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Policy and Procedure Name:
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FIREFIGHTERS WITH CANCER
OCCUPATIONAL DISEASE CLAIMS
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Policy #:
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CP-06-06
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Code/Rule Reference:
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O.R.C.
4123.68 (X); 5 CFR § 550.902, as amended
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Effective Date:
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11/05/2021
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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-06-06, effective 09/29/2017 and Procedure #CP-06-06.PR1,
effective 09/29/2017
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History:
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Previous versions of this policy are available upon
request
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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
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.
This policy applies to Claims Services staff and Legal
staff.
Hazardous
Duty: duty performed under circumstances in which an accident could
result in serious injury or death.
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.
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.
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 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.