What you need to know about BWC’s prospective billing transition credits

As the Ohio Bureau of Workers’ Compensation (BWC) works toward implementing a prospective billing system, it has indicated that transition credits will be given to employers to eliminate any double billing as the change occurs from the current in arrears payment cycle.

Smart Business spoke with Heather Vogus, vice president at CompManagement, Inc., about the details of the transition credit and how it will be applied to an employer’s premium for the policy year.

Why are transition credits being offered?

A one-time premium credit is being given to all state fund employers to aid in the transition to a prospective billing cycle from the current retrospective (in arrears) payroll reporting and premium payment cycle. To eliminate the need for double payments during the transition, BWC will provide $1.2 billion in premium credits. The transition will not cost Ohio employers any extra money.

How will the transition credits work?

Private employers will receive full credit to their final in arrears premium payment due in August 2015, based on their Jan. 1, 2015, to June 30, 2015, payroll. In addition, they will receive a two month or 1/6 credit for the first prospective payment for the July 1, 2015, to June 30, 2016, payroll period.

Public employers will not transition to a prospective billing cycle until the Jan. 1, 2016, policy year. They will then receive a 50 percent credit on their May 2016 premium payment, based on 2015 payroll, and a 50 percent credit on their first prospective payment, based on 2016 payroll.

Who qualifies for the transition credits?

All state fund private and public employers that pay premium during the periods will receive the credit. However, they must be in an active status during the transition. Private employers must be active as of Aug. 31, 2015, and they must file their Jan. 1, 2015, to June 30, 2015, payroll report in order to be eligible to receive the full transition credit for that period. Public employers must be active as of May 15, 2016.

What will the BWC use as premium to calculate the credits?

The premium amount utilized to calculate the credit will be dependent on the rating program that an employer may be participating in for the policy year. For instance:

  • The group rating is dependent on the group rated premium.
  • The individual retrospective rating is based on minimum retrospective premium. The transition credits will not apply to claims costs paid under the retrospective rating plan.
  • The group retrospective rating is dependent on merit rated or base rated premium. The transition credits will not include any group retrospective refunds or assessments.
  • The deductible program is based on the discounted premium. The transition credits will not apply to claims costs paid under the deductible plan.
  • The destination excellence is dependent on merit rated or base rated premium. The transition credits will not be reduced by any lapse-free, go green, safety council rebates or other premium-based bonuses and credits.
  • The individual or base rating is dependent on merit rated or base rated premium.

Why are alternative premium discount program enrollment dates changing and when are the deadlines?

Enrollment dates have been moved up about three months in advance because employers will now be paying in advance for coverage and thus premium paid is impacted by this enrollment. Private employer deadlines for the 2015 policy year include:

  • Group rating: Monday, Nov. 24, 2014, previously last business day of February.
  • Group retrospective rating and other alternative rating programs: Friday, Jan. 30, 2015, previously last business day of April.
  • Destination excellence programs: Friday, May 29, 2015, previously last business day of April.

Enrollment deadlines for public employers do not change for the Jan. 1, 2015, policy year. Public employers will move to prospective billing for the Jan. 1, 2016, policy year so deadlines will change in 2015, not this year.

Insights Workers’ Compensation is brought to you by CompManagement, Inc.

Changes to premium discount programs mean earlier deadlines

As the Ohio Bureau of Workers’ Compensation (BWC) begins its transition to a prospective billing system, it has announced the first changes to be made in order to implement this new system, which involves the enrollment deadlines for premium discount programs.

“In order to implement prospective billing, BWC has created earlier deadlines to sign up for incentive/discount programs,” says John Logue, vice president at CompManagement, Inc. “Employers will have to make their selections sooner than normal as the transition becomes effective July 1, 2015, for private employers and Jan. 1, 2016, for public employers.”

Smart Business spoke with Logue to determine when employers need to be prepared to act this year and next so that they do not miss the opportunity to reduce their annual workers’ compensation premium.

When do private employers need to act for their upcoming policy year?  

Private employer deadlines for the 2015 policy year, which is the first year impacted by prospective billing, have been moved up about three months in advance of normal:

  • The group rating deadline has been changed to Monday, Nov. 24, 2014. It was previously the last business day of February.
  • The group retrospective rating/other alternative rating program deadlines are Friday, Jan. 30, 2015. They had previously been the last business day of April.
  • Destination excellence program deadlines are Friday, May 29, 2015. These have moved from the last business day of April.

Are there other deadline changes outside of the premium discount programs for private employers this year?

Settlement applications (C240 forms) for private employers are due Tuesday, July 15, 2014, for any settlements that are to be applied to the 2015 experience. Previously, this deadline was Oct. 15.

