OhioBWC - Worker: Claim Settlement Description

OhioBWC - Worker: Claim Settlement Description

Claim Settlement Description

When the parties to the claim, the injured worker, employer and BWC agree to a sum of money, which BWC will pay to the injured worker, they settle the claim. In exchange for this sum of money, the settlement forever resolves all past, present, or future medical and compensation issues and liabilities in the claim, whether known or unknown. BWC always acts in the best interest of all parties to establish a fair and equitable settlement.

BWC administers and approves all claim settlements. The Industrial Commission of Ohio may review a settlement within 30 days following the agreement date to ensure that the settlement is fair to all parties.

The settlement agreement sets forth the specific terms of settlement. Those terms include, but are not limited to:

Effective settlement date - Date BWC mails the settlement approval letter. This is the same date the settlement agreement is published;
BWC will not make any payments after the effective settlement date for medical bills or services rendered, regardless of the date of service, whether or not BWC has received the bills;
All settlements are subject to court-ordered family support, which may be the entire settlement amount in some cases;
All settlements are subject to overpayment recoupment. This can be the entire settlement if the overpayment amount exceeds the amount of the agreed-upon settlement;
Settlement of the claim does not impair BWC's right to subrogation recovery;
Any finding of fraud allows BWC to rescind the settlement agreement and address any overpayment due to fraudulent activity and refer for criminal prosecution.

Who can file a settlement?
The injured worker/injured worker representative or the employer/employer representative may file a settlement application. The managed care organization (MCO) is not a party to the claim; therefore, it cannot initiate or advise the injured worker to settle a claim. However, an MCO may point out BWC potential candidates for settlement.

Do I have to have an attorney to file for settlement?
No. If you do not have an attorney, BWC will contact you personally once you have filed your application. However, if you do have an attorney, BWC will work directly with your attorney to negotiate the settlement of the claim.

What form do I use to file a settlement?
Use Settlement Agreement and Application for Approval of Settlement Agreement (C-240) for state-fund claims. The purpose of this application is to document the agreement to the terms and conditions of the settlement. A valid settlement application requires the signatures of you or your legal representative and your employer or their legal representative. A legal representative can sign the settlement application on behalf of yourself or your employer. The only exception is when the employer is no longer doing business in Ohio. If the employer is no longer doing business in Ohio, BWC does not require a signature from the employer.

How does BWC evaluate a claim for settlement?
BWC has no pre-set formulas for determining the settlement value of a claim. The settlement figure is the amount BWC is willing to pay you for the anticipated future cost of your claim. These costs are then pro-rated based upon the likelihood that they will occur. BWC considers both the future medical and indemnity (compensation) when it evaluates the claim. For example, if you file for a claim where you may need surgery or lose time from work, BWC will consider both of these as part of the settlement. It is important to note that BWC does not base settlement value on pain and suffering or administrative costs.

What happens after the settlement is approved?
The effective settlement date is the day BWC mails the settlement agreement. Then the 30-day waiting period begins. This is a cooling-off period for the settlement parties. During this time, any party to the claim can withdraw from the settlement and re-negotiate any changes in the terms of the original settlement agreement. None of the parties can waive the 30-day waiting period. The settlement is binding if BWC does not receive a written withdrawal before the expiration of the 30-day waiting period. BWC suspends all ongoing medical and compensation benefits at the beginning of the 30-day waiting period.

How can I withdraw from a settlement?
Any party, including BWC, can withdraw its consent to the settlement agreement anytime prior to expiration of the 30-day waiting period. To withdraw from the settlement the party must send the request in writing and send it to BWC before the expiration of the 30 days. If any party withdraws from the settlement, BWC will issue a letter of explanation to all parties.

Can BWC collect overpayment from my settlement?
If you received an overpayment in your claim, BWC will absorb the overpayment out of the settlement before you receive your money. This applies even if you were overpaid in another claim. Once BWC handles the existing overpayment, you will receive any remaining balance. If the overpayment amount exceeds the amount of the settlement, BWC will absorb the entire settlement.
For example, if you were overpaid by $2,000 and you agreed to a settlement of $1,500, BWC will absorb the entire settlement and apply it toward the overpayment. The remaining overpayment would be $500.

Can family (child) support be collected from the settlement?
If you owe any family support, the family support agency will take proceeds from the settlement to cover the debt. The family support agency has first claim on the settlement money. BWC will notify the family support agency when it generates the settlement agreement and will hold the settlement for a 30-day period. If you do owe, BWC will send the money directly to the Family Support Enforcement Agency.

What if I have unpaid medical or rehab bills?
When BWC receives an application, it sends letters to all medical or rehab providers who submitted bills within the last two years. This letter gives the provider 20 days to submit any outstanding bills and tells how to resolve outstanding billing issues. Once BWC issues the settlement agreement, BWC will not pay any bills. If an outstanding bill is discovered and your claim is within the 30-day waiting period, BWC can dismiss the settlement and resolve the billing issue.

Can I settle multiple claims?
You can settle multiple claims with one if all claims are with the same employer. For example, you may have three claims for separate injuries with the same employer. However, if more than one employer is involved, you must file a separate application for each employer. So, if you have three claims with three different employers, you must file a separate settlement application for each claim. The applications must include the signatures of each employer.

Can I file for a partial settlement?
BWC bases most settlements on both the projected future medical costs and the indemnity (compensation) costs. However, in rare circumstances, you may settle part of a claim. For example, you may want to settle the indemnity (compensation) portion of your claim but leave the medical portion open. If you choose to do this you will no longer be eligible to receive any future compensation in the claim. But you will be eligible for further medical treatment. BWC will use discretion when considering requests for partial settlement.

Can I settle a claim if incarcerated?
Injured workers with dates of injury on or after Aug. 22, 1986 cannot receive worker's compensation benefits while incarcerated. Therefore, BWC will not settle a claim if you are incarcerated or if BWC learns you will be incarcerated. BWC will withdraw from the settlement if it learns of the incarceration during the 30-day waiting period. BWC will not issue the settlement payment if it learns of the incarceration after the 30-day waiting period expires but before it issues settlement payment. You can only settle if you receive the payment before the date of incarceration. Although these rules do not apply for any claim with a date of injury prior to Aug. 22, 1986, BWC will use discretion when settling a claim for any injured worker who is incarcerated.