The CVC Application Process
What happens to an application once it reaches the Crime Victims' Compensation (CVC) Program? We have been asked this question during our monthly and regional trainings and compiled this general explanation in response. We generalize as each application is unique and requires different documentation and review because of the circumstances involved with each type of crime and reimbursement request.
The application process actually begins with law enforcement officers and liaisons, prosecutor victim assistance coordinators, hospital and medical emergency personnel, and advocates - often the victim's first contacts after the crime. Article 56 of the Texas Code of Criminal Procedure requires law enforcement agencies and prosecutors to give crime victim compensation information to victims. In fiscal year 2005, the OAG awarded more than $36 million in grants to over 300 organizations that assist victims in completing compensation applications in addition to other direct services. While we distributed more than 150,000 applications last year, this network of local responders is integral to getting information to victims about the existence of the program, helping them complete applications, and gathering necessary documentation.
Central Records Section
Central Records receives all initial applications and incoming mail including bills and reports, employment verification forms, and other correspondence. Central Records staff reviews and then routes documents to the proper section. Routing is done electronically after paper documents are imaged and indexed into the computer.
Applications are assigned a claim number within two to five business days after they arrive by mail. Staff members review applications for proper signatures and send requests to law enforcement for offense reports if not included. The Central Records staff also handles all incoming phone calls and operates the Provider Support Call Center.
The compensation process actually consists of two steps. First, the Eligibility Section determines if the application is eligible for benefits. If so, then the application moves to the Awards Section for benefit decisions.
Eligibility Section staff members review the application, offense report, and any witness statements to ensure compliance with all applicable laws. The time involved depends upon the availability of these documents.
The threshold requirement for application consideration is that the victim suffered personal injury or death as a direct result of an eligible criminal offense. Applicants must also meet residency, reporting, and filing requirements, and cooperate with authorities in the investigation and prosecution of the case. Applications are also reviewed to establish the degree of the contributory behavior by the victim, if any.
Once the application decision is made, the Awards Section reviews approved claims to determine compensation benefits. A team, led by a case manager and including a nurse and support staff, reviews each claim. Case managers consult with victims and claimants to determine the best allocation of available funds and work with the responsible parties, victims, their families, and service providers, to obtain the necessary documentation to substantiate the payments.
Since CVC is categorized by statute as the payer of last resort, collateral sources such as health insurance benefits, auto insurance, and Medicaid must be accessed and considered in the payment process (see the article in this newsletter on "Collateral Resources").
All expenses approved for payment are sent to the CVC Accounting Section for processing. If a collateral source is available and payment has been made, then the award is adjusted accordingly. Medical and counseling bills are sent to the medical cost containment contractor for adjustment review under the Texas Worker's Compensation Medical Fee Guidelines as required by statute. After quality control checks are made, the payment is released and checks are requested from the State Comptroller's Office and mailed to the victim or service provider.
A victim may appeal an eligibility determination or an awards decision for payment to the Legal Section. If the victim or claimant feels that the decision is made in error, they are asked to submit a written request for reconsideration. If the original decision stands, the victim or claimant can ask for a reconsideration hearing to present additional information. Hearings are made as accessible to the concerned parties as possible and include the use of teleconferencing and videoconferencing. The victim or claimant may file a lawsuit in District Court if they are dissatisfied with the final ruling hearing after first sending CVC a written notice of dissatisfaction.