What changes occur this year for public employers?

Enrollment deadlines for public employers do not change for the Jan. 1, 2015, policy year. Employers should enroll by the following deadlines this year:

  • Group rating: Friday, Aug. 29, 2014.
  • Group retrospective rating/other alternative rating programs: Friday, Oct. 31, 2014.
  • Destination excellence programs: Friday, Oct. 31, 2014.

What changes should public employers be aware of for the 2016 policy year?

Public employer deadlines for the 2016 policy year, which is the first policy year impacted by prospective billing for this employer population, are as follows:

  • The group rating deadline will be Friday, May 29, 2015, moved up from the last business day of August.
  • Group retrospective rating/other alternative rating programs will be Friday, July 31, 2015. Previously, the deadlines were the last business day of October.
  • Destination excellence program deadlines are Monday, Nov. 30, 2015, moved from the last business day of October.
  • Settlement applications (C240) are due Monday, Feb. 16, 2015, for settlements to be applied to the 2016 experience. This was previously May 15.

With the implementation of prospective billing and change to enrollment deadlines, will employers end up having two payments at once?

To eliminate having to pay two semi-annual premium payments during the transition, one-time premium credits will be given by BWC to help offset the transition to prospective billing from the current ‘in arrears’ reporting. Private employers will receive a full credit to their final in arrears premium payment due in August 2015, which is payroll between Jan. 1, 2015, and June 30, 2015, and a two-month or 1/6 credit for the first prospective payment for payroll between July 1, 2015, and June 30, 2016. Public employers will receive a 50 percent credit on their May 2016 premium payment, based on 2015 payroll, and a 50 percent credit on their first prospective payment, based on 2016 payroll.

Insights Workers’ Compensation is brought to you by CompManagement Inc.

How Ohio safety council program participation can lead to savings

The Ohio safety council rebate program created by the Ohio Bureau of Workers’ Compensation (BWC) rewards employers for their active participation in a local safety council. It also provides an additional performance bonus rebate for reducing the frequency or severity of workers’ compensation claims.

“With the number of safety councils available across the state with a focus on a variety of industries, employers are able to not only receive information on new safety techniques, products and services to assist their businesses, but also reduce their premium for simply attending these helpful meetings throughout the year,” says Russ Hocutt, vice president at CompManagement, Inc.

Smart Business spoke with Hocutt about how this rebate program works.

How much of a rebate can be earned?

Currently the incentive program enables employers to receive a rebate of 2 percent of their annual workers’ compensation premium through program participation and an additional 2 percent performance bonus based on the reduction of the frequency or severity of claims.

How can a local safety council be found?

BWC’s Division of Safety & Hygiene sponsors more than 80 safety councils across the state, organized through chambers of commerce, trade and manufacturing associations, American Red Cross chapters or other local, safety-minded organizations. A list is available at www.ohiobwc.com.

What are the requirements for the participation rebate portion?

An employer must enroll in a local safety council by July 31. Once enrolled, an employer must attend 10 meetings or events between July 1 and June 30. Two of the 10 meetings may be external educational options such as BWC Safety & Hygiene training courses or industry-specific training. The chief executive officer must attend at least one safety council-sponsored function or meeting. Semiannual reports must be submitted for the calendar year to document attendance. The documentation must be an official certificate of attendance or transcript. Only employers that meet the participation eligibility requirements will be eligible for an additional 2 percent performance bonus.

How is the performance bonus calculated?

Employers that reduce their frequency or severity of claims by 10 percent or more compared to the previous year’s frequency or severity, or employers that maintain both frequency and severity at zero, will receive an additional 2 percent refund of their annual premium, assuming the participation portion of the safety council program is met.

BWC calculates frequency by multiplying the total number of claims reported in the measurement year by 1 million and dividing by the employer’s total reported payroll for that year. Severity is determined by multiplying the total number of days absent during the measurement year by 1 million and then dividing by the employer’s total reported payroll for that year. The measurement period for private employers is claims and payroll reported between July 1 and June 30 compared to the previous year. For public employers, the measurement period is between Jan. 1 and Dec. 31.

What impact would the program have on a midsize company’s premium?

Assuming the participation requirements are met and the employer was able to reduce the frequency or severity of claims as indicated above, a midsize service company could expect the following in annual premium savings, assuming the employer is participating in no other alternative rating programs:

  • Payroll — $3,990,000.
  • Individual discount — 16 percent.
  • Individual premium — $14,683.
  • 2 percent safety council participation rebate —  $200*.
  • 2 percent safety council performance rebate — $200*.

