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BWC offers a variety of compensation types. If your claim has been allowed you may qualify
for compensation even if you have not lost time from work as a result of your injury. Some
of the types of compensation are:
Temporary Total Compensation (TT)
TT compensation is provided to compensate an injured worker who is totally disabled
from work on a temporary basis or a short period of time due to the work related
injury or occupational disease. TT is generally the initial award of compensation
paid to an injured worker to compensate for lost wages.
Scheduled Loss (SL)
A certain amount of permanent damage (called residual damage) may remain as a
result of the injury. A scheduled loss (formerly known as a permanent partial) award
encompasses amputations and loss of use, including vision and hearing. A scheduled
loss award is based on the loss suffered by the injured worker prior to treatment,
not on the injured workers condition after treatment.
A scheduled loss award does not have to be requested on a Motion (C-86). A SL award
can be requested on the First Report of Injury or identified during the initial
claim investigation. Compensation for this type of award is based upon the nature
of the injury as well as the year that the injury occurred.
BWC or the self-insuring employer will pay all initial awards of Scheduled Loss
(SL) compensation under ORC 4123.57(B) .
This includes payment of all scheduled losses (amputations), loss of use, ankylosis,
loss of vision and total loss of hearing. These awards are commonly referred to
as "Paragraph B" awards.
An injured worker is entitled to an amputation award when s/he sustains a loss of a
body part that is a result of severance through the bone due to a work related
injury.
Permanent impairment of a member without severance usually entitles the injured
worker to an award and is regarded as being the same as loss by severance.
Percentage of Permanent Partial Award (%PP)
A certain amount of permanent damage (called residual damage) may remain as a
result of the injury. %PP is commonly referred to as C-92 awards and is
compensation awarded for residual impairment resulting from an allowed injury or
occupational disease according to ORC 4123.57.
For example, if an injured worker sustains a broken arm and can no longer
extend it to the full degree, he would be eligible for an award based upon the
residual loss. The permanent impairment may be physical, psychological or
psychiatric.
%PP is not payable for any psychiatric condition(s) unless there is an allowed
accompanying medical condition in the claim. C-92/C-92A awards are based on
medical information and the findings of the exam/review. The C-92/C-92A
determination is supported by an independent exam and the examining physician will
not contact the injured workers doctor/provider of record for medical
information.
Permanent Total Disability (PTD)
Permanent Total Disability (PTD) is the injured workers inability to perform
sustained remunerative employment due to the allowed condition(s) in the claim. The
purpose of PTD benefits is to compensate the injured worker for impairment of
earning capacity. Compensation for PTD is payable for life. When an injured worker
applies for permanent total disability, he/she must attend an Industrial Commission
examination and hearing to determine if he/she meets the eligibility criteria for
this type of compensation.
Disabled Workers Relief Benefits (DWRF)
Disabled Workers Relief Fund (DWRF) is a separate supplemental fund established to
provide relief to an injured worker who is receiving permanent total disability
(PTD) compensation benefits by raising the cost of living level.
Change of Occupation (COA)
Injured workers who have contracted silicosis, coal miners pneumoconiosis or
asbestosis may be entitled to a change of occupation award according to
ORC 4123.57(D). These injured workers
have been medically advised that a change of occupation is recommended in order to
substantially decrease further exposure to silica dust, asbestos or coal dust.
Firefighters and police officers who have contracted a cardiovascular and pulmonary
disease as defined in ORC 4123.68 may be entitled to a change of occupation award
according to ORC 4123.57(E). These injured workers have been medically advised to
change their occupation in order to substantially decrease further exposure to
smoke, toxic gases, chemical fumes and other toxic vapors.
Facial Disfigurement Award (FD)
A Facial Disfigurement Award (FD) is a one-time award granted for visible damage to
the face or head with the potential to impair the injured workers ability to secure
or retain employment. ORC 4123.57.
The maximum amount payable for this type of award is $10,000. Awards are based
upon the severity of the damage sustained by the injured worker. Facial
Disfigurement awards are in addition to other types of partial disability
compensation or scheduled loss awards paid according to ORC 4123.57 under and are
paid in a lump sum.
Self Insuring Employers are responsible for the determination and issuance of a
facial disfigurement award for SI claims. BWC is responsible for SI Bankrupt
Facial Disfigurement awards claims. ORC 4123.35(L)
Wage Loss (WL)
Wage Loss compensation may be paid to an injured worker (IW) that suffers a
reduction in earnings as a direct result of restrictions from the allowed
conditions in the claim. Wage loss is payable in claims with a date of injury or
diagnosis on or after Aug. 22, 1986.
Two conditions must be met to be eligible for WL.
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A loss or decrease in wages exists.
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The wage loss is a direct result of the restrictions caused by the allowed conditions in the claim.
There are two types of wage loss benefits that may be considered in a claim.
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Working Wage Loss (WWL)
This is payable when the IW returns to employment other than his or her
former position of employment. This would include return to work with the
employer of record or a new employer with different job duties, less hours
and less pay resulting from the physical restrictions.
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Non-Working Wage Loss (NWWL)
This is payable when the IW is unable to find suitable employment. In
order to qualify for NWWL the injured worker must demonstrate that he/she
is making a good faith effort to secure employment within his/her physical
restrictions.
