OhioBWC - Basics: (Policy library) - File

Policy and Procedure Name:

FIREFIGHTERS WITH CANCER OCCUPATIONAL DISEASE CLAIMS

Policy #:

CP-06-06

Code/Rule Reference:

O.R.C. 4123.68 (X); 5 CFR § 550.902, as amended

Effective Date:

11/05/2021

Approved:

Ann M. Shannon, Chief of Claims Policy and Support

Origin:

Claims Policy

Supersedes:

Policy #CP-06-06, effective 09/29/2017 and Procedure #CP-06-06.PR1, effective 09/29/2017

History:

Previous versions of this policy are available upon request


 

Firefighters with Cancer Occupational Disease Claims

 

I. POLICY PURPOSE

II. APPLICABILITY

III. DEFINITIONS

Hazardous Duty

IV. POLICY

A.          Cancer Contracted by a Firefighter

B.          Limited Compensation Benefits

V. PROCEDURE

A.          General Claim Note and Documentation Requirements

B.          Investigation for Firefighter with Cancer Claim

C.         Limited Compensation and Benefits

 

 


 

I. POLICY PURPOSE

 

The purpose of this policy is to ensure that BWC determines and manages a claim for a firefighter with cancer as an occupational disease in compliance with applicable laws.

 

II. APPLICABILITY

 

This policy applies to Claims Services staff and Legal staff.

 

III. DEFINITIONS

 

Hazardous Duty:  duty performed under circumstances in which an accident could result in serious injury or death.

 

IV. POLICY

 

A.     Cancer Contracted by a Firefighter

1.     It is the policy of BWC that the claimant has the burden of proof and shall submit:

a.     Evidence to establish the presumption of causation is met; and

b.     BWC’s Presumption of Causation for Firefighter Cancer (C-265) form or its equivalent; and

c.      First Report of Injury (FROI-1) form or its equivalent.

2.     It is the policy of BWC to presume that a firefighter’s cancer was contracted in the course of and arising out of the firefighter’s employment when the following criteria are met:

a.     Worked as a firefighter;

b.     Worked hazardous duty as a firefighter for a minimum of six years;

c.      Exposed to an agent classified by the International Agency for Research on Cancer (IARC) as a Group 1 or Group 2A carcinogen while working as a firefighter;

d.     A written narrative cancer diagnosis from a physician; and

e.     The firefighter, due to the cancer, on or after April 6, 2017 was:

i.       First diagnosed,

ii.      First received treatment;

iii.     First quit work: or

iv.    Died due to the cancer.

v.      If the firefighter was first diagnosed or first received treatment prior to April 6, 2017 but has not yet quit work due to the disease, the claim is eligible for consideration under the presumption.

3.     BWC shall consider the presumption of causation rebutted when any of the following applies:

a.     The firefighter is 70 years of age or older;

b.     The firefighter was last assigned to hazardous duty as a firefighter more than 15 years ago.

c.      The firefighter was exposed to cigarettes, tobacco products or other conditions that present an extremely high risk for the development of the cancer alleged, and such exposure was probably a significant factor in the cause or progression of the cancer;

d.     There is evidence that shows, by a preponderance of competent scientific evidence, that exposure to the type of carcinogen alleged did not or could not have caused the cancer being alleged;

e.     There is evidence that the firefighter was not exposed to an agent classified by the International Agency for Research on Cancer (IARC) as a Group 1 or Group 2A carcinogen while working as firefighter;

f.       There is evidence that the firefighter incurred the type of cancer alleged prior to becoming a firefighter.

4.     It is the policy of BWC to allow a claim when the claimant has met the requirements in sections IV.A.1. and IV.A.2. and a rebuttal of the presumption of causation is not received.

5.     BWC may obtain an independent physician file review or medical examination for an alleged firefighter with cancer occupational disease claim.

6.     When the presumption of causation is not met, in accordance with this policy, BWC may process the claim under the general Occupational Disease Claims policy and procedure.

 

B.     Limited Compensation Benefits

1.     For a firefighter with cancer occupational disease claim that is presumptively allowed under R.C. 4123.68(X), compensation shall be limited to:

a.     Temporary Total Disability compensation;

b.     Working wage loss compensation;

c.      Permanent Total Disability compensation;

d.     Death Benefits.

2.     For claims filed on 04/06/2017 through 09/28/2017, a firefighter with cancer occupational disease claim that is presumptively allowed under R.C. 4123.68(X) is not eligible for to receive working wage loss compensation.

3.     BWC shall follow all other applicable policies for processing benefits for a firefighter with cancer occupational disease claim that is presumptively allowed under the law.

 

 

V. PROCEDURE

 

A.     General Claim Note and Documentation Requirements

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.

 

B.     Investigation for Firefighter with Cancer Claim

1.     Claims services staff shall ensure the claim is timely filed and refer to the Jurisdiction (Statute of Limitations, Statutory Life of a Claim) policy for additional information.

2.     In addition to the requirements of this policy and procedure, claims services staff shall follow the:

a.     General investigative requirements of the Initial Claim Determination policy and procedure, such as, initial contacts; and

b.     Elements of compensability requirements of the Compensable Injuries policy and procedure.

3.     During the investigation, claims services staff shall:

a.     Ensure the C-265 form or its equivalent and FROI form are completed in its entirety and if information is missing, contact the party to secure the information;

b.     Establish the date of disease with latest date available in accordance with section IV.A.2.e.;

c.      Review the claim to see if there is evidence to rebut the presumption of causation in accordance with section IV.A.3.

4.     Claims services staff shall send an email to the BWC Legal Director of Hearing Services/Field Support to evaluate the claim and to:

a.     Determine if the firefighter’s cancer was contracted in the course of and arising out of the firefighter’s employment and the claim meets the presumption;

b.     Determine whether evidence is sufficient to rebut the presumption, if applicable;

c.      Address any issue(s) identified or questions from the claim’s services staff, for example:

i.       IW is over 70 years old; or

ii.      There is confusion over the date of disability (e.g., first treatment date is 11/21/2020 and diagnosed on 11/30/2020; therefore, the date of disease/occurrence we are applying is 11/30/2020 -would legal concur?)

5.     With approval from the supervisor and BWC staff attorney, claims services staff may obtain a physician file review or independent medical examination.

6.     When BWC Legal responds to claims services email and:

a.     The conditions to establish the presumption have been met, claims services staff shall issue a BWC Initial Allowance order in the claim.

b.     The presumption is not met, or the presumption is rebutted, claims services staff shall refer to the Occupational Disease Claims policy to evaluate the claim under standard occupational disease criteria.

 

C.    Limited Compensation and Benefits

1.     Claims services staff shall only consider and pay the following types of compensation for a firefighter with cancer claim presumptively allowed under the law:

a.     Temporary total disability compensation;

b.     Working Wage Loss Compensation for claims filed on or after 09/29/2017;

c.      Permanent total disability compensation;

d.     Death.

2.     Claims services staff shall review a compensation request with a BWC staff attorney when it is not for a compensation listed in section IV.C.1.a.-d. in order to determine the next steps and, when applicable issue a notice of referral to the Industrial Commission.

3.     Claims services staff shall follow any other applicable policy for processing benefits once BWC has presumptively allowed a firefighter with cancer claim.