*Based on pure premium which does not include assessments for DWRF and administrative costs for operation of BWC/IC

Savings reflected above do not include the additional savings that can be realized by also participating in programs compatible with the safety council program such as Destination Excellence, Drug Free safety Program, Group Rating (performance bonus only), Group Retrospective Rating (participation bonus only), Large/Small Deductible, Individual Retrospective Rating, or One Claim Program. Always have your third-party administrator conduct a feasibility study to evaluate the best savings options available for your organization.

Insights Workers’ Compensation is brought to you by CompManagement, Inc.

How to use deductibles to lower workers’ compensation premiums

Mark MaGinn, Vice President, CompManagement, Inc.

Mark MaGinn, Vice President, CompManagement, Inc.

The Deductible Program was implemented in 2009 by the Ohio Bureau of Workers’ Compensation (BWC) as another alternative for employers to control their costs while promoting workplace safety. Over the past few years, the program has been enhanced to include a small and large deductible program so that employers of different sizes, hazard groups and risk tolerance levels have options that best fit their organization.

“The Deductible Program can be financially beneficial for those employers that have a focus on their safety efforts and are able to keep their claim costs low,” says Mark MaGinn, vice president at CompManagement, Inc. “An employer should consider having a feasibility study performed by their third-party administrator prior to participating in order to analyze the deductible levels available and ensure it is the best program for their organization.”

Smart Business spoke with MaGinn about how this alternative rating program works.

How does the Deductible Program work? 

Similar to other insurance deductible plans, an employer agrees to pay the portion of a workers’ compensation claim that falls below their selected deductible level in exchange for an upfront premium discount. Claims costs are paid in full by the BWC, then the employer reimburses the BWC for the claim costs up to the selected deductible level. The employer will receive monthly invoices from the BWC until the selected deductible level is reached. All deductible bills must be paid within 28 days of the invoice date.

What deductible amounts are available to choose from?

Deductible levels range from $500 to $200,000. The small deductible program includes levels of $500, $1,000, $2,500, $5,000 and $10,000. The large deductible program includes levels of $25,000, $50,000, $100,000 and $200,000. There is no deductible level available between $10,000 and $25,000. An employer is limited to 25 percent of its annual premium if the deductible selected is less than $10,000, and 40 percent of annual premium if the deductible is $25,000 or more.

How does an employer join the Deductible Program?

An employer must complete a BWC Application for Deductible Program (U-148) to enroll in the Deductible Program, and meet eligibility requirements. The enrollment deadline for private, state-funded employers is the last business day in April for coverage beginning July 1, and for public employers it is the last business day of October for coverage beginning Jan. 1. Changes to the deductible level or withdrawal from the program are not allowed until the next policy year.

Is there any method to cap the annual out of pocket?

Employers selecting a deductible level of $25,000 or more have the option to request an annual aggregate stop-loss limit of three times the deductible, allowing them to cap the potential annual out-of-pocket expense that may arise from participating in the program.

How is the Deductible Program savings projection calculated?

Based on the deductible level chosen and the employer’s hazard group, which is based on the employer’s manual classifications and risk level, the BWC will establish the savings percent. This discount can range anywhere from 1.4 to 26 percent for small deductible options and is applied to the employer’s standard premium.

An example for a midsize service company selecting a $5,000 deductible within the small deductible program:

• Payroll — $5,000,000.

• Individual premium — $460,000.

• Deductible discount savings — $32,000.

• Premium with discount — $428,000.

• Plus estimated deductible billing — $10,000.

• Net premium — $438,000.

• Net savings — $22,000.

In addition to this savings, deductible payments under the small deductible program will not be charged to the claim, therefore possibly reducing future rate calculations. λ

Savings reflected above do not include the additional savings that can be realized by also participating in programs compatible with either the small or large deductible program, such as the Go Green or Safety Council discounts.

Mark MaGinn is vice president at CompManagement, Inc. Reach him at (800) 825-6755, ext. 65868 or mark.maginn@sedgwickcms[email protected]

Insights Workers’ Compensation is brought to you by CompManagement, Inc.

 

How to use deductibles to lower workers’ compensation premiums

Mark MaGinn, Vice President, CompManagement, Inc.

Mark MaGinn, Vice President, CompManagement, Inc.

The Deductible Program was implemented in 2009 by the Ohio Bureau of Workers’ Compensation (BWC) as another alternative for employers to control their costs while promoting workplace safety. Over the past few years, the program has been enhanced to include a small and large deductible program so that employers of different sizes, hazard groups and risk tolerance levels have options that best fit their organization.

