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Policy
and Procedure Name:
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Abatement
and Claims Processing Post Notification of Death
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Policy
#:
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CP-01-05
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Code/Rule
Reference:
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O.A.C.
4123-5-21
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Effective
Date:
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04/26/2024
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Approved:
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Shawn
Crosby, Chief Operating Officer
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Origin:
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Claims
Policy
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Supersedes:
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Policy
#CP-01-05, effective 09/15/2021
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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
Abatement
Application
Claimant
Pending Application
IV. POLICY
A. Abatement of
Pending Applications
B. Abatement Does
Not Prohibit
V. PROCEDURE
A. General Claim
Note and Documentation Requirements
B. Verification of
Claimant’s Death
C. Discontinuing
Indemnity Payments
D. Pending
Applications
E. Issuing an
Order to Abate a Pending Application
F. Applications
Filed After Death
The
purpose of this policy is to ensure that, upon notification of an injured
worker or claimant’s death, BWC takes the proper steps to abate a pending
application(s) and/or stop payment of benefits.
This
policy applies to claims services staff.
Abatement: To
discontinue any further action on a pending application(s) in a claim at the
time of the injured worker’s or claimant’s death.
Application: A form or
other means of communicating to BWC the following:
1. Requests:
Communications requesting an initial or subsequent action be taken. Examples
include, but are not limited to:
a. First Report of
an Injury, Occupational Disease or Death (FROI);
b. Request for
Temporary Total Compensation (C-84);
c. Motion (C-86).
2. Authorizations:
Communications that serve to grant permission. Examples include, but are not
limited to:
a. Claimant
Authorized Representative (R-2);
b. Authorization
to Receive Workers’ Compensation Payment (C-230).
3. Agreements:
Communications that serve as a contract between the parties. Examples include,
but are not limited to:
a. Settlement
Agreement and Application for Approval of Settlement Agreement (C-240);
b. Amended
Settlement Agreement and Release (C-241);
c. Rehabilitation
Agreement
(RH-1).
Claimant: One who
asserts a right, demand or claim for workers’ compensation benefits. For
purposes of this policy, a claimant may be an injured worker or a person
pursuing workers’ compensation benefits due to the injured worker’s death.
Pending
Application:
For purposes of this policy, an application that is not in a final status, such
as dismissed, allowed or denied when notice of death is received. A suspended
application is considered to be pending.
1. It is the
policy of BWC to abate a pending application, if applicable, when the claimant dies.
2. BWC will abate
the application only upon the receipt and verification of notice of the claimant’s
death.
1. BWC will not
abate a pending application:
a. For a C-240
and/or a C-241, if the claimant dies after issuance of the “LSS Approval”
letter;
b. For the payment
of approved medical services related to the injured worker’s allowed injury or
occupational disease claim; or
c. When it is
before the Industrial Commission (IC) on appeal by the employer or
administrator.
2. Abatement of an
application filed by an injured worker does not prohibit:
a. A surviving claimant
(e.g., dependent, spouse) from filing an application in a deceased claimant’s
claim; or
b. BWC from
pursuing continuing jurisdiction.
1. BWC staff must refer
to the Standard Claim
File Documentation and Altered Documents policy and procedure for claim
note and documentation requirements; and
2. Must follow any
other specific instructions for claim notes and documentation included in this
procedure.
1. Upon receipt of
notice of the death of a claimant, claims services staff must verify the death
through:
a. Social Security
cross match;
b. A death
certificate;
c. A published
obituary; or
d. A police report.
2. If the
claimant’s death cannot be verified using one of the sources described
immediately above, claims services staff may use other reliable means
consistent with the Death
Claims policy.
1. When a claimant
is receiving payments in a claim, claims services staff must discontinue
payment immediately upon verification of the claimant’s death.
2. Payments will
be discontinued effective the date of the claimant’s death.
3. Claims services
staff may seek guidance from BWC Legal on issues regarding discontinuation of
payment in a claim.
1. After
confirming the claimant’s death, claims services staff must determine if there
are pending applications in the claim that must be abated.
a. If no
applications are pending, no action is necessary.
b. If an
application is pending and no order addressing the request has been published,
claims services staff must abate the application.
c. If the pending
application has been addressed by order and is still within the appeal period
claims services staff:
i.
Must
vacate the order, abate the application, and update the status of the
application to dismissed in the claims management system if:
a) No appeal has
been filed; or
b) An appeal has
only been filed by the claimant.
ii. Will
not abate the application if an appeal
has been filed by the employer and/or administrator. If the pending
issue is whether the claim should be allowed, and the IC:
a) Allows the
claim, claims services staff must staff with a BWC attorney.
b) Denies the
claim, no further action is necessary.
2. Claims
services staff should not abate the following applications:
a. Requests
for payment of medical services rendered as a result of an injured worker’s
allowed injury or occupational disease claim; and
b. C-240s
and C-241s. Reference the Lump Sum
Settlement policy and procedure for specific action steps.
1. Claims services
staff must issue:
a. An Abatement
Order when the pending FROI (either signed or unsigned by the IW) is being
abated; or
b. A Miscellaneous
Order for all other pending applications or requests using the “Abatement Adhoc
Insert for Miscellaneous Order” on the Abatement and Post
Notification of Death Processing policy page on the Claims Online
Resource (COR).
2. The order must:
a. Document the
specific application that is being abated; and
b. Note the basis
for BWC’s decision to abate the application(s) (i.e., how the claimant’s death
was verified, e.g., a death certificate, published obituary, etc.).
3. Claims services
staff must send the order to all parties, including:
a. The surviving
spouse; or
b. If no surviving
spouse can be identified, to another dependent or family member; and
c. To the deceased
claimant’s authorized representative, if applicable.
i.
Claims
services staff must not immediately expire the deceased claimant’s authorized
representative upon notice of death.
ii. Refer to the Authorized
Representatives
policy for further instructions.
4. If claims
services staff is unable to identify a surviving spouse, another dependent or
family member, claims services staff must make the following change in the
claims management system:
a. Use “Change
Delivery Options” in the claims management system and address the order to “The
family of…”; and
b. Mail it to the deceased
claimant’s last known address.
5. Claims services
staff may also need to update the claims management system to:
a. Change the
“Original Recipient”; or
b. Add a “New
Participant”.
6. If an order
abating a pending application is appealed, claims services staff will refer the
issue to the IC, following the Notice of Referral
to the Industrial Commission policy.
1. Upon receipt of
an application following the death of an IW or surviving spouse, claims
services staff:
a. Must process
the application(s) following all applicable policies and procedures (e.g., Accrued
Compensation
and Death Claims); and
b. May staff the
request with BWC Legal.
2. When BWC
receives medical bills for approved medical services related to the allowed
injury or occupational disease, claims services staff must refer the bills to
the managed care organization (MCO) for processing.