FY OSHR Workers Compensation Claim Settlement Reserve Fund Administration Process
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1 1. On or before October 30, 2015, OSHR shall utilize information received from the NCDOJ-Workers Compensation Section and the following claim information included on Corvel reports or in the CareMC database to identify potential Eligible Claims in all state agencies that may be appropriate for settlement utilizing funds from the Settlement Reserve Fund. a. Employing agency. b. Employee s name. c. Employee s home address. d. Employee s date of injury. e. Employee s age and statutory life expectancy based upon NCGS f. Number of workers compensation claims filed by the employee while employed by the State. g. Employee s pre injury position title and job description. h. Employee s average weekly wage, weekly compensation rate, and whether injury qualified for salary continuation benefits. i. Length of employee s entitlement to ongoing workers compensation disability benefits if claim is not settled. j. Documented efforts to return the employee to work. k. Employee s return to work potential. l. Employee s current medical condition related to the workers compensation claim. m. Employee s comorbidities or other medical conditions unrelated to the workers compensation claim, if applicable. n. Employee s projected future medical treatment related to the workers compensation claim. o. Will the claim settlement include the employee s resignation, if still employed with the State? p. Has the employee retired? q. Is the employee eligible for or receiving Long-Term Disability benefits? r. Is the employee currently receiving, has applied for, is appealing a denial, or plans to apply for Social Security Disability (SSDI) benefits in the near future? s. Whether Medicare Set Aside Agreement (MSA) will be required and dollar amount to be included in the claim settlement, if already calculated. t. Prior Industrial Commission Orders, Opinions and Awards, Consent Agreements, or Consent Orders on record for the claim.
2 Page 2 of 5 u. Pending current litigation and issues to be determined included on the Industrial Commission Form 33 Request for Hearing and/or Form 33R Response to Request for Hearing. v. Projected future litigation. w. Total dollar amount of expenditures already paid for the claim including breakdown into separate amounts spent for Indemnity costs (IND), Medical costs (MED), and Allocated Expenses (ALE) costs. x. Total dollar amount of current claim reserves including breakdown into separate amounts projected to be paid for future indemnity (IND), medical (MED), and allocated expenses (ALE) costs. y. Projected total dollar amount of lifetime exposure for all potential future costs related to claim. z. Name of employee s attorney and whether the attorney is currently receiving an ongoing attorney s fee. aa. Other pertinent information. 2. On or before November 6, 2015, OSHR shall send an explanatory memo detailing the Settlement Reserve fund application and approval process to each agency with a list of potential Eligible Claims that may be appropriate for Settlement Reserve funding. 3. On or before November 20, 2015, each agency shall send a response to OSHR with comments and proposed additions to the agency s Eligible Claims list for Settlement Reserve funding. 4. On or before December 1, 2015, OSHR shall provide all state agencies, the third party administrator, and the NCDOJ-Workers Compensation Section with a list of Eligible Claims for Settlement Reserve funding. 5. Additional claims may be added to the Eligible Claims list at the discretion of OSHR. 6. An injured employee must already be separated from State employment or the employee s resignation must be included as part of the settlement for such claim to be eligible for Settlement Reserve funding. 7. From December 1, 2015 March 31, 2016 state agencies may apply to OSHR for Settlement Reserve funding for Eligible Claims PRIOR TO reaching any settlement by submitting the following via to workerscomp@nc.gov: (a) OSHR Settlement Reserve Fund Application Form; and (b) Settlement Evaluation prepared by the third party administrator dated no more than ten (10) days prior to the Settlement Reserve Fund application submission date. Agency requests shall be reviewed in the order received. These documents shall include the following information items: a. Employee s agency. b. Employee s name.