“The Deductible Program can be financially beneficial for those employers that have a focus on their safety efforts and are able to keep their claim costs low,” says Mark MaGinn, vice president at CompManagement, Inc. “An employer should consider having a feasibility study performed by their third-party administrator prior to participating in order to analyze the deductible levels available and ensure it is the best program for their organization.”

Smart Business spoke with MaGinn about how this alternative rating program works.

How does the Deductible Program work? 

Similar to other insurance deductible plans, an employer agrees to pay the portion of a workers’ compensation claim that falls below their selected deductible level in exchange for an upfront premium discount. Claims costs are paid in full by the BWC, then the employer reimburses the BWC for the claim costs up to the selected deductible level. The employer will receive monthly invoices from the BWC until the selected deductible level is reached. All deductible bills must be paid within 28 days of the invoice date.

What deductible amounts are available to choose from?

Deductible levels range from $500 to $200,000. The small deductible program includes levels of $500, $1,000, $2,500, $5,000 and $10,000. The large deductible program includes levels of $25,000, $50,000, $100,000 and $200,000. There is no deductible level available between $10,000 and $25,000. An employer is limited to 25 percent of its annual premium if the deductible selected is less than $10,000, and 40 percent of annual premium if the deductible is $25,000 or more.

How does an employer join the Deductible Program?

An employer must complete a BWC Application for Deductible Program (U-148) to enroll in the Deductible Program, and meet eligibility requirements. The enrollment deadline for private, state-funded employers is the last business day in April for coverage beginning July 1, and for public employers it is the last business day of October for coverage beginning Jan. 1. Changes to the deductible level or withdrawal from the program are not allowed until the next policy year.

Is there any method to cap the annual out of pocket?

Employers selecting a deductible level of $25,000 or more have the option to request an annual aggregate stop-loss limit of three times the deductible, allowing them to cap the potential annual out-of-pocket expense that may arise from participating in the program.

How is the Deductible Program savings projection calculated?

Based on the deductible level chosen and the employer’s hazard group, which is based on the employer’s manual classifications and risk level, the BWC will establish the savings percent. This discount can range anywhere from 1.4 to 26 percent for small deductible options and is applied to the employer’s standard premium.

An example for a mid-sized service company selecting a $5,000 deductible within the small deductible program:

• Payroll — $5,000,000.

• Individual premium — $460,000.

• Deductible discount savings — $32,000.

• Premium with discount — $428,000.

• Plus estimated deductible billing — $10,000.

• Net premium — $438,000.

• Net savings — $22,000.

In addition to this savings, deductible payments under the small deductible program will not be charged to the claim, therefore possibly reducing future rate calculations.

Savings reflected above do not include the additional savings that can be realized by also participating in programs compatible with either the small or large deductible program, such as the Go Green or Safety Council discounts.

Mark MaGinn is vice president at CompManagement, Inc. Reach him at (800) 825-6755, ext. 65868 or [email protected]

Save the date: Deductible Program enrollment for private employers ends April 30 for the 2013 policy year.

Insights Workers’ Compensation is brought to you by CompManagement, Inc.

 

 

Why Group Retrospective Rating may be a solution for your organization

Heather Vogus, vice president, Comp Management, Inc.

Over the past few years, many employers in Ohio have been looking at the Group Retrospective Program implemented in 2009 by the Ohio Bureau of Workers’ Compensation (BWC) as another option to garner savings when it comes to their workers’ compensation premium. Enrollment numbers have doubled each year, especially with employers that are of medium size and debit-rated by the BWC.

“If you are an employer in Ohio who has some claims in your experience — as accidents will happen — but also has a solid safety program in place, Group Retrospective Rating may be an option. Organizations that do not qualify for a Group Rating program or are seeing little savings from this program should consider Group Retrospective Rating as an alternative,” says Heather Vogus, vice president at CompManagement, Inc.

Group Retrospective Rating enrollment for private employers ends April 30 for the 2013 policy year.

Smart Business spoke with Vogus about the program and why it has the attention of businesses across Ohio.

What is Group Retrospective Rating? 

Group Retrospective Rating is a performance-based incentive program designed to recover a portion of premiums for employers that reduce injury rates and lower associated claims costs. It is similar in concept to Group Rating, as companies are grouped together to be rated as if the group was one big company. However, with this program, companies continue to pay their own individual premium but have the opportunity to receive retrospective premium adjustments, such as refunds or assessments, at the end of each of the three evaluation periods performed by the BWC.

How are groups evaluated by the BWC?

