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Policy and Procedure Name:
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Accrued Compensation
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Policy #:
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CP-01-04
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Code/Rule Reference:
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O.R.C. 4123.60;
4123.57; 4123.511(K);
O.A.C. 4123-3-08
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Industrial Commission (IC) Resolution/Memo
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None
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Effective Date:
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10/21/2020
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Approved:
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Ann M. Shannon, Chief of Claims Policy and Support
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Origin:
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Claims Policy
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Supersedes:
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Policy # CP-01-04, effective 08/07/2018
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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
Accrued Compensation
Claimant
Dependent
IV. POLICY
A. Eligibility
B. Timeframe
for Filing
C. Determination
D. Miscellaneous
E. Death
of a Claimant
V. PROCEDURE
A. General
Claim Note and Documentation Requirements
B. Accrued
Compensation Assignment
C. Processing
the Accrued Compensation Request
D. Accrued
Compensation Determination
E. Paying
Accrued Compensation
The purpose of this policy is to ensure BWC properly
identifies and pays accrued compensation to a dependent, a provider or
individual that rendered or paid for services related to the injured worker’s
(hereafter the “decedent”) death or to the estate of the decedent consistent
with applicable rules and statutes.
This policy applies to claims services staff.
Accrued Compensation:
The unpaid portion of an award of compensation in an allowed claim due to the
decedent at the time of their death, regardless of whether the death was the
result of an allowed injury or occupational disease claim.
Claimant:
One who asserts a right, demand or claim for workers’ compensation benefits.
For purposes of this policy, “claimant” typically refers to the surviving
spouse, other dependents or a provider that is seeking reimbursement or payment
for services pertaining to the decedent’s death (e.g., a funeral home).
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.
1. It
is the policy of BWC to pay accrued compensation benefits, when it meets the
eligibility and timeframe for filing requirements outlined in this policy, for
the following:
a. Temporary
total compensation (TT);
b. Permanent
partial compensation, including:
i.
Percentage of permanent partial disability (%PP);
ii. Scheduled
loss compensation (SL);
iii. Facial disfigurements.
c. Permanent
total compensation (PTD).
2.
It is the policy of BWC to pay accrued compensation benefits to which
the decedent was entitled, up to and including the date of death, to the
following:
a. The
decedent’s dependent(s); or
b. If
there is no dependent(s), BWC will pay accrued compensation benefits to a
provider or individual that rendered or paid for services related to the
decedent’s death.
i.
BWC will only pay a provider or individual up to the amount of the cost
of the services rendered or paid, and no more than what is accrued.
ii. For
example:
a) If
the cost of services rendered or paid were $500.00, but the accrued
compensation benefits were $1,000.00, the provider or individual would only be
entitled to $500.00.
b) If the
cost of services rendered or paid were $1,500.00, but the accrued compensation
benefits were $600.00, the provider or individual would only be entitled to
$600.00.
c. If
there is no dependent(s), provider, or individual that rendered or paid for services
related to the decedent’s death, BWC will pay accrued compensation benefits to
the estate of the decedent.
3. The decedent’s
dependent(s), a provider, or individual that rendered or
paid for services related to the decedent’s death, or the estate, will make
an application in writing by submitting an Application for Accrued
Compensation (C-6) form or its equivalent.
a. The
C-6 must completed in its entirety, or the equivalent request must contain all
the same information as the C-6; and
b. The
application or request must be signed by the person requesting the accrued
compensation.
c. Supporting
documentation must be submitted in accordance with the instructions on the C-6
form and the Death
Claims policy and procedure.
4. A
claimant will be determined a dependent in accordance with the Death
Claims policy and procedure.
1. A dependent,
a provider, or individual that rendered services pertaining to the decedent’s
death, or the estate, has one year from the date of the decedent’s death to
file an application for payment of accrued compensation from a benefit that was
awarded to the decedent prior to death.
2. An application
for accrued compensation from an application abated due to the decedent’s death,
or a benefit that the decedent was lawfully entitled to have applied for at the
time of their death must be filed within one year of the date of decedent’s
death.
1. It
is the policy of BWC to make a determination on accrued compensation no later
than 28 calendar days from receipt of the application.
