e.g., sick leave, paid time off, occupational
injury leave (OIL), etc).
Temporary total compensation (TT): Compensation paid to an IW who is unable to return to
the former position of employment on a temporary basis due to the work-related
injury or occupational disease and who has not been found to have reached
maximum medical improvement (MMI).
1. It is BWC’s
policy to recognize an EOR’s payment of regular full wages to the IW and document
the payment in the claims management system.
2. It is BWC’s
policy to issue correspondence to all parties in the claim acknowledging the
EOR’s payment of regular full wages to the IW when verification of payment has
been obtained before the correspondence is issued.
1. It is BWC’s
policy that the employer and/or IW must report to BWC any changes in payment of
regular full wages to the IW.
2. When it is
requested, BWC may pay the difference between the TT rate in the claim and the
employer’s after-tax salary continuation payment to the IW.
1. BWC staff must
refer to:
a. The Standard
Claim File Documentation and Altered Documents policy and procedure for
claim note and documentation requirements; and
b. The Jurisdiction
policy and procedure to determine if a claim is statutorily open.
2. BWC staff must
follow any other specific instructions for claim notes and documentation
included in this procedure.
1. During the
initial determination investigation of a claim, claims services staff must
contact the EOR:
a. To determine if
the EOR is continuing to pay to the IW their regular full wages; or
b. Intends to pay to
the IW their regular full wages;
c. To obtain
the salary continuation payment beginning date and the duration of the salary
continuation payment(s); and
d. To request
detailed wage information pursuant to the Wages
policy and procedure.
2. If the EOR does
not provide claims services staff with confirmation of salary continuation,
claims services staff must:
a. Encourage the
EOR to contact their third-party administrator; and
b. Inform the EOR they
have three full business days to respond regarding their position on the payment
of salary continuation.
3. While speaking
with the EOR, claims services staff must explain that the IW may be eligible
for Temporary Total compensation (TT) if:
a. The EOR stops
paying the IW’s regular full wages; or
b. Pays the IW at
less than regular full wages; and
c. The IW has
submitted the required documentation for payment of TT.
4. Claims services
staff must contact the IW to:
a. Inquire about receipt
of salary continuation payment, when necessary; and
b. Request wage
information.
5. While speaking
with the IW, claims services staff must explain that if the EOR continues to
pay salary continuation at the IW’s regular full wages, the IW may not be
eligible for TT.
6. Claims services
staff must ask the IW and EOR to contact claims services staff
immediately if the employer’s payment changes, stops, or is less than the IW’s regular
full wages.
1. In order to
verify that salary continuation is being paid, claims services staff must
obtain agreement or acknowledgment of payment of salary continuation from the
EOR and the IW. The following list (not all inclusive) includes acceptable
proof of salary continuation payment:
a. Verbal
acknowledgment or agreement from both the IW and EOR;
b. Salary
continuation box checked on C-84 from IW with verification from the EOR;
c. Pay stubs
for corresponding dates of payment from IW or EOR; or
d. Other written
documentation (e.g., C-55).
2. When confirmation
of receipt of salary continuation has been received, but wage information has
not been obtained, claims services staff must enter the IW’s AWW/FWW as $0.00,
but will not issue an order setting the IW’s wages at $0.00. If compensation
becomes payable at a later time, claims services staff must gather wage
information and set the AWW/FWW by order.
3.
When acceptable proof of salary continuation payment, as outlined in
V(C)(1)(a-d.) above, is received prior to issuing a BWC order, claims services
staff must:
a. Acknowledge the
payment of salary continuation in the order; and
b. Note the specific
manner in which proof was obtained in “Add Text” of the order (e.g., The injured
worker documented receipt of salary continuation on the C-84 submitted 11/1/22 and
the employer provided verbal confirmation on 11/4/22).
4. If the claim
investigation is complete and claims services staff still has not received
definitive confirmation of payment of salary continuation, claims services
staff must NOT acknowledge payment of salary continuation in the BWC order.
5. When
confirmation of payment of salary continuation is obtained during the BWC order
appeal period or after the appeal period has expired, claims services staff
must enter a claim note explaining that payment of salary continuation has been
confirmed.
1. After claims
services staff has verified that salary continuation is being paid, they must
build the salary continuation benefit plan in the claims management system:
a. Including when
salary continuation has been paid in lieu of Living Maintenance.
b. Even if claims
services staff has been unable to obtain wage information.
2. Claims services
staff must set a work item as a reminder to follow up with the EOR to determine
if salary continuation payment will continue or the IW has returned to work.
3. Once claims
services staff verifies that salary continuation payment will continue and how
long it will continue, the extension of payment must be entered in the claims
management system. In addition, a new work item must be set to follow up with
the EOR prior to the expiration of the payment.
4. If the IW has returned
to work, the return to work (RTW) date must be documented when it is obtained.
Claims services staff may also accept a confirmed RTW date acquired by the
managed care organization (MCO).
1. When the IW
submits a C-84 and supporting medical evidence for the same period of time in
which salary continuation was paid, claims services staff must contact the IW
to verify why they are requesting TT and whether salary continuation is still
being paid.
2. When there is a
difference between the TT rate in the claim and the employer’s after-tax (gross
minus taxes only) salary continuation payment, the IW may request TT for the
difference. Claims services staff must also review the C-84 to determine if the
IW is receiving any other benefits (including continued payment of wages from
an employer who is not the EOR) that may cause an offset to TT. If benefits
are being paid that would cause an offset to TT, claims services staff must
review the issue with a BWC attorney.
3. Claims services
staff must obtain paystubs for the period of time salary continuation was paid from
either the EOR or IW that show deductions from the IW’s gross wages in order to
determine the salary continuation after-tax payment.
4. If the salary
continuation after-tax payment is lower than the TT rate in the claim and no
other benefits are being paid that would cause an offset, the difference is
payable to the IW as TT if they have submitted a valid C-84 and sufficient
supporting medical evidence.
a. Taxes that are to
be deducted from the IW’s gross wages include the following:
i. Federal
(including Social Security and Medicare);
ii. State;
iii. City/local; and
iv. Retirement tax, including,
but not limited to, Ohio Public Employees Retirement System (OPERS) and State
Teachers Retirement System of Ohio (STRS).
b. Example:
The IW’s TT rate for the claim is $1,000 and their salary continuation gross
wages for the week are $900. Deductions from their gross wages equal $500 with
$300 for taxes and $200 for other deductions. The IW’s after-tax salary
continuation amount is $600 (Gross wages [$900] minus taxes only [$300]).
Therefore, the IW is entitled to a TT payment of $400 (TT rate [$1,000] minus
after-tax salary continuation amount [$600]) if they have submitted a valid
C-84 and sufficient supporting medical evidence.
5. If BWC has
issued an order to grant payment of TT and, during the order’s appeal period,
the EOR or IW subsequently submits written proof of salary continuation payment
or verbally notifies claims services staff that salary continuation was paid
over the same period as TT, claims services staff must:
a. Review the
documentation submitted and consider vacating the order that grants TT. If the
EOR verbally notifies claims services staff of salary continuation payment, it
must be verified with the IW.
b. If claims
services staff determines the order granting TT will be vacated, claims
services staff must obtain agreement from all parties to the claim to vacate the
order and issue a new order to acknowledge payment of salary continuation.
6. If TT was
ordered and paid by BWC, but it is discovered later that salary continuation
was paid over the same period, claims services staff will not accept
reimbursement for the TT from the EOR or IW.