Three evaluations are performed by the BWC at 12, 24 and 36 months after the end of the policy year. At the end of each period, the BWC looks at the expected losses of the group and compares those to the actual losses to calculate the group’s Retrospective Premium. If the premium calculated is less than the group’s total Standard Premium, the participants receive a refund for that period. However, if the premium is greater, an assessment will be levied by the BWC, but each group limits the maximum assessment by selecting a premium cap that can be factored into your budget so that your organization is prepared. Before entering a program, be sure to have a feasibility study created to ensure this program fits the risk tolerance of your organization and has the ability to garner appropriate savings.

Why should my organization participate?

If your organization is committed to improving workplace safety and accident prevention, as well as taking action to reduce the frequency and severity of accidents involving your employees, this program has the ability to attain premium savings to boost your bottom line. The BWC has just released statistics showing that the 2009 private employer Group Retrospective Rating program has refunded a grand total of $12.4 million to date, for an average of $33,940 per employer.

How is the Group Retrospective savings projection calculated?

First, the overall group premium is calculated. As an example, suppose the Standard Premium for the group is $4 million and the Minimum Premium, assuming 25 percent, is $1 million. Add Developed Losses, which is incurred losses multiplied by the BWC developmental factor of  $1.4 million, and that equals the Retrospective Premium — the minimum premium plus developed losses — to give you $2.4 million.

The Group Retrospective Refund, which is the Standard Premium minus Retrospective Premium, is  $1.6 million, and the Estimated Refund Percentage is 40 percent.

Using the estimated refund percentage of 40 percent from the group example above, a mid-sized service company, assuming a payroll of $1 million, may expect:

• Individual Premiums of $62,500

• Group Retrospective Rating Premiums of $37,500

• Group Retrospective Rating Savings of  $25,000.

Savings reflected above do not include the additional savings that can be realized by also participating in programs compatible with Group Retrospective Rating such as Destination Excellence Go Green and Safety Council (participation rebate).

Heather Vogus is vice president at CompManagement, Inc. Reach her at (800) 825-6755, ext. 65440 or [email protected]

Insights Workers’ Compensation is brought to you by CompManagement, Inc.


 

How Group Rating allows employers to lower their premium expense

John Logue, vice president, CompManagement, Inc.

Across the country, every business continues to look for ways to save money and reduce operational expenses in order to reinvest in their people, technology and other business practices. Workers’ compensation premiums are one operational expense that may be reduced if your organization has implemented safe work practices and adopted claims management best practice techniques.

“If you are an employer in Ohio, there are many solutions available to you for discounted workers’ compensation premium. Group Rating remains one of the best programs available as a solution for your company with high discounts and program compatibility options,” says John Logue, vice president at CompManagement, Inc.

Smart Business spoke with Logue about why every employer in Ohio should review options for workers’ compensation discounts regardless of size.

What is Group Rating and why should my organization participate?

The Ohio Bureau of Workers’ Compensation (BWC) designed Group Rating in the early 1990s as an incentive program for those employers who establish and maintain safe working conditions. Employers with a better-than-average safety record and little if any claim costs pay at or below the base premium rates established by the BWC. The BWC looks at the group of employers and adjusts the rates as if the group was one big company, thus potentially giving employers much lower premium rates than they could attain on their own. Discounts typically range between 15 percent and the maximum discount available from BWC, which for policy year 2013 is 53 percent for private employers.

How are groups formed?

Third-party administrators (TPAs) that represent sponsoring organizations, such as trade associations and chambers of commerce, review an employer’s experience (current year and past four years). Once the employer has signed a Temporary Authorization to review their information, the TPA will review both the employer’s claim costs and payroll. Group participation is a year-to-year enrollment. If the employer’s experience meets the sponsor’s guidelines for the policy year, then they are invited to participate in the program. Many employers are already members of trade associations or chambers of commerce in their community, so it is worthwhile to investigate whether or not it includes this member benefit.

If eligible for Group Rating, what other programs should my organization consider?  

While participating in Group Rating, an employer may also earn additional discounts through Destination Excellence, Drug Free Safety Program and Safety Council, to name a few. Some of these programs include elements of things companies are already doing today, such as making payments online, paying on time, being active in local safety councils and reducing the frequency/severity of claims, and establishing drug-free workplace policies. An employer should contact the group sponsor’s program administrator to evaluate the multiple options and discount percentages allowed, as well as be informed of the different eligibility requirements and expectations to be met for continued participation in the programs.

How is the group savings projection calculated?

Group savings will differ between sponsor programs with those with larger groups offering more stability and accuracy in projected savings. It is very important to make sure that your organization provides the most current payroll information and any future budget impacts when comparing quotes between sponsoring organizations, as payroll, claim costs and industry are major factors in determining the premium for your organization.

