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OhioBWC - Basics: (Policy library) - File

Policy Name:

Changing the Employer and/or Policy Number after Initial Determination

Policy #:

CP-03-01

Code/Rule Reference:

R.C. 4123.01

O. A.C. 4123-3-08 and 4123-17-15

Effective Date:

07/13/15

Approved:

Rick Percy, Chief of Operational Policy, Analytics & Compliance (Signature on File)

Origin:

Claims Policy

Supersedes:

Changing the Employer and/or Policy Number after Initial Determination policy number CP-03-01 dated 06/17/14

History:

New 06/17/14; Rev. 07/13/15

Review date:

07/13/20

 

 

I. POLICY PURPOSE

 

The purpose of this policy is to ensure that the Ohio Bureau of Workers’ Compensation (BWC) determines the correct employer of record and/or policy number for each claim via a comprehensive investigation when BWC receives information after the initial determination of the claim suggesting that the employer of record and/or policy number assigned during the initial determination of a claim is incorrect.

 

II. APPLICABILITY

 

This policy applies to BWC Field Operations staff and Employer Services staff.

 

III. DEFINITIONS

 

Assigned Employer: The entity that is designated as the employer of record during the initial determination.  

 

Employer:  Includes, but is not limited to, the following, as defined in R.C. 4123.01: 

·         The state, including state hospitals, each county, municipal corporation, township, school district, and hospital owned by a political subdivision or subdivisions other than the state;

·         A person, firm, professional employer organization, and private corporation, including any public service corporation, that (a) has in service one or more employees or shared employees regularly in the same business or in or about the same establishment under any contract of hire, express or implied, oral or written, or (b) is bound by any such contract of hire or by any other written contract, to pay into the insurance fund the premiums as provided by law.

 

Professional Employer Organization (PEO):  A sole proprietor, partnership, association, limited liability company or corporation that enters into an agreement with one or more client-employers for the purpose of co-employing all or part of the client-employer’s work force at the client-employer’s work site. This does not include a temporary service agency.

 

Potential Employer:  The entity that is likely to be designated as the employer of record following an investigation of the employer and/or policy number after the initial determination; typically not the employer assigned to a claim at initial determination.  

 

IV. POLICY

A.    Upon receipt of a written request with supporting documentation to change the employer, it is BWC’s policy to investigate the assignment of the employer of record, including policy number, to determine if the employer assignment and/or policy number is correct, and issue an order or refer to the Industrial Commission of Ohio (IC) for determination.

1.    If the assigned employer contests assignment of the claim in writing, but fails to submit supporting evidence, the employer has the following number of days to submit supporting evidence following notice from BWC:

a.    Five (5) calendar days when contacted by phone; or

b.    Ten (10) calendar days when contacted by mail.

2.    If the assigned employer fails to timely submit supporting evidence, BWC will dismiss the request to consider reassignment of the claim.

      

B.    It is BWC’s policy to issue an order for claim reassignment when:

1.    A request to change employer assignment is submitted in writing with supporting evidence; and

a.     The IC has not ruled on the initial claim determination/correct employer (The issue of correct employer is included in the initial claim determination);

b.    The claim has not been to a hearing; and

c.    The assigned employer and the potential employer agree to the reassignment of a claim.

2.    BWC’s Self-Insured (SI) Department finds that a claim should be assigned to a SI PEO.

 

C.   It is BWC’s policy to send a copy of the claim-reassignment order to the following entities to serve as notice that the assigned employer is being corrected and the claim in question will not be designated to the employer assigned to the claim during initial determination:

1.    The IW;

2.    The newly assigned employer;

3.    The employer assigned to the claim during initial determination (NOTE:  Central Claims/Medical Claims will send a letter to the employer assigned to the claim during initial determination the day before sending the order.  The employer assigned during initial determination will not receive a copy of the claim-reassignment order.);

4.    The managed care organization of the employer assigned to the claim during initial determination (NOTE:  Central Claims/Medical Claims will send a letter to the MCO of the employer assigned to the claim during initial determination the day before sending the order.  The MCO of the employer assigned during initial determination will not receive a copy of the claim-reassignment order.); and

5.    Any authorized representative(s) for the above-named parties, including any authorized representative(s) for the employer assigned to the claim during initial determination, as listed in BWC’s initial determination order (NOTE:  Central Claims/Medical Claims will send a letter to any authorized representative(s) of the employer assigned to the claim during initial determination the day before sending the order.  Any authorized representative(s) of the employer assigned during initial determination will not receive a copy of the claim-reassignment order.).

 

D.   It is BWC’s policy to refer an employer-assignment issue to the IC by Notice of Referral when:

1.    The assigned employer contests assignment of the claim in writing and with supporting evidence, but the potential employer objects to assignment of the claim;

2.    The assigned employer disputes assignment of a claim in writing and with supporting evidence after the claim has gone to a hearing;

3.    The IC has already ruled on the initial claim determination/correct employer (The issue of correct employer is included in the initial claim determination); or

4.    BWC does not agree with the request for change. 

 

E.    When BWC receives a written request with supporting documentation to change the employer in the claim from an SF employer to an SI employer or change the employer in the claim from an SI employer to an SF employer:

1.    It is BWC’s policy to:

a.    Investigate the request to change employer assignment to determine if the change is appropriate;

b.    Contact the employers to seek agreement to the change; and

c.    Issue a claim-reassignment order once the investigation reveals the change is appropriate and both employers agree. 

2.    It is BWC’s policy to refer the issue to the SI Department to request additional investigation when:

a.    The employers do not agree to the change of employer; or

b.    BWC determines that the change of employer is not appropriate.  

 

F.    It is BWC’s policy to change an employer from an SI employer to another SI employer when:

1.    A request is submitted in writing with supporting documentation;

2.    BWC agrees to the change; and

3.    The employers agree to the change.      

 

 

BWC staff may refer to the corresponding procedure entitled “Procedure for Changing the Employer and/or Policy Number after Initial Determination” and to the corresponding claims processing document for further guidance.


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