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OhioBWC - Basics: (Policy library) - File

Complaint Policy

 

Manual Protests

 

Unit Responsible: Classification Unit in Columbus

Policy Effective Date: June 1, 2008

Policy Revision Date: October 17, 2011

 

 

Complaint Assignment: Manual complaints are assigned to the Classification Unit in Columbus.

 

 

Management Approvals: The following management level sign-offs are required.

·        Classification Unit Supervisor

 

 

Description / Background

 

Employers are assigned manual classifications using the National Council of Compensation Insurance (NCCI) standards.  If an employer disagrees with the manual classifications assigned to them through the application process or through the audit process they can file a complaint.  Issues in this category concern employer complaints of the manual numbers to which their payroll is assigned.  Generally, employers question the appropriateness of their current operating manuals and request different operating manuals.  Other issues in this category involve employer requests for multiple operating manuals when the employer feels it maintains two or more distinct operations with verifiable segregated payroll.  In addition there could be issues of whether a manual number should be prospectively adjusted.

 

The purpose of this policy is to outline the specific steps for reviewing and determining if the manual complaint can be resolved prior to an adjudication hearing. Due to the nature of NCCI it has been determined by the Classification Unit of the Underwriting/Premium Audit Department that there are no extenuating circumstances where Ohio Bureau of Workers’ Compensation (BWC) personnel recommends approval for the employer’s request for manual reclassification.  The NCCI classification criteria is what it is and cannot be waived. The only recourse for the employer is if the classification is in error.

 

This policy outlines procedures including key steps to determine the accurate classification of the employer.  In cases where the BWC staff member recommends that the employer request be granted, the procedure is to update WCIS with recommended manual changes.  WCIS will then generate a system letter advising employer of these changes.

 

 

Steps in Process

 

The steps listed below should be followed when determining the accuracy of a classification of an employer.

 

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.

 

 

When the employer has filed a complaint on the manual classification the BWC personnel will take the following steps in trying to determine whether the employers complaint is valid.  It must first be determined if the employer is properly classified.

 

 

Steps to take to determine classification

 

When the request is received, you first need to determine if the Employer’s current classification covers the operations/duties that the Employer states they have.  To do this you must look at the following documents/tools:

 

·        Call the Employer to obtain additional information about the change in operations, their new product, process, operations, etc.

 

·        The original application for coverage – This is to determine if they have changed operations from when the original application was classified or if the information on the application was incomplete.

 

·        UDS and WCIS – Are there any notes that