Commonly Asked Ohio Workers’ Compensation Questions
Ohio workers’ compensation differs from that in other states. Coverage must be obtained through the State, unless you qualify for Self-Insurance. With laws, programs, and classifications ever changing, keeping up can be difficult. We have provided some commonly asked questions regarding Ohio Workers’ Compensation below that may help.
General Policy Questions
Do I need to have a workers’ compensation policy?
If you have any employees, even if you are a subcontractor or independent contractor, you must have an active workers’ compensation policy to insure coverage for workers against a workplace injury.
What if I own my own business?
Owners of sole proprietorships, partners in a partnership and individuals incorporated as a corporation (with no employees) are not considered employees and have the option whether or not to cover themselves.
Why should I have a policy if I am an owner of a sole proprietorship, partner in a partnership or an individual incorporated as a corporation (with no employees)?
You would be able to report an injury against your policy and upon BWC approval, medical bills and lost time wages can be paid. The liability of elective coverage is that you must report your wages to the BWC and pay the appropriate premiums on your net income.
How do I apply for coverage?
The Application for Ohio Workers’ Compensation Coverage (U-3) is required to apply for coverage.
What does my policy cover?
After a claim for a work injury is allowed, payment of medical bills, compensation for lost time wages, and permanent disability are covered.
How much does coverage cost?
Workers' compensation rates are based on the employer industry and employee job classification. The gross wages of the employees being insured are multiplied by the rate to calculate the premium to be paid.
When are my premiums due?
Premiums are due twice a year. The coverage period January 1st – June 30th is due in August and the coverage period July 1st – December 31st is due in February.
Third Party Administrator (TPA) and Managed Care Organization (MCO) Related Questions
What is a Third Party Administrator?
A Third Party Administrator (TPA) is a company which can work with you, your policy, and your claims to control cost and risk associated with workers’ comp. A TPA manages claims and can help with program enrollment.
Why should I use a Third Party Administrator?
Claims often can get out of control. Many factors can attribute to this such as fraudulent claims, improper representation at hearings, inexperience, as well as minimal knowledge of reimbursement opportunities. A TPA is an expert in Ohio workers’ compensation, and has the employer’s best interest in mind. ECP works with each of their clients to control risk, keep claims costs realistic, and award reimbursements when eligible.
In addition to claims management, utilizing a TPA is the only way to be part of a Group Rating Program to receive a group discount.
Can I change my TPA at any time?
There are no restrictions on when you are able to change your TPA. An updated permanent authorization form (AC-2) will be required to do so. In addition, a letter of termination should be provided to your prior TPA to prevent double billing or claims management issues.
If I have an active claim, can I still change my TPA?
Yes, you may still change your TPA. Thousands of companies are faced with this situation every year. The BWC generally allows a continuance for the hearing. This provides the new TPA with time to become familiar with the claim.
Learn more » Third Party Administrator (TPA)
What is a Managed Care Organization?
A Managed Care Organization (MCO) is a private company that an employer works with to medically manage an injured workers’ claim. MCO’s are responsible for approval or denial of treatment. They are an integral part of returning the injured employee to work.
Do I have to have an MCO?
Any employer with a BWC Policy is required to select an MCO. If a new employer does not select an MCO, one is randomly assigned. MCO selection/change can only occur once every two years. The next enrollment is May 2014.
If I have a claim, when and how long will that claim impact my premium rates?
Once a claim occurs, there is a green year assessed to the claim. For example, if a claim occurred in 2009, it will not begin to impact your experience until July 1, 2011.
Once it enters your claims experience, it will remain in your experience for 4 years. For example, if a claim occurred in 2009, it will not fall off of your experience until June 30, 2015.
What is a reserve?
The BWC assesses a reserve to claims; this reserve is the estimated future cost of a claim at a point in time.
Once a reserve is assessed, how can it be removed?
Reserves remain until one of the following occurs:
- Settlement of a claim
- Period of inactivity
- In the event of changes to the current reserving system
How does a reserve affect my premium?
Dependent upon the following scenarios, a reserve could be the difference between significant or minimal premium discounts. Reserves are accounted for in two ways:
- In reference to Group Rating eligibility; the full amount of the reserve is accounted for.
- In reference to Individual experience rating, there is a max claim value assessed for each company (up to $250,000), this amount including the reserve is used.
Premium Reduction Questions
How can I get discounts on my premium?
Discount programs, rating programs, and deductible programs are available. Working with a TPA to enroll and participate in these programs is usually beneficial to ensure you are getting the most out of them. Not all programs are compatible with others, and there are different enroll by dates assessed to each one. Regardless of which programs you are enrolled in, the maximum discount you can obtain at this time is -53%.
Learn more about Premium Reduction
What is Group Rating?
Group Rating offers employers within the same industry the opportunity to “group” together to achieve significant premium discounts. A TPA is required to enroll in Group Rating.
Learn more about Group Rating.
We understand that you may have more questions that what we have covered here, contact an ECP representative at 513-759-3151 for additional answers.