OhioBWC - Basics: (Policy library) - File

                               

Policy Name:

One Claim Program (OCP)

Policy #:

EP-15-01

Code/Rule Reference

ORC 4123.29(A)(4)(e); and OAC 4123-17-05.1, Appendix A; 4123-17-16; 4123-17-33.1, Appendix A; 4123-17-71; 4123-17-74, Appendices A, B, and C.

Effective Date:

July 1, 2023

Approved:

Rex Blateri, Chief of Employer Services

Origin:

Employer Policy

Supersedes:

All policies and procedures regarding the OCP that predate the effective date of this policy.

History:

Revised: January 4, 2024; August 12, 2021; August 20, 2020; May 15, 2018; August 8, 2016; December 7, 2015; April 6, 2015; July 3, 2012.

Review Date:

July 1, 2028

 

I.       Policy Purpose

 

The Ohio Bureau of Workers’ Compensation (BWC) provides a program to lessen the impact of a significant claim that comes into an employer’s experience. BWC permits such employers to participate in the One Claim Program (OCP) as outlined in all applicable laws and rules.

II.     Applicability

This policy applies to employers, authorized representatives, BWC Employer Programs, and Employer Management Services.

III.   Definitions

A.      Industry-specific training course: Safety course specifically identified by BWC as applicable to a specific industry group. Private employer industry groups are identified in OAC 4123-17-05, Table 1, Part A. Industry-specific safety courses are listed in the Division of Safety & Hygiene (DSH) Safety Services Catalog.

B.      Minor claim: A medical-only or lost-time claim whose total value or maximum claim value, whichever is lower, will be less than the employer’s total limited losses (TLL) as defined in OAC 4123-17-03, subject to the TLL provisions of a significant claim that became effective July 1, 2020.

C.      One Claim Program (OCP): BWC’s voluntary rate program which offers a private employer (PA employer) or a public employer taxing district employer (PEC employer) the opportunity to mitigate the impact of a significant claim entering the employer’s experience for the first time.

D.     Online safety training class: Training course offered by the DSH through the Internet (as opposed to a classroom course).

E.      Program eligibility period: The four policy years in which an employer has a significant claim in its experience period.

F.      Significant claim: A claim whose total value or maximum claim value, whichever is lower, will be greater than the employer’s TLL as defined in OAC 4123-17-03. Effective July 1, 2020, for PA employers whose expected losses fall below the minimum expected loss provided in OAC 4123-17-05.1, Appendix A, a TLL of $300 shall be used; for PEC employers whose expected losses fall below the minimum expected loss provided in OAC 4123-17-33.1, Appendix A, a TLL of $550 shall be used. Once a claim has been designated as the significant claim, that designation cannot be changed during the program eligibility period.

G.     Total limited losses (TLL): Total expected losses for an employer multiplied by the limited loss ratio. Total expected losses are determined by applying expected loss rate to the payroll of each classification in the employer’s experience period. See OAC 4123-17-03.

IV.   Policy

A.      Eligibility requirements. As of the initial application deadline, the employer must be enrolled in the Group Experience Rating Program. At the time of initial application and each renewal application, the employer must:

1.      Be current with respect to all payments due BWC, as defined in OAC 4123-17-14;

2.      Be current on the payment schedule of any part-pay agreement into which it has entered for the payment of premiums or assessments;

3.      Not have cumulative lapses in workers’ compensation coverage in excess of forty (40) days within the prior twelve (12) months; and

4.      Report actual payroll for the preceding policy year and pay any premium due upon reconciliation of estimated premium and actual premium for that policy year no later than the application deadline set forth in OAC 4123-17-74. See the Payroll True-Up policy for additional information.

B.      Application requirements and BWC evaluation of application.

1.      BWC will automatically identify and send notice to employers of their initial and continuing eligibility for the OCP.

2.      BWC has the final authority to approve participation.

3.      The employer must complete and submit the Application for One Claim Program (OCP-1) to request participation in the OCP for each year of the program eligibility period.

4.      The OCP-1 must be signed by the Chief Executive Officer or designated management representative of the employer.

5.      Application deadlines:

a.      For a PA employer, the application must be filed by the last business day of January preceding the policy year beginning July 1.

b.      For a PEC employer, the application must be filed by the last business day of July preceding the policy beginning January 1.

c.       If the application is received after the application deadline, BWC will reject the application and notify the employer by letter.

6.      An employer may participate in the OCP for a maximum of four years in which the employer has a significant claim in its experience period.

7.      BWC will evaluate the employer’s eligibility each year of the program eligibility period and provide a renewal application.

C.      General program requirements.

1.      In signing the application form, the chief executive officer, or designated management representative of the employer, is certifying to BWC that the employer will comply with all program requirements.

2.      The employer may have a maximum of three minor claims at any time, in addition to the one significant claim, in the employer's experience period.

a.      As a minor claim exits the employer's experience period, the employer may include a new minor claim.

b.      The combined total costs of the three minor claims must be below the employer's TLL.

3.      The employer may participate in the OCP with no more than one significant claim within the program eligibility period from the date of the employer's initial participation in the program.

4.      Once a claim has been designated as the significant claim in initial enrollment, the employer is not permitted to change this designation during the program eligibility period.

