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OhioBWC - Basics: (Policy library) - File

Complaint Policy

 

Employer Petition Objecting to a Premium Assessment

 

Unit: Responsible: The Bureau department for which the underlying debt arose

Policy Effective Date: June 1, 2008

Policy Revision Date: October 17, 2011

 

 

Complaint Assignment: Employer Petition Objecting to Assessment complaints are assigned to the Bureau department for which the underlying debt arose.

 

 

Management Approval: See sign off grid at the end of this policy to determine required management level sign-offs.

 

 

Description / Background

 

Prior to taking out a premium judgment lien against an employer, Ohio Revised Code (ORC) 4123.37 gives the employer twenty (20) days to file a “Petition Objecting to the Assessment” with the Administrator of the Ohio Bureau of Workers’ Compensation (BWC).  The right to file a “Petition Objecting to the Assessment” is given to any employer against which BWC seeks to take a premium judgment lien.  The nature of the debt which drives the need for the lien can be varied.  Typical examples include: 

1.     Estimated premiums when an employer fails to properly report and pay premiums;

2.     Audit findings;

3.     Rate adjustments;

4.     VSSR assessments.  

 

Noncompliance Claims have their own lien filing procedures and are not subject to a “Petition Objecting to the Assessment.”

 

Once an employer files a “Petition Objecting to the Assessment,” the employer is entitled to a hearing.  Therefore, these matters should be automatically set for hearing with the Adjudicating Committee.  In order to perfect a lien, a hearing must be given to the employer.  However, there is no right to an appeal hearing with the Administrator’s Designee.  The employer is entitled to a “Petition Objecting to the Assessment” hearing even if the employer has exhausted all appeals through the regular Adjudicating Committee hearing process.

 

Legal Background: Legal reference for this policy is found in ORC 4123.37, Failure to Pay Premiums by Amenable Employer.  The following is extracted from that statute.

 

In this section “amenable employer” has the same meaning as “employer” as defined in division (J) of section 4123.32 of the Revised Code.

 

If the administrator of workers’ compensation finds that any person, firm, or private corporation, including any public service corporation, is, or has been at any time after January 1, 1923, an amenable employer and has not complied with section 4123.35 of the Revised Code the administrator shall determine the period during which the person, firm, or corporation was an amenable employer and shall forthwith give notice of the determination to the employer. Within twenty days thereafter the employer shall furnish the bureau with the payroll covering the period included in the determination and, if the employer is an amenable employer at the time of the determination, shall pay a premium security deposit for the eight months next succeeding the date of the determination and shall pay into the state insurance fund the amount of premium applicable to such payroll.

 

If the employer does not furnish the payroll and pay the applicable premium and premium security deposit within the twenty days, the administrator shall forthwith make an assessment of the premium due from the employer for the period the administrator determined the employer to be an amenable employer including the premium security deposit according to section 4123.32 of the Revised Code if the employer is an amenable employer at the time of the determination, basing the assessment upon the information in the possession of the administrator.

 

The administrator shall give to the employer assessed written notice of the assessment. The notice shall be mailed to the employer at the employer’s residence or usual place of business by certified mail. Unless the employer to whom the notice of assessment is directed files with the bureau within twenty days after receipt thereof, a petition in writing, verified under oath by the employer, or the employer’s authorized agent having knowledge of the facts, setting forth with particularity the items of the assessment objected to, together with the reason for the objections, the assessment shall become conclusive and the amount thereof shall be due and payable from the employer so assessed to the state insurance fund.

 

When a petition objecting to an assessment is filed the bureau shall assign a time and place for the hearing of the same and shall notify the petitioner thereof by certified mail. When an employer files a petition the assessment made by the administrator shall become due and payable ten days after notice of the finding made at the hearing has been sent by certified mail to the party assessed. An appeal may be taken from any finding to the court of common pleas of Franklin county upon the execution by the party assessed of a bond to the state in double the amount found due and ordered paid by the bureau conditioned that the party will pay any judgment and costs rendered against it for the premium.

 

When no petition objecting to an assessment is filed or when a finding is made affirming or modifying an assessment after hearing, a certified copy of the assessment as affirmed or modified may be filed by the administrator in the office of the clerk of the court of common pleas in any county in which the employer has property or in which the employer has a place of business. The clerk, immediately upon the filing of the assessment, shall enter a judgment for the state against the employer in the amount shown on the assessment. The judgment may be filed by the clerk in a loose leaf book entitled “special judgments for state insurance fund.” The judgment shall bear the same rate of interest, have the same effect as other judgments, and be given the same preference allowed by law on other judgments rendered for claims for taxes. An assessment or judgment under this section shall not be a bar to the adjustment of the employer’s account upon the employer furnishing the employer’s payroll records to the bureau.

