Saving $200,000 on Workers Comp Claim
John Doe is a worker who was killed on the job in Ohio. He lives and works in Texas. Doe has no dependents and is unmarried. The laws in all jurisdictions are very specific when it comes to death benefits in the event of a work related fatality.
Texas death benefits include burial allowance and 364 weeks of weekly Workers Compensation benefits commonly called Temporary Total Disability (TTD). This amount totals $195,560 in Doe’s case. If an individual has no dependents, then the $195, 560 is paid to the Texas State Subsequent Injury Fund by statute, not any other family member.
Ohio on the other hand, pays the death benefits as follows: Burial allowance and no additional payment if there are no dependents.
Since the amount of money the family receives for burial allowance is similar and no other monet is due family members in both states, this claim should have been reported as an Ohio claim.
We obtained a legal opinion on the feasibility of changing jurisdiction at this late date. A Tecas Woekers Compensarion arroirnet with Legal Firm indicated there is a fair possibility the jurisdiction can be changed. If the state is not aware that there is no dependant they do no know to come forward to demand this money. In order to change the jurisdiction, XYZ would have to file a Plain Language Notice (PLN1_ that says, “Upon further investigation there is no Texas jurisdiction. Claim in Texas is being closed”. Then report the claim to your TPA in Ohio and provide proof of payment to the State of Ohio on the burial expense and close it out.
This will eliminate a $219,353.11 reserves ($195,560 payment to the state that would have been paid on 7-25-07 and a $23,793 reserve set by XYZ for medical and expenses). The development of this claim is over 2.0 which would increase the forecast by $438,706. ABC, inc.
does not pay $195,560 and $438,706 in reserves on the balance sheet.
We have spoken about missed opportunities in the claims process where the outcome can be positively impacted. This is one of the missed jurisdictional opportunities.