5.      Settled and subrogated claims are included in the employer's total claim count.

6.      The employer must meet training requirements outlined in section IV.D below.

D.     Training requirements.

1.      Employers must complete training requirements by the following deadlines:

a.      For PA employers, the last business day of March of the policy year.

b.      For PEC employers, the last business day of September of the policy year.

2.      The employer must meet safety requirements as prescribed by the DSH.

3.      During each policy year of the program eligibility period,  participants must attend or complete any one of the following offered by the DSH:

a.      One half-day in-person classroom course;

b.      Three hours of e-courses;

c.       Three one-hour in-person training sessions at the All-Ohio Safety Congress and Expo;

d.      Three one-hour webinars; or

e.      One half-day virtual training class.

4.      Training requirements must be satisfied by the employer on a policy number basis because each policy number is considered a separate entity.

E.      Operation of program.

1.      BWC will credit the employer with a discount from the employer's base rate as follows:

a.      For the first year of the program eligibility period, a 20% discount (EM = 0.80);

b.      For the second year of the program eligibility period, a 15% discount (EM = 0.85);

c.       For the third year of the program eligibility period, a 10% discount (EM = 0.90); and

d.      For the fourth year of the program eligibility period, a 5% discount (EM = 0.95).

2.      The discount is only applied to the premium rate including administrative costs, not to the Disabled Workers' Relief Fund (DWRF). DWRF is calculated by strictly using the base rate.

3.      Since the OCP rate is a fixed discount rate that cannot be changed, no adjustments will be applied to the employer's account. For example, if an employer has a 90% disability relief on a claim during the time the employer is in the program, the disability relief will not be applied to the OCP discount.

4.      An employer participating in the OCP may participate in other compatible BWC discount programs during its participation in the OCP as outlined in OAC 4123-17-74, Appendix C.

F.      Removal/exit from program.

1.      BWC will remove an employer from participation in the OCP at the beginning of the next policy year and, upon removal, will return the employer to its individual EM if the employer:

a.      Fails to meet all eligibility and general requirements of the OCP set forth in OAC 4123-17-71(C) and (D);

b.      Has more than four claims in its experience period;

c.       Has more than one significant claim in its experience period;

d.      Has combined claims costs of the three minor claims exceed the employer's TLL; or

e.      Did not complete the required training.

2.      An employer removed from OCP for failure to report actual payroll for the preceding policy year and pay any premium that is due upon reconciliation of estimated premium with actual premium will be rerated for the current policy year at the employer's base rate, or experience modified rate, as determined by the employer's expected losses for the policy year.

3.      BWC will notify an employer by letter when a requirement is not met and give justification for removal.

4.      An employer may withdraw from the program at any time by notifying BWC in writing.

a.      An employer that withdraws from the OCP during the policy year will be reassigned its individual experience modifier for the entire policy year.

b.      If an employer withdraws from the program and has any remaining years in the program eligibility period, the employer may reapply for the OCP using the same significant claim as its one designated claim. For example, an employer enrolls in OCP for the first year, and then withdraws the second year. The employer may reapply for the third, or any subsequent, year remaining on its original program eligibility period.

G.     Resolution of complaints.

1.      Employer complaints are processed under the General Employer Complaint Policy.

2.      Specific extenuating circumstances that apply to the OCP.

a.      Circumstance involving employer's denial into the OCP as a result of not meeting the claim eligibility requirements.

i.        Extenuating Circumstance. Employer protests the eligibility criteria for participating in the OCP. Situations falling under this scenario may include the following:

a)      Claims assigned to wrong risk;

b)     Claims originally allowed, reversed on appeal, and not updated to disallowed status; or

c)      Claims costs exceeding TLL due to payments made in error.

ii.      Supporting documentation may include, but is not limited to, BWC or IC orders detailing reversals of previous claim decisions that specifically impact the employers' general program requirements.

b.      Circumstance involving an employer's policy that is fully combined into a successor's policy where the predecessor policy was enrolled in the OCP with eligibility years remaining in the program.

i.        Extenuating Circumstance. The successor policy desires to maintain eligibility and retain the discount. The successor may be granted OCP participation provided all criteria for program eligibility are met.

ii.      Supporting documentation: Documentation showing the predecessor policy completed all requirements for policy years in which it actively participated in the OCP.

iii.    The following conditions must be met for the employer's request to be granted:

a)      The total combined number and types of claims from the predecessor, and the successor, must meet the claim requirement for participation in the OCP.

b)     The successor policy is not participating in any other BWC program that is incompatible with OCP.

c)      Depending on the effective date of the combination, BWC will either:

i)        Require the successor to file an OCP-1; or

ii)      Use the predecessor's OCP-1 to transfer program participation to the successor.       

iv.     The successor policy will be granted the OCP discount effective with the start of the next applicable policy year. The predecessor will receive the OCP discount through the end of the policy year in which the combination took place, and the successor will receive the discount beginning with the start of the next policy year. The successor policy discount is only for the remaining years of the original program.

H.     Scenarios.

1.      An employer attends two local safety council seminars lasting two hours each and believes that satisfies the requirement for one training course for the OCP. Are these seminars valid?

Answer: No, safety council meetings are not considered DSH-sponsored training courses. An employer must attend, depending on year of participation, a DSH sponsored course, online class, or attend the All-Ohio Safety Congress & Expo.

2.      An employer has two significant claims and two minor claims but settles one of the significant claims. Is the employer now eligible for the OCP?

Answer: No. Settled claims are included in the claim count. The employer still has two significant claims on its record.