 

The administrator, for good cause shown, may waive a default in the payment of premium where the default is of less than sixty days’ duration, and upon payment by the employer of the premium for the period, the employer and the employer’s employees are entitled to all of the benefits and immunities provided by this chapter.

 

Purpose of this policy

 

The purpose of this policy is to outline the extenuating circumstances under which an objection would be accepted as timely received when the employer has failed to respond within the required twenty days (20 days).

 

The specific scenarios listed in the policy contain details on the conditions under which BWC will accept as timely an objection received beyond the required twenty days (20 days).   When BWC personnel is recommending that an employer's objection be accepted as timely when received after the required twenty days (20 days), management approval is required prior to accepting the objection as timely received.

 

 

Steps in Process

 

The steps listed below should be followed when evaluating a petition for reassessment that has been received within the required time limitations, and where there are extenuating circumstances associated with the reason the employer failed to file a petition within the required time limitations.

 

Note:

 

This procedure is general in nature and cannot address all potential situations.

 

Employees finding that a good cause exists to grant a request for relief must provide adequate documentation to support such finding.

 

Findings of good cause must be brought to the attention of the immediate supervisor for review and approval.

 

 

The Bureau Department for which the underlying debt arose from should be the Department which handles the “Petition Objecting to an Assessment.”  Example:  if the underlying debt is an audit finding, then the Audit department would handle the complaint.  If the underlying debt is an estimated premium assessment, then Accounting Collections would handle the complaint.  The best way to determine if the employer is entitled to a hearing is to contact the Accounting Collections Unit and determine when the “210 letter” was sent to the employer.  If the petition is received within 20 days of the “210 letter” being sent then the employer is entitled to a hearing.  If there is a question about whether the letter is timely or not, the “210 letters” are sent certified mail.  The certification card is scanned to UDS and can be used to determine timely receipt of petition.

 

All timely “Petitions Objecting to an Assessment” must be accepted by the Bureau and all must be set for hearing.  The only exceptions shall be:  1) Debt in which the Bureau is not attempting to secure under 4123.37; or 2) Petitions not timely filed.

 

 

Adjustment of the Employer’s Account

 

Per ORC 4123.37 an assessment or judgment does not bar the adjustment of the employer’s account upon the employer furnishing payroll records to BWC.  The complaint handler retains the ability to assist the employer to report actual payroll, through the submission of payroll records.  The employer must submit documentation to support the payroll records if the payroll period(s) involved are greater than two years from the beginning of the current payroll period.

 

When actual payroll is entered into WCIS, the estimated payroll will be voided.  The Attorney General will receive a systematic update so the correct balance is being collected from the employer.  The employer is still responsible for all interest and collection fees billed, unless the original balance was certified in error.  The lien will stay in place until the balance is paid in full.

 

Note: the complaint handler can accept actual payroll, with appropriate documentation, even if the employer’s petition objecting to a premium assessment is denied under this policy.

 

 

Evaluate Scenarios with Extenuating Circumstances

 

When researching and evaluating a petition for reassessment filed by an employer or its authorized representative that was received beyond the required twenty days (20 days), you will encounter situations having unusual or extenuating circumstances that resulted in the petition being filed beyond the required twenty days (20 days).

 

If one of the scenarios listed below is identified, the steps outlined in this policy should be followed.

 

·        Research and document the facts.

 

·        Determine if an extenuating circumstance exits.

 

·        Obtain management approval as outlined in this policy.

 

·        Send Petition Objecting to a Premium Assessment to the Adjudication Committee to be set for hearing.

 

 

Scenarios That Do Not Qualify as Extenuating Circumstances: The following are examples of scenarios that should NOT be categorized as being an extenuating circumstance.

 

·        Changes to the management staff within the organization

 

·        Change in personnel or CPA

 

·        Bookkeeper or CPA error

 

·        Confusion over Ohio workers’ compensation law and rules

 

·        Implementation of a new computer system

 

 

Scenarios That Qualify as Extenuating Circumstances

 

Scenario 1: Scenarios Involving a Significant Unpredictable Event.

 

·        This scenario is intended to include situations that are unpredictable and out of the employer’s control that prevented the employer from filing appropriate paperwork in a timely manner.  Situations falling under this scenario may include, but are not limited to:

 

·        Acts of Nature such as a tornado, flood, etc. 

 

·        Significant loss events such as water line break, fire, etc.