An example of the potential savings for a mid-sized service company:

•  Payroll — $3,990,000

•  Individual discount — 16 percent

•  Individual premium — $14,683

•  Group discount — 53 percent

•  Group premium — $9,632

•  Group savings — $5,051

John Logue is vice president at CompManagement, Inc. Reach him at (800) 825-6755, ext 6574 or [email protected]

Save the date: Group Rating enrollment for private employers ends Feb. 28 for the 2013 policy year

Insights Workers’ Compensation is brought to you by CompManagement


How to reduce annual workers’ compensation premium through limiting claim costs

Nick Principe, vice president of claims, CompManagement, Inc.

The Ohio Bureau of Workers’ Compensation calculates an employer’s annual premium based on three factors: the employer’s industry, claim costs and payroll. In order to begin to control claim costs, organizations at a minimum should have written work rules that are enforced uniformly and consistently, implement best practices for injury reporting, and have written guidelines and procedures for supervisors to follow for proper injury investigation.

“One of the most important phases in the life of a claim starts at the very beginning, when the claim is first acknowledged,” says Nick Principe, vice president of claims at CompManagement, Inc. “Every organization should have policies in place for reporting injuries, investigating and documenting accidents, offering transitional duty and having ongoing communication with injured workers.”

Smart Business spoke with Principe about what all employers should be doing when a claim occurs in their workplace.

How do I know the difference between an injury and an incident?

An injury, or claim, is when an employee seeks outside treatment instead of onsite first aid, an accident report is completed and submitted to a supervisor instead of filing an incident report, and a supervisor investigates the ‘accident’ instead of a supervisor investigating the ‘incident’ or ‘near miss.’

What is key information to communicate to an employee prior to any injuries occurring?

Make sure all employees understand the reporting protocol, such as the time frame for reporting, who should complete an accident report and to whom it should be submitted, and whether failure to comply with the company policy could result in disciplinary action.

Failure to properly report injuries also results in loss of calendar and disability days and does not allow the employer to address workplace hazards that may exist.

How do I know if a claim is compensable in Ohio?

Ohio has a ‘no-fault’ workers’ compensation system, which means injuries are compensable regardless of negligence by any party. The only exceptions to this are when an injury results from drugs and/or alcohol; a self-inflicted injury, or an injury resulting in or arising from ‘horseplay.’ With a substantial aggravation or worsening of symptoms, a pre-existing condition can be considered compensable.

Should I always certify a claim?

Claim documentation should be reviewed to determine if, as the employer, you are in agreement with the injury description and each condition listed, and then the claim may be certified. The claim should be continually monitored to ensure that only appropriate medical benefits and compensation are being paid. A valid reason for not certifying a claim is always needed. Rejecting a valid claim only delays recovery time and may increase your workers’ compensation costs. If you believe the claim is invalid, information must be gathered to support rejection of the claim.

What are some key points an employer should look for when a new claim is filed to help with the certification decision?

• Injury reporting: Watch for lapses between the date of injury and the first notice to the employer. This could indicate that the injury occurred outside of the workplace.

• Timing of the injury: Watch for injuries reported prior to holidays or before/after the weekend. Some may view an injury as an opportunity to extend a holiday, weekend or take a vacation.

• Witness statements: Watch for injuries that have no witnesses or that contain conflicting statements. This can lead to credibility issues and opportunities to reject the merits of the incident.

• Accident descriptions are subjective or vague: Watch for accident descriptions that do not paint a clear picture of what happened. You should be able to visualize the accident and draw conclusions from the description. Be on the lookout for changes to statements or inconsistencies in recollection of the accident/injury.

• Work performance: Watch for injuries following disciplinary actions. These types of injuries are often retaliatory in nature and either lack the objective evidence to support them or can be viewed as self-inflicted.

• Multiple claims: Watch for injuries to similar body parts or claims filed around the same time of the year, for example, a reinjury to the same body part or a link to outside activities such as hunting season, sports or hobbies.

How can I prevent significant ongoing costs in a claim if one does occur?

One cost containment strategy that may be utilized is developing a transitional work program. Transitional work is a cost-containment strategy for workers’ compensation that helps injured workers return to productivity in the workplace by providing modified job duties that accommodate their medical restrictions due to work-related injuries. The idea is to return an injured employee to gainful employment activities as soon as possible to avoid the so-called ‘disability trap.’ With transitional work, the injured worker receives a full paycheck with the ultimate goal of returning to his/her original job. The advantages to implementing a transitional work program include a reduction in costs associated with long-term claims, improved productivity, lower injury downtime, improved employee recovery time, increase in employee morale and a protection of your work force investment, as the loss of experienced employees will result in additional training costs associated with hiring new employees.

