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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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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 his or her 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.
A. Eligibility
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;
b. Permanent
partial compensation, including;
i. Percentage
of permanent partial disability;
ii. Scheduled
Loss compensation;
iii. Facial
Disfigurements.
c. Permanent
total compensation.
2.
It is the policy of BWC to pay accrued compensation benefits 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 shall pay accrued compensation benefits to a provider or
individual that rendered or paid for services related to the decedent’s death.
i. BWC
shall 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) or provider or individual that rendered or paid services related
to the decedent’s death, BWC shall 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, shall make an
application in writing by submitting an Application for Accrued Compensation
(C-6) form or
its equivalent.
a. The C-6 is
completed in its entirety or the equivalent request contains all the same
information as the C-6; and
b. The application
or request has a signature of the person requesting the accrued compensation.
4. Supporting
documentation must be submitted in accordance with the instructions on the C-6 form and the
Death
Claims policy and procedure.
5. A claimant shall
be determined a dependent in accordance with the Death
Claims policy and procedure.
B.
Timeframe for Filing
1. A dependent, a
provider or individual that rendered services pertaining to the decedent’s
death or the estate has one (1) 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 decedent’s death or
a benefit that the decedent was lawfully entitled to have applied for at the
time of his or her death must be filed within one (1) year from 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 Industrial Commission (IC) for determination.
3.
BWC shall recoup an overpayment pursuant to R.C. 4123.511(K) and the
claimant would receive the balance, if a balance exists.
1. BWC may treat Disabled
Workers’ Relief Fund (DWRF) 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 scheduled loss compensation
award or percentage of permanent partial disability award and the claimant
dies, BWC shall 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 shall 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 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.
1. When claims
services staff receives a notice of death of an injured worker or a claimant,
claims services staff shall 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 shall:
a. Advise the
claimant to submit the request in writing; and
b. Provide the
claimant with an Application for Accrued Compensation (C-6) form or
direct the claimant to the BWC website to obtain the form. (Any claimant may
use the C-6 to apply for accrued compensation. However, any written request
providing equivalent information is sufficient).
c. Claims
services staff assigned to the claim shall process upon receipt the Application
for Accrued Compensation (C-6) form or its
equivalent from a claimant.
3. General
assignment guidelines:
a. The claims
services staff assigned 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 death claim request is filed, claims
services staff will reassign the claim to the appropriate team for processing death
benefits.
b. When an Application
for Death Benefits and/or Funeral Expenses (C-5) form 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 shall consult and agree upon a
plan to resolve everything pending in a timely and efficient manner.
1. Claims services
staff shall:
a. Upon receipt of
an accrued compensation application, 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 3
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 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 work item(s)
has expired with no response.
2. Claims services
staff shall ensure the request meets the eligibility
and timeframe for filing requirements of this policy.
3. Depending on the
requestor, claims services staff shall verify:
a. Proof of
dependency, if applicant is a dependent.
b. An invoice,
proof of payment or other credible documentation if the applicant is a provider
or individual who rendered or paid for services related to the decedent’s death.
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; or
4. If supporting
documentation is not on file, claims services staff shall 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
shall:
a. Evaluate the
request; and
b. Staff the
application with the supervisor and may if necessary, the BWC attorney to address
any legal issues.
6. Accrued compensation
from an award not granted prior to decedent’s death
a. Claims services
staff shall 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 shall process the application in the manner appropriate
for the type of benefit for which accrued compensation is being requested
(e.g., scheduled loss compensation or percentage of permanent partial
disability).
c. Example:
i. The
injured worker files for a scheduled loss (SL) award.
ii. The
injured worker 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 shall issue a BWC order to the claimant, copying all other claimant(s), when
granting the accrued compensation request. Claims services staff shall 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 shall:
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. Claim
services staff shall 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. Claim services
staff shall issue a notice of referral to the Industrial Commission, 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 notice of referral to
the Industrial Commission for denial.
4. Claims services
staff shall adhere to additional requirements in the Orders,
Waivers, Appeals and Hearings policy and procedure.
1. When accrued
compensation is awarded, claims services staff shall 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 shall:
a. Search for
and/or add the payee as a customer:
i. If
paying to a provider or an estate, claims services staff shall 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 shall not make payment in the name of, or in the care of, an
executor or any other individual.
ii. Claims
services staff shall 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., temporary total,
permanent total disability);
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 shall email Benefits Payable at eftgroup@bwc.state.oh.us
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 (i.e.,
percentage of permanent partial, permanent total disability);
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. Benefits Payable
will generate the payment and place a note in the claim file.
4. Claims services
staff shall pay an award for on-going Percentage of Permanent Partial
Disability and Scheduled Loss Compensation for the period after the decedent’s
date of death in biweekly payments to the surviving spouse, dependent child or
other dependent.
a. Claims services
staff shall not process a request for a lump sum advancement against an
on-going percentage of permanent partial disability or scheduled loss compensation;
and
b. Refer to the Lump
Sum Advancement policy and procedure for additional information.
5. Claims services
staff shall refer to the “Date
of Death - Claimant” CoreSuite job aid for further assistance.