 

·        Terrorist activities.

 

·        Violence in the workplace. 

 

·        There must be a direct correlation between the event and the reason the employer failed to file a petition for reassessment within the required twenty days (20 days).

 

 

Scenario 2: Scenario Involving Notification Not Reaching the Intended Employer

 

·        This scenario deals with a situation when notification of assessment is received by a person not associated with the business and not forwarded to the employer.

 

·        The employer is required to provide BWC with a valid address.  Non-notification due to the employer failing to provide BWC with a valid address is not an acceptable extenuating circumstance.

 

 

Scenario 3: Scenarios Involving Serious Illness, Injury, or Death of Essential Personnel.

 

·        This scenario deals with a situation where essential personnel within the organization; such as the owner, Chief Operating Officer, Chief Financial Officer; has a serious illness, injury or death that prevented the employer from filing appropriate paperwork or documentation (either hard copy or electronic) in a timely manner.

 

·        A physician’s verification must accompany the request.  Such physician verification should not include specific medical reasons for the absence, but must include the dates the essential personnel missed work due to serious illness, injury, or death.

 

·        There must be a direct correlation between the absence of the essential personnel and the reason the employer was unable to complete the required activities within the required timeframes.

 

·        This extenuating circumstance may be utilized only to extend the required timeframe to meet a specific requirement.  It cannot be used to allow non-completion of the specific requirement.

 

 

Scenario 4: Scenarios Where Key Personnel/Owner Called to Active Military Duty.

 

·        This scenario deals with a situation where essential personnel within the organization such as the owner,   officer, Chief Operating Officer, Chief Financial Officer has been called to active military duty that prevents the employer from filing appropriate paperwork in a timely manner.

 

 

Obtain Supporting Documentation

 

·        When a recommendation is being made to accept as timely an employer’s petition for reassessment that has been received beyond the required twenty days (20 days), supporting documentation must be provided to validate the accuracy of the information submitted by the employer.

 

·        Examples of appropriate supporting documentation are as follows:

 

·        News report or insurance claim related to a natural disaster or significant event.

 

·        An indication that the person signing for the certified mail is not/has not ever been an employee of the employer.

 

·        Death certificate or statement from treating physician.

 

·        Military order/call to active duty.

 

 

Document Facts

 

·        Complete the Complaint Tracker.  Documentation must include:

 

·        Summary information (i.e., background and other related facts).

 

·        Clearly state your recommendation and rationale for same.

 

·        File name(s) of documents in UDS.

 

 

Obtain Approval For Your Recommendations

 

·        Once the assigned BWC staff member has evaluated the complaint and made a determination, the staff member will forward their recommendation for management approval using the complaint tracking system.   The system will automatically forward the complaint to the next level for review and approval. (refer to approval sign-off at beginning of this policy)

 

·        At each level of approval, the reviewer will indicate approval or denial using the complaint tracking system.  The final reviewer will notify the initially assigned BWC staff member and the appropriate BWC unit of their action.

 

·        Note: Management approval in the complaint tracking system does not mean the employer’s request is granted.  Management approval means management is agreeing with the BWC staff member’s recommendation to either grant or deny the employer’s request.

 

 

Process Complaint

 

·        Depending upon whether the complaint is returned to the service office or to a central processing unit, the responsible individual/unit will:

 

·        Send the employer a written response explaining the results of the employer’s request.

 

·        Create WCIS notepad entry to document the result of the employer’s request.

 

·        Close out the Complaint Tracker entry.

 

·        Save all documentation in the UDS Employer Electronic File Room.

 

 

Management Sign-Off Chart

 

Premium Assessment

UNDERLYING DEBT AROSE (see below*)

Complaint Type

Assigned Area

1st Sign-Off

2nd Sign-Off

3rd Sign-Off

Audit Findings*

Audit Unit

Audit Supervisor

Director of Underwriting & Premium Audit if granting and financial impact is > $50,000

 

Estimated premiums, failure to report & properly pay premium, including supplemental coverage*

Service Office

Employer Management Supervisor

Director of Underwriting & Premium Audit if financial impact is > $5,000 either grant or deny complaint

Chief of Employer Services if financial impact is > $100,000 either grant or deny

Rate Adjustments*

Actuarial

Supervisor

Director, Actuarial if granting and financial impact is > $1,000

Chief Actuarial Officer if granting and financial impact is > $10,000

Experience Combine, Earlier effective date*

Policy Processing

Policy Processing Supervisor

Director of Underwriting & Premium Audit if financial impact is > $10,000 either grant or deny

 

 


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