NICK PRINCIPE is the vice president of claims for CompManagement, Inc. Reach him at (800) 825-6755, ext. 65819, or [email protected]

Insights Workers’ Compensation is brought to you by CompManagement, Inc.

How to reduce ultimate workers’ compensation spend through settlements and handicaps

Lisa O’Brien, Director of Rates and Underwriting Services, CompManagement, Inc.

Settlement of a claim and a handicap reimbursement award are two cost containment strategies available to employers to manage claim costs and impact annual premiums. A settlement fixes the claim cost, which then allows the premium to reflect the settlement amount and possibly reduce the employer’s premium. If a handicap award is granted, a portion of the costs of the claim will be charged to the Surplus Fund and not to the employer’s experience.

“By removing costs from an employer’s experience, an employer may be able to lower its annual premium rate calculated by the Ohio Bureau of Workers’ Compensation (BWC), thus reducing its annual spend,” says Lisa O’Brien, director of rates and underwriting services for CompManagement, Inc. “Employers should always review these two very effective cost containment strategies when managing their workers’ compensation claims to make an impact to their bottom line.”

Smart Business spoke with O’Brien about these cost containment options available to employers in Ohio.

What is a settlement?

A settlement is an agreement among the employer, the injured worker and the BWC for a specific amount to settle one or more workers’ compensation claims. All three parties must agree to the settlement amount before a claim can be settled either in full, which settles all allowed conditions and benefits, or a partial settlement, which settles only certain conditions and/or benefits, either medical or indemnity (compensation).

What happens when a claim is settled?

When a claim is settled, the injured worker will receive a lump sum payment from the BWC.  Settlement affords injured workers the freedom to manage their treatment priorities, on their timeline and on their schedule.

If the claim is settled for both the indemnity and medical portions, the injured worker will receive no additional compensation or medical benefits in the settled claim. If the claim is settled for either medical only or indemnity only, the injured worker can no longer receive the benefit type that has been settled (either medical or indemnity).

For employers, settlement can help manage costs and bring closure to a claim for their employee. Settling the claim removes reserves (indemnity, medical or both depending on the type of settlement) associated with the claim from all future rate-making. However, costs already paid out, plus the settlement amount, will continue to be charged to and impact the employer’s premium rate.

When will a settlement impact the employer’s premium?

Settlement of a claim will affect an employer’s premium rate only going forward. In order for a settlement to be included in the employer’s upcoming year’s rate, the fully executed settlement application (signed by both the employer and the injured worker) must be filed by May 15 for public employers or by Oct. 15 for private, state-funded employers.

These deadlines do not apply for settlements that occur through the court of common pleas. Common pleas settlement inclusions in the employer’s experience are based on the date the settlement is paid.

For a court of common pleas settlement to be included in an employer’s upcoming rates, the settlement must be paid to the injured worker before the applicable survey date, June 30 for public employers and Dec. 31 for private employers.

 

What is a handicap reimbursement?

The BWC encourages employers to hire and retain employees with handicapped conditions. To help offset the challenges those with handicaps often experience in the job market, the BWC offers the Handicap Reimbursement program as a means for employers to reduce their claim costs. Ohio law defines a handicapped employee as one who has a physical or mental impairment, whether congenital or due to injury or disease, whose impairment jeopardizes the person’s ability to obtain employment or re-employment. Also, the impairment must be due to one of the 25 eligible diseases or conditions that Ohio law recognizes.

The most commonly recognized conditions are arthritis, ankylosis, diabetes, cardiac disease and epilepsy.

When should an employer file an application for handicap reimbursement?

If an injured worker suffers a lost-time claim (eight or more days away from work) and a handicap condition is met, the employer can file a CHP-4 application with the BWC requesting reimbursement of claim costs charged. The employer must show the handicap is a pre-existing condition (prior to the date of injury) and that it either caused the claim or contributed to increased costs or a delay in recovery. Applications are reviewed and awards are granted by the BWC’s Legal Operations Department. Once awarded, the BWC will apply the handicap reimbursement award to chargeable claim costs, thereby reducing costs and possibly premium rates.

Private, state-funded employers must file handicap reimbursement applications by June 30 of the calendar year no more than six years from the year of the date of injury. Public employers must file handicap reimbursement applications by Dec. 31 of the year no more than five years from the year of the date of injury.

Claims with a handicap reimbursement can be settled and settled claims can continue to be considered for handicap reimbursement.

What is the typical range of handicap reimbursements awarded?

Per BWC public information, handicap reimbursements typically range between 5 and 100 percent, depending on the degree to which the handicap condition impacts the claim. On average, current public information shows a handicap award to be approximately 26.17 percent.