3 Page 3 of 5 c. Employee s home address. d. Employee s date of injury. e. Employee s age and statutory life expectancy based upon NCGS f. Number of workers compensation claims filed by the employee while employed by the State. g. Employee s pre injury position title and brief job description. h. Employee s average weekly wage and weekly compensation rate for this claim. i. Length of employee s entitlement to ongoing workers compensation disability benefits if claim is not settled. j. Description of agency s documented efforts to return the employee to work. k. Description of employee s return to work potential. l. Description of employee s current medical condition related to the workers compensation claim. m. Description of employee s comorbidities or other medical conditions unrelated to the workers compensation claim, if applicable. n. Description of employee s projected future medical treatment related to the workers compensation claim. o. Will the claim settlement include the employee s resignation, if still employed with the State? p. Is the employee receiving retirement benefits? q. Is the employee eligible for or receiving Long-Term Disability benefits? r. Is the employee currently receiving, has applied for, is appealing a denial, or plans to apply for Social Security Disability (SSDI) benefits in the near future? s. Whether Medicare Set Aside Agreement (MSA) will be required and dollar amount to be included in the claim settlement, if already calculated. t. Description of any prior Industrial Commission Orders, Opinions and Awards, Consent Agreements, or Consent Orders on record for the claim. u. Description of any pending current litigation and issues to be determined included on the Industrial Commission Form 33 Request for Hearing and/or Form 33R Response to Request for Hearing. v. Description of any projected future litigation.
4 Page 4 of 5 w. Total dollar amount of expenditures already paid for the claim including breakdown into separate amounts spent for Indemnity costs (IND), Medical costs (MED), and Allocated Expenses (ALE) costs. x. Total dollar amount of current claim reserves including breakdown into separate amounts projected to be paid for future indemnity (IND), medical (MED), and allocated expenses (ALE) costs. y. Projected total dollar amount of lifetime exposure for all potential future costs related to claim. z. Total dollar amount of proposed claim settlement denoting any amount included for Medicare Set Aside Agreement (MSA). aa. Dollar amount of funds for proposed claim settlement agency is requesting from Workers Compensation Settlement Reserve Fund. bb. Name of employee s attorney and whether the attorney is currently receiving an ongoing attorney s fee. cc. Other pertinent information. 8. Incomplete applications will not be reviewed and will be returned to the requesting agency. Agencies may resubmit complete applications. 9. Upon receipt of a complete application, OSHR shall obtain a copy of the Attorney General s Settlement Approval memo for the claim for which settlement funds are being requested. 10. Within seven (7) business days of receipt of the complete application, Settlement Evaluation, and Attorney General Settlement Approval Memo, OSHR shall review an agency request and may approve a Settlement Reserve fund award. OSHR anticipates that individual cases may be awarded up to thirty-five percent (35%) of the total settlement cost including Medicare Set Aside (MSA) amount. Requests for full funding of a claim settlement will be considered on an individual basis. 11. OSHR shall send individual Settlement Reserve funding decisions via to the agency contact person listed on the OSHR Settlement Reserve Fund Application Form. OSHR Director Neal Alexander shall send written notification of Settlement Reserve funds approval to OSC. 12. The agency shall have ninety (90) days after receiving notice from OSHR of approved Settlement Reserve funds to obtain a written settlement agreement. OSHR shall remind agencies with Settlement Reserve funds allocations that the ninety (90) days period is about to expire approximately fifteen (15) days prior thereto. This deadline may be extended upon receipt of a written request from the Attorney General assigned to the claim sent to workerscomp@nc.gov. 13. If the agency does not obtain a written settlement agreement for the claim during the ninety days (90) period plus any OSHR approved extensions, OSHR Director Neal Alexander shall notify the agency and OSC that previously approved Settlement Reserve funds are no longer available.
5 Page 5 of If the agency decides not to settle a claim for which Settlement Reserve funds have been approved by OSHR, the agency shall notify OSHR via to workerscomp@nc.gov as soon as this determination is made. OSHR Director Neal Alexander shall notify OSC that such funding obligation is cancelled so that those funds will be available for other settlements.
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