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Policy and Procedure Name:
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Facial Disfigurement
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Policy #:
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CP-06-02
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Code/Rule Reference:
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R.C. 4123.57(B)
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Effective Date:
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03/29/2022
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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-06-02, effective 10/21/2021
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History:
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Previous versions of this policy are available upon
request
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Facial Disfigurement
Table of Contents
I. POLICY PURPOSE
II. APPLICABILITY
III. DEFINITIONS
Facial Disfigurement
Facial Disfigurement Award
IV. POLICY
A. General Policy
B. Eligibility for a
Facial Disfigurement Award
C. Facial Disfigurement
Award Maximum and Decision
V. PROCEDURE
A. General Claim Note and
Documentation Requirements
B. Review and Evaluation
of Eligibility of a Facial Disfigurement Award
C. Evaluating Degree of Impairment
of a Facial Disfigurement
D. Decision and Payment of
a Facial Disfigurement Award
The purpose of this policy is to ensure that an award for a facial
disfigurement is made in compliance with the law.
This policy applies to all BWC claims services staff and
legal staff.
Facial
Disfigurement: A visible, serious deformity, mark or scar to the
face or head. Slight scarring or discoloration is not necessarily a facial
disfigurement.
Facial
Disfigurement Award: An award granted to an injured worker for an
injury or occupational disease that results in serious facial or head
disfigurement which either impairs or may in the future impair the opportunities
to secure or retain employment.
1. It is the
policy of BWC that upon receipt of a motion (C-86) or its equivalent, to
determine eligibility for a facial disfigurement award and evaluate the degree
of impairment.
2. BWC may
pay a facial disfigurement award in addition to any other partial disability
compensation award(s).
3. A facial
disfigurement award is paid in a lump sum.
1. To be
eligible for a facial disfigurement award, the facial disfigurement must:
a. Be a
direct result from the injured worker’s compensable injury or occupational
disease; and:
b. Be visible
on the injured worker’s face or head; and
c. Impair
or have the potential to impair the injured worker’s opportunities to secure or
retain employment.
2. It is the
policy of BWC to make a facial disfigurement award determination only after the
facial disfigurement has stabilized.
3. The
injured worker’s employment status is not a factor in determining eligibility
for a facial disfigurement award.
1. The
maximum award for a compensable injury or occupational disease occurring on or
after June 30, 2006, is $10,000.
2. The
maximum award for a compensable injury or occupational disease occurring on or before
June 29, 2006, is $5,000.
3. BWC will
publish a order when granting an award and when denying the request will issue
a notice of referral to the Industrial Commission.
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 and documentation
included in this procedure.
1. Claims
services staff shall do a timely review of a motion (C-86) or its equivalent
requesting a facial disfigurement award.
2. To provide
notice to the employer or employer representative, claims services staff shall:
a. Make a
telephone call to the employer or employer’s representative.
i. Document
the attempt or contact made in claim notes for each party.
ii. Set
a work item for three full business days, not including the date the telephone
call was placed. (e.g., the call was made on Thursday, left a message. Set a
work item for three business days – Friday, Monday & Tuesday, and continue
processing application on Wednesday.)
b. If there
is no response or a returned call, claims services staff shall send notice by
letter (Insured Due Process) via fax, email or mail to the applicable parties:
i. Document
action taken in claim notes for each party.
ii. Set
a work item, as follows:
a) Three full
business days to respond if the letter is sent by fax or email; or
b) Seven full
business days to respond if the letter is sent by mail.
c. After
sufficient notice to the employer or employer representative is provided or
when the work item(s) has expired with no response, claims services staff shall
continue to process the facial disfigurement request.
3. Claims
services staff shall ensure the facial disfigurement has medically stabilized
and will not likely require additional medical treatment or surgeries.
4. When the
facial disfigurement is stabilized, claim services staff and BWC attorney shall
determine if the facial disfigurement:
a. Is a
direct result of the injured worker’s compensable injury or occupational
disease;
b. Is visible
on the injured worker’s face or head; and
c. Impairs
or has the potential to impair the injured worker’s ability to secure or retain
employment.
5. Claims
services staff and BWC attorney shall base decisions for eligibility using
medical, psychological, and/or vocational evidence.
1. When
evaluating the degree of impairment and impact of a facial disfigurement to
determine the amount of the award, claims services staff and BWC attorney shall
consider:
a. The
impacts of the facial disfigurement on the injured worker’s ability to retain
or secure employment; and
b. The
severity of the facial disfigurement, including but not limited to:
i. Shape,
color, anatomic location and any evidence of ulceration;
ii. Depression
or elevation;
iii. Texture
(soft and pliable, hard, thin, smooth or rough);
iv. Attachment or
detachment, if any to underlying bone, joint, or muscles or other tissue;
v. Whether
there are disfigurements based on peripheral nerve dysfunction or loss of range
of motion;
vi. Whether the disfigurement
can be made less visible or concealed; and
vii. Whether it is likely
to change appearance over time.
2. Claims
services staff may gather any other relevant information prior to staffing with
the supervisor and BWC attorney in evaluating the impact of the facial disfigurement
such as:
a. Medical
evaluations;
b. History of
the medical condition;
c. Results
of the most recent medical evaluation;
d. Assessment
of medical status, prognosis, diagnosis and treatment plan;
e. Photographic,
video graphic or other visual evidence of the disfigurement;
f. Present
and planned educational level;
g. Prior or
planned vocational training;
h. Description
of present or planned employment;
i. Summary
of specific vocational assessment;
j. Psychological
exam/evaluation;
k. History
of psychological condition;
l. Results
of the most recent psychological evaluation.
3. Claim
services staff and BWC attorney may consider a maximum facial disfigurement award
for the following:
a. “Full
thickness” injuries resulting in the removal of multiple layers of flesh on the
face or head or possible skin grafting;
b. Any facial
disfigurement, which is so severe that there is massive distortion of the
normal facial or head structure; and
c. Only
severe facial injuries qualify for the maximum award. The majority of facial
disfigurements do not qualify for the maximum award.
4. Claims
services staff must staff with their supervisor and BWC attorney when
determining the amount of the award and prior to publishing the order. Claims
services staff may also include other areas when discussing these requests
(e.g., Nurse, Rehab) as warranted.
1. When
granting an award claims services staff shall publish the decision using the
subsequent order and selecting “facial disfigurement.”
2. When
denying the request claims services shall issue a notice of referral to the Industrial
Commission.
3. Claims
services staff shall use the receipt date of the request (i.e., Motion
(C-86) or its equivalent) to pay the facial disfigurement award in the claims
management system.
4. Claims
services staff shall notify a BWC attorney of an appeal filed on our facial
disfigurement award order and request BWC attorney attendance.