2. It
is the policy of BWC to ensure that an application for accrued compensation is
either allowed by BWC or is referred to the Ohio Industrial Commission (IC) for
determination.
3.
BWC will recoup an overpayment pursuant to R.C. 4123.511(K), and the
claimant will receive the balance, if a balance exists.
1. BWC
may treat Disabled Workers’ Relief Fund benefits as accrued compensation, up to
and including the date of death, when it meets the eligibility
and timeframe for filing requirements of this policy.
2. BWC
may consider travel reimbursement as accrued compensation, whether pending and
abated at the time of the decedent’s death or filed as a new application when
it meets the eligibility and timeframe for filing requirements of this policy
and is completed in compliance with the Travel
Reimbursement policy and procedure.
1. When
a claimant is awarded and receiving payments from an ongoing SL award or %PP award
and the claimant dies, BWC will pay to the estate of the claimant only the
accrued compensation payable, up to and including the date of the claimant’s
death, when no other claimant, as determined by BWC, is eligible.
2. When
death benefits are awarded to a claimant and the claimant dies before the funds
are disbursed, BWC will pay to the claimant’s estate accrued compensation for
the period between the decedent’s death and the claimant’s death, when no other
claimant, as determined by BWC, is eligible.
1. BWC
staff will 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. When
claims services staff receives a notice of death of an injured worker (IW) or a
claimant, claims services staff must verify the death through reliable means,
such as:
a. A
social security cross match;
b. A death
certificate;
c. A
published obituary;
d. A police
report; or
e. Some
other reliable means.
2. When
a request for accrued compensation is made verbally, claims services staff will:
a. Advise
the claimant to submit the request in writing; and
b. Provide
the claimant with a C-6 form, or direct the claimant to BWC’s website to obtain the form. Any claimant may
use the C-6 to apply for accrued compensation, but any written request
providing equivalent information is sufficient.
c. Claims
services staff assigned to the claim will process the C-6 form, or its
equivalent, upon receipt.
3. General
assignment guidelines:
a. The claims
services staff member assigned to the original claim when a C-6 application is
filed must process the request for accrued compensation, except when an Application
for Death Benefits and/or Funeral Expenses (C-5) form is filed at the same
time as the C-6. When a C-5 is filed, claims services staff will reassign the claim
to the appropriate team for processing death benefits.
b. When
an C-5 is subsequently filed after the C-6 application (i.e., a day later or
multiple days later), the supervisor of the team assigned and the supervisor of
the appropriate team for processing death benefits will consult and agree upon
a plan to resolve everything pending in a timely and efficient manner.
1. Upon
receipt of an accrued compensation application, claims services staff will:
a. Provide
notice to all known claimants and dependents, including any attorney
representative(s) of the application filed. Notice must also include the
employer of record, if applicable.
b. Make
a telephone call to each applicable dependent(s), claimant(s),
representative(s), and if applicable, the employer and employer’s
representative.
i.
Document the attempt/contact made in claim notes for each applicable
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, send notice by letter via fax, email,
or mail to the applicable party:
i.
Document action taken in claim notes for each applicable party.
ii. The
applicable hold periods are as follows:
a) Three
full business days to respond if the letter is sent by fax or email; or
b) Seven
calendar days (plus four additional days per the Mailbox
Rule policy) to respond if the letter is sent by mail.
d. Continue
reviewing request after sufficient notice has been provided, or when the work
item(s) has expired with no response.
2. Claims
services staff will ensure the request meets the eligibility and timeframe for
filing requirements of this policy.
3. Depending
on the requestor, claims services staff will verify:
a. For
a dependent, proof of dependency;
b. For
a provider or individual that rendered or paid for services related to the
decedent’s death, an invoice, proof of payment, or other credible
documentation; or
c. For
an estate, proof of executor status (i.e., documentation from the court
verifying the claimant’s authority to act on behalf of the estate) and the
estate’s tax identification number if a tax identification number has been
obtained for the estate.
4. If
supporting documentation is not on file, claims services staff will request the
applicable supporting documentation necessary to process the application.
5. Accrued
compensation from an award granted prior to decedent’s death, claims services
staff will:
a. Evaluate
the request; and
b. Staff
the application with the supervisor and the BWC attorney, if necessary, to address
any legal issues.
