Workers’ Compensation Questions and Answers
1. Workers’ Compensation alternatives The Ohio Bureau of Workers’ Compensation permits several alternative premium payment programs for individual employers. While larger companies (generally 500 or more employees) may choose to be self-insured, small to moderate size organizations must pay premiums to the Ohio State Insurance Fund operated by Ohio Bureau of Workers’ Compensation. Small and moderate size businesses, however, do have some alternatives when it comes to workers’ compensation. These employers may select one of the following rating programs: 1.) Individual base/merit rating; 2.) Individual retrospective rating; or 3.) Group rating. Group rating plans offer favorable rates for employers. 2. What is Group Rating? Ohio Bureau of Workers’ Compensation permits employers with better-thanaverage claim histories to join together through a sponsoring organization for the purpose of being rated as a larger group. By participating in the group rating plan, employers enjoy a much lower premium rate than they could achieve independently. 3. How can My Company Determine the Value of Group Enrollment? Comprehensive Risk Management (CRM), the group plan administrator, provides employers with a no-obligation estimate that outlines the potential saving a group rating plan offers. Each year beginning in March, CRM distributes AC-3 FORMS To interested employers. By signing this form, you authorize CRM to obtain your organization’s loss history from the state and assemble an analysis of your projected group rating plan savings. The analysis will be sent to you for your review. Completing and returning the AC-3FORM does not obligate you in any way to join a group. After receiving and reviewing the analysis, you have the opportunity to complete enrollment forms. 4. What if My Company is Already in Another Group? Even if your company is currently a member of a different group, you can obtain a comparative analysis from Comprehensive Risk Management. However, you may enroll in only one group per year. You are permitted to switch plans on an annual basis by completing an AC-26 Application for Group Rating for the group you wish to join. For more information or assistance in your transition to a CRM group, please contact our Group Rating Dept (216) 901-0066
5. How Much Can My Company Save? Groups administered by Comprehensive Risk Management have realized saving between 40% and 90% on individual company premiums. No two group rating plans offer the same savings, and the actual savings a group experiences are dependent upon the type of business, final loss figures, enrollment, and reported payroll of participating individual members. Study estimates are based on the most recent loss information available and are developed conservatively. Because statewide rules dictate that group enrollment must occur six months before Ohio Bureau of Workers’ Compensation publishes the actual group rate, no group program can guarantee the final savings. 6. What is the Enrollment Process? All group programs follow the same approximate time table. The enrollment process consists of completing a study authorization, receiving an estimate of potential savings, and completing an enrollment application FORM AC-26 and contract prior to January 31. March-July July-August Employer completes study authorization AC-3 New rates are released by BWC Group Administrator reviews and performs study
October-November Group administrator mails study results with Enrollment application to employer January 1 CRM Claim Management Service begins Procedures manuals mailed to all group members BWC’s enrollment deadline New group payroll rate effective Reduced premiums payable February 2007 and August 2007
January 31 July 1
7. Will I Receive Any Additional Services by Enrolling in the Group Program? Yes---Administration. While your organization retains its individual risk account and ability to decide on its own claims, Comprehensive Risk Management provides cost control services and will work with you in administering your program. CRM’s team of specialized representatives is available to assist with any workers’ compensation problems including legal representation at scheduled hearings and assisting you in
improving your safety practices. A full outline of available services is provided with the group analysis. Yes----Managed Care Organization. Ohio Bureau of Workers’ Compensation requires employers to select a Managed Care Organization (MCO). Your group plan sponsor may recommend an MCO, but the sponsor cannot require you to select any particular MCO as a prerequisite for participating in the group rating plan. No additional cost is required to enroll with the Managed Care Organization. An MCO’s revenues are paid a percentage of employer premiums. 8. General Comments The decision to participate in a group plan is made annually. An existing participant must notify CRM each year to continue enrollment. Should an individual member leave the group either voluntarily or because of poor history, the individual company will be rated based upon its own claim history as is the current practice. You must return all requested information to Comprehensive Risk Management to enroll. The applications will be filed in January and reviewed by Ohio Bureau of Workers’ Compensation to ensure compliance with specific Bureau rules. 9. Ohio Bureau of Workers’ Compensation Rules and Regulations In addition to acceptance into the group, each employer must maintain an account in good standing with Ohio Bureau of Workers’ Compensation:
Any outstanding premium balances, assessments or partial payment plan amounts must be paid in full by January 31 unless a written protest of the balance has been filed with Ohio Bureau of Workers’ Compensation prior to the application date. Applicants must not have cumulative coverage lapses of more than 59 days within the 18 months preceding the January 31 application deadline. Coverage must be active and in effect as of July 1. 2007. The formation of the group must improve claims handling procedures and accident prevention. All group participants must agree to improve both safety practices and claims management via procedures established by the group.
IMPORTANT: An individual company may not enroll in more than one group plan. Ohio Bureau of Workers’ Compensation can reject those who join more than one group plan.
10. What Does it Cost to Join a Group? Upon enrollment in a group, you must pay administrative fees. These fees are calculated based upon the projected savings. The amount you pay covers claims management services for the period beginning in January and is for professional services provided by the plan administrator. Legal representation is included (whenever needed) until the case goes into the Court of Common Pleas. This means that CRM incurs all attorney costs at the District Hearing, Staff Hearing, and Industrial Commission Hearing Levels. Additionally, plan participants must be members in good standing of the sponsoring organization and agree to remit dues to the association according to its by-laws.
Comprehensive Risk Management Comprehensive Risk Management specializes in the area of workers’ compensation claims control, aggressively representing employers in all matters before Ohio Bureau of Workers’ Compensation and Industrial Commission of Ohio, while using attorneys instead of hearing representatives at NO additional cost to you. Comprehensive Risk Management is the only company in the state of Ohio whose registered representative is a law firm. United States Supreme Court dictates that only lawyers may cite statutes and case law, and cross-examine witnesses at court hearings. In addition, CRM’s experienced claims staff and our access to advanced computer capabilities including on line links to Oho Bureau of Workers’ Compensation allow Comprehensive Risk Management to effectively assist in managing your fees as well as your claims.