Living Maintenance Wage Loss (LMWL)
LMWL may be paid to an injured worker with a date of injury on or after Aug. 22,
1986. The injured worker must have completed a rehabilitation plan and continues
to have physical restrictions and experiences a wage loss upon return to work.
Living Maintenance (LM)
A type of compensation paid to an injured worker while they are actively
participating in an approved rehabilitation plan. This section in the MCO Policy
Reference Guide information about living maintenance (LM) payments which are
provided to the injured worker in place of temporary total compensation when
participating in a vocational rehabilitation plan. This information also includes
information about suspending and terminating LM. When an injured worker is actively
participating in a vocational rehabilitation plan, he or she shall receive living
maintenance payments in place of temporary total compensation (OAC 4123-18-04 ).
ORC 4121.63 states that BWC will issue this compensation for a
period not to exceed six months in the aggregate, unless BWCs review reveals the
injured worker will benefit by an extension. The CST can issue living maintenance
upon receipt of the vocational rehabilitation agreement and plan.
Death Claims
A dependent's right to death benefits does not begin until after the death of the
worker. If the decedent settled a workers compensation claim prior to their death,
this will not stop the dependent's right to file a claim for death benefits. A death
claim is filed by the dependents of an injured worker (IW) who died as a result of
an industrial injury or occupational disease. Dependent death benefits will be
based on the level of dependency or support each dependent had while the worker was
living.
Death benefits can be divided into two categories. The first is when death results
instantaneously as a result of an injury. The second is when death is not an
instantaneous but a proximate result of an injury or occupational disease.
Death benefits may be applied for by using any one of the following methods:
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The First Report Of Injury (FROI);
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The Industrial Commission form Application for Additional Award for Fatal Injury (IC-3019);
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By letter if the death is a result of an existing claim;
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The new Additional Information for Death Benefits (C-5) or the OD-2 forms may also be used for additional information;
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Death benefits may also be applied for by calling 1-800-OHIOBWC, or the local customer service office;
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A managed care organization (MCO) can also report the death due to injury or disease by filing the claim via External Data Interchange (EDI).
Claims alleging that death is the result of an injury or occupational disease must
be filed within two years of the date of death according to
OAC 4123-3-08(D)(6)and ORC 4123.85.
Violation of Specific Safety Requirement (VSSR)
No employer will violate a specific workplace safety requirement established by
legislation or BWC. The injured worker (IW) or dependent, (when there has been a
fatality) may file an application for a Violation of Specific Safety Requirements
(VSSR) award if there is evidence that a violation has or may have occurred from
the failure of the employer to comply with a specific safety requirement. Ohio
Constitution Article II 35, ORC4121.47(A),
OAC 4123-3-20.
The Industrial Commission (IC) maintains jurisdiction over the application and
determination process for a VSSR award. The Staff Hearing Officer (SHO) hears the
request for a VSSR award and can assess a penalty ranging from 15 percent to 50 percent of the
maximum workers compensation award established by law if the employer is found to be
in violation of a specific safety requirement.
In death claims, the application shall be on the IC-9 form and in nonfatal cases, the
application shall be on the IC-8 form. Such applications must be completed in the
manner established by the industrial commission. The determination of awards by reason
of violation of specific safety requirements being within the exclusive jurisdiction
of the industrial commission, such applications, if filed with the bureau, shall be
referred, forthwith, to the industrial commission for further consideration.
Lump Sum Settlement (LSS)
Per Ohio Revised Code (ORC) 4123.65, a
settlement can be initiated only by the injured worker/injured worker representative,
employer/employer representative or BWC. The managed care organization (MCO) is not a
party to the settlement; therefore, the MCO may not initiate nor advise the IW to
settle their case. However, an MCO may identify potential candidates for pursuit of
settlement based on treatment patterns/trends.
The Settlement Agreement and Application of Settlement Agreement (C-240) is to be used
by the injured worker or employer for the settlement of state fund claims. The purpose
of this application is to document the agreement to the terms and conditions of the
settlement. If you employer is self-insured, the settlement application should be
filed on a SI-42 and be submitted to the SI employer.
If you would like more information in regard to settlements, contact your legal
representative. If you do not have legal representation, you may contact your
assigned claims service specialist (CSS).
Lump Sum Advancement (LSA)
A Lump Sum Advancement (LSA) is the prepayment of future compensation. Advancement
applications will be reviewed for meeting financial relief and rehabilitation purposes
only. Advancements may be requested by injured workers or dependents (in case of death)
who are currently receiving Permanent Total Disability, Scheduled Loss or Death
Benefits. Lump Sum Advancements may be requested on the following applications:
C-32, IC-32A and OIC-3016.
Requests for financial relief, such as household bills, estimates of emergency
repairs or purchases, school tuition, handicap lift installed in an existing or new
van, etc. must have supporting documentation attached to the application.
Determination of attorney fees remains with the Industrial Commission (IC). All
requests for advancement of attorney fees should be forwarded to the IC. After
determination, the IC returns the request to the assigned BWC claims service
specialist for processing.
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