Policy Name:	Self-Insured Professional Employer Organization  Client and Claims Reporting Requirements
Policy #:	SI-16-01
Code/Rule Reference:	Ohio Administrative Code (OAC) 4123-17-15.5 (B)(6), 4123-17-15.7(B)(5), 4123-19-06 & 4123-19-08
Effective Date:	August 1, 2015
Origin:	Self-Insured Department/Employer Services
Supersedes:	N/A
History:	New
Review Date:	August 1, 2020

 

I.                Policy Purpose

This policy defines the responsibilities of a Self-Insured Professional Employer Organization to provide the BWC Self-Insured department a quarterly report listing active client employer relationships and worker’s compensation claims.

II.              Applicability

This policy applies to Self-Insured Professional Employer Organizations and the BWC SI department.

III.             Definitions

A.    SI: Self Insured.

B.    SI Employer: Self-Insuring Employer.

C.    SI-PEO: Professional Employer Organization that has been granted the privilege to self-insure for workers’ compensation purposes.

D.    Client Employer: Employer with an active State Insurance Fund policy that has been approved to participate in a PEO agreement with a SI-PEO.

E.    PEO Lease Agreement: Written contract between a professional employer organization (SI-PEO) and a client employer for duration of not less than twelve (12) months.

F.     UA-3SI: Self-Insured Professional Employer Organization (SI-PEO) Client Relationship Notification.

IV.            Policy

A.    Pursuant to OAC 4123-17-15.5 (B)(6), a SI-PEO is required to report on a quarterly basis to the SI department information detailing active client employer relationships and claim liabilities associated with the self-insured policy.

 

B.    A SI-PEO must submit the quarterly report within 10 calendar days from the end of each quarter.

1.     Quarterly reports must be emailed to the SI department at SIINQ@bwc.state.oh.us.

2.     The SI department will request quarterly reports from the SI-PEO, via email, fourteen (14) days prior to the end of each quarter (March 31, June 30, September 30, December 31).

 

C.    A SI-PEO that does not submit the required quarterly report may be subject to revocation of its PEO status pursuant to OAC 4123-17-15.7 (B)(5) or non-renewal or revocation of its self-insured status pursuant to OAC 4123-19-06 and 4123-19-08.

 

D.    A SI-PEO must report all active client employers, as of the end of the current quarter, and include the following information as part of the client employer report:

1.     PEO name;

2.     PEO policy number;

3.     PEO contact information;

4.     Client employer name;

5.     State fund policy number of client;

6.     Effective date of PEO relationship with client;

7.     Type of lease agreement: all under PEO policy or all under client policy.

 

E.    The SI-PEO must report all claims associated with the self-insurance policy, as of the end of the each quarter. This includes:

1.     A claim incurred, on or after the effective date of self-insurance, by the SI-PEO or any other approved entity operating as part of the self-insured policy, where the self-insured policy is the employer of record.

2.     Any claim incurred by a client employer, on or after the effective date of the PEO agreement, where the SI-PEO policy is the employer of record.

a.     If the PEO agreement has been approved as “Full Client Reporting”, claims incurred during the effective dates of the PEO agreement should not be included on the quarterly report.

 

F.     Claims should be listed individually and the following information is required as part of the claims report:

1.     BWC claim number;

2.     Injured worker first and last name;

3.     Injured worker social security number;

4.     Date of injury;

5.     Total paid medical;

6.     Total paid indemnity;

7.     Total case reserves.

a.     Case reserves must consider the total outstanding liability for the life of the claim.

b.     Upon request by the SI department, claim costs and reserves must be validated by an independent actuarial report.

 

G.    The quarterly claims report will be reviewed to determine the appropriate security requirements for a PEO.

1.     Pursuant to the Self-Insured Employer Securitization Requirements Policy, a SI-PEO is required to provide security of at least 100% of current claim case reserves.

2.     The security requirement for a SI-PEO may be adjusted if the reported case reserves change by more than 10% from the previous quarter.

3.     A SI-PEO may appeal a request for additional security within 14 days of the request pursuant to the Self-Insured Resolution of Complaints Policy.

a.     If no appeal is filed, a SI-PEO will be required to provide additional security within 30 days of the receipt of a written request made by the BWC SI department.

 

H.    The quarterly client report will be reviewed to verify existing PEO/client relationships and type of lease. The SI department will reconcile all information against its records and notify the SI-PEO if a discrepancy exists. Discrepancies to be reconciled include:

1.     A PEO/client relationship that is not reflected in BWC records.

a.     The PEO must provide a copy of the UA-3SI PEO/Client Relationship notification and email confirmation reflecting timely submission of the lease relationship.

b.     If the requested record confirms the relationship, the SI department will recognize the agreement and effective date indicated on the UA-3SI.

a.     If unable to provide record of timely submission of the UA-3SI, the PEO will be required to submit a new UA-3SI and BWC will determine the effective date.

                                  i.         All payroll and claims remain the responsibility of the state funded employer up to the effective date determined by the SI department as indicated in the Self-Insured Professional Employer Organization Client Relationship Notification Policy.

2.     The PEO does not include a client relationship on its report and BWC records indicate a PEO/client relationship exists.

a.     The PEO must provide a copy of a UA-3SI PEO/Client Relationship Termination notification and email confirmation reflecting timely submission of the lease termination.

b.     If the requested record confirms termination of the PEO/client relationship, the SI department will recognize the effective date indicated on the UA-3SI.

c.     If unable to provide record of timely submission of the UA-3SI, the PEO will be required to submit a new UA-3SI termination notification and BWC will determine the effective date.

                                           i.         All claims incurred up to the PEO/client relationship termination effective date remain the responsibility of the SI-PEO as indicated in the Self-Insured Professional Employer Organization Client Relationship Notification Policy.

3.     The PEO report lists the lease type as “all under PEO policy or all under client policy” and it conflicts with the BWC UA-3SI record.

a.     The PEO must provide a copy of a UA-3SI Lease Change notification and email confirmation reflecting timely submission of the lease change.

b.     If the requested record confirms the lease type change, the SI department will recognize the effective date indicated on the UA-3SI.

c.     If unable to provide record of timely submission of the UA-3SI, the PEO will be required to submit a new UA-3SI lease change and BWC will determine the effective date.

                                           i.         If the lease type was All under PEO policy, all claims incurred up to the effective date of the lease type change remain the responsibility of the SI-PEO.

                                         ii.         If the lease type was all under client policy, all payroll and claims remain the responsibility of the state funded employer up to the effective date of the lease type change.

VI.        Resolution of Complaints

A.    Any complaints or disputes related to this policy must be submitted in writing to the SI department via mail or email as detailed in the Self-Insured Resolution of Complaints Policy.

Ohio Bureau of Workers’ Compensation

Attn. Self-Insured Department

30 W. Spring St., 22nd Floor

Columbus, Ohio 43215-2256

Email: SIINQ@bwc.state.oh.us.

B.    The SI department will issue a formal written response to any complaint. If the complaint is not resolved as a result of the formal response issued by the SI department, a written request that the issue be referred to the Self-Insured Review Panel (SIRP) may be submitted by the SI employer or SI-PEO.