6. Accrued
compensation from an award not granted prior to decedent’s death:
a. Claims
services staff will staff the request with the supervisor and BWC attorney to
ensure any legal issues are addressed.
b. If
it is found the request has been timely filed and any legal issues have been
addressed, claims services staff will process the application in the manner
appropriate for the type of benefit for which accrued compensation is being
requested (e.g., SL or %PP).
c. Example:
i.
The IW files for a SL award.
ii. The
IW dies before the SL award is determined.
iii. Claims services
staff abate the application for SL.
iv. Within one
year of the decedent’s death, the claimant files a motion for accrued
compensation from the SL.
v. Claims
services staff will resume processing the SL application.
1. Claims
services staff will issue a BWC Accrued Compensation Order to the claimant,
copying all other claimant(s), when granting the accrued compensation request.
Claims services staff will include in the order:
a. Type
of compensation; and
b. Any
overpayment(s), if applicable:
i.
When declared prior to decedent’s death, claims services staff will:
a) Use
the absorption rate applicable for the type of compensation being paid; and
b) Attach a
copy of the order declaring the overpayment in the claim.
ii. Claims
services staff will refer to the Overpayment
of Compensation policy and procedure when an overpayment was not
declared by BWC or IC order prior to the decedent’s death.
2. Claims
services staff will issue a notice of referral (NOR) to the IC, copying all
parties to the claim, when recommending denial.
3. Claims
services staff may request the claimant withdraw the application when no
accrued compensation is payable in the claim to prevent sending a NOR to the IC
for denial.
4. Claims
services staff will adhere to additional requirements in the Orders,
Waivers, Appeals and Hearings policy and procedure.
1. When
accrued compensation is awarded, claims services staff will issue payment when
the appeal period has expired and no appeal is filed, unless a waiver is
received from all parties (see the Orders,
Waivers, Appeals, and Hearings policy and procedure).
2. To
pay accrued compensation through the claims management system claims services
staff will:
a. Search
for and/or add the payee as a customer:
i.
If paying to a provider or an estate, claims services staff will enter
the entity’s tax identification number, provided via a Request for Taxpayer
Identification Number and Certification (W-9). If there is no estate tax
identification number, refer to Section V.E.3. below.
ii. A
social security number is not required if paying to a person/customer.
b. Enter
the payee as a participant and alternate payee in the claim, if not already
attached as an existing participant (e.g., beneficiary or dependent);
c. If
the accrued compensation is awarded to the estate, make payment to “The estate
of…”
i.
Claims services staff must not make payment in the name of, or in the
care of, an executor or any other individual.
ii. Claims
services staff will request the estate’s tax identification number from the
person making the request, as well as documentation from the probate court
establishing that person’s relationship to the estate. If there is no estate
tax identification number, refer to Section V.E.3. below.
d. Code
the accrued compensation by the type of compensation that accrued (e.g., TT, PTD);
e. Schedule
the payment; and
f.
Modify the allocation information (defaulted to the claimant) to update
the primary payee to reflect payment to the participant as appropriate.
3. If
there is no tax identification number for an estate:
a. Claims
services staff will email BWC Benefits
Payable and include the following information in the email:
i.
The claim number;
ii. The
name of the deceased claimant;
iii. An explanation
that there is no tax identification number for the estate, and details
regarding the contact made and how this information was obtained;
iv. That the
check should be made payable to “The estate of [deceased claimant’s name]”;
v. The
address the check is to be sent to;
vi. The amount
to be issued;
vii. The type of payment (e.g.,
%PP, PTD);
viii. The period of time the payment
covers, if applicable; and
ix. Any
pertinent documents (e.g., the BWC order, the application for accrued
compensation, any relevant court documents).
b. BWC Benefits
Payable will generate the payment and place a note in the claim file.
4. Claims
services staff will pay an award for ongoing %PP and SL for the period after
the decedent’s date of death in biweekly payments to the surviving spouse,
dependent child, or other dependent. Claims services staff:
a. Must
not process a request for a lump sum advancement against ongoing %PP or SL; and
b. May
refer to the Lump
Sum Advancement policy and procedure for additional information.
5. Claims
services staff may refer to the Date of Death - Claimant CoreSuite job
aid for further assistance.