Lisa O’Brien is the director of rates and underwriting services for CompManagement, Inc. Reach her at (800) 825-6755, ext. 65441, or [email protected]

Insights Workers’ Compensation is brought to you by CompManagement

Transitional work grants available for employers in Ohio

Randy Jones, Senior Vice President, TPA Operations, CompManagement, Inc.

As an employer, does your organization have departments with tasks or duties that never seem to get done? If you are like many employers in Ohio, the answer to this question is yes.

One possible solution to create a win-win scenario for both your organization and your injured workers is to consider implementing a transitional work program with the assistance of grants offered by the Ohio Bureau of Workers’ Compensation (BWC). Transitional work is a cost containment strategy for workers’ compensation that helps injured workers return to productivity in the workplace by providing modified job duties that accommodate their medical restrictions due to work-related injuries.  In turn, the employer reduces the costs associated with long-term claims and improves overall company productivity.

“Implementing a transitional work program is an ideal way to keep injured workers engaged in their employment and assist them with their income stream,” says Randy Jones, senior vice president, TPA Operations for CompManagement, Inc. “But it also offers the employer an alternative to downtime, the retention of knowledgeable and experience employees, and lower premium costs by preventing a loss in wages and payment of compensation by BWC.”

Smart Business spoke with Jones about the monies that are now available for your business in Ohio.

Who is eligible to receive a grant?

All active employers, both public and private, participating in the state-funded workers’ compensation program are eligible for the grant. Self-insured employers and state agencies are not eligible.

An employer must also be current with respect to all payments due to the BWC and have no cumulative lapses in coverage in excess of 40 days within the 12 months preceding the application date. Employers that received a transitional work grant through the BWC’s prior program from 2001 to 2006 will not be eligible for a new grant but will be eligible for a performance bonus. Employers that may have an existing transitional work program without use of a prior grant are also eligible only for a performance bonus after their current program is reviewed and approved by BWC.

Why should my organization apply for this grant and implement a transitional work program?

A transitional work program provides an alternative to lost time and allows an employer to minimize workers’ compensation disability costs associated with lost work days, compensation, and reserves. Often with minor modification in job duties or hours, an employee is able to return to work following an injury. The idea is to return an injured employee to gainful employment activities as soon as possible to avoid the so-called ‘disability trap.’

Injured workers receive a full paycheck, with the goal of returning to their original job. The advantages include a reduction in costs associated with long-term claims, improved productivity, lower injury downtime, improved employee recovery time, increases in employee morale and a protection of your work force investment, as the loss of experienced employees will result in costs associated with hiring new employees.

How is the amount of the grant determined?

BWC determines the amount of the grant based on employer size and the complexity of services needed for transitional work.  Factors include the employer’s payroll, job classifications, job analyses needed and collective bargaining units.

How does the application for grant monies work?

Applications are received and reviewed by BWC. The application form is available on its website at www.ohiobwc.com. Key components will include policies and procedures, job analyses, program evaluation criteria, medical provider listing and employee education.

Who can develop a transitional work program for my organization?

Transitional work developers certified to participate in the Health Partnership Program as a vocational rehabilitation case manager, occupational therapist or a physical therapist can assist your organization.  Your developer of choice must also complete BWC-sponsored transitional work development training prior to delivering programs and have verified experience in developing programs or verified mentoring experience according to BWC’s transitional work policy.

Any costs associated with a transitional work developer preparing and submitting a proposal to an employer are not reimbursable under the grant.

Can my organization receive additional monies for participation?

A separate application may be filed to receive a performance bonus of up to 10 percent. The calculation occurs at six months following the end of the applicable policy year (June 30 for private employers, Dec. 31 for public) and is dependent on the number of eligible claims and successful use of the program.

All claims with injury dates within the applicable policy year will be evaluated to determine how many had the potential for transitional work services and how many of those actually utilized those services. Say an employer had 12 claims during the policy year and 10 met the requirements for transitional work. Of those 10, five injured workers were offered and accepted transitional work services. Because 50 percent of eligible claims were helped by transitional work, the employer would receive 50 percent of the possible 10 percent bonus, which equals 5 percent.

Are there deadlines for applying for the grant?

There is no deadline for applying for the grant, but there is for the performance bonus. For private employers the deadline is the last business day of April; for public employers it is the last business day of October.

Randy Jones is the senior vice president of TPA Operations for CompManagement, Inc. Reach him at (800) 825-6755, ext. 65466, or [email protected]

Insights Workers’ Compensation is brought to you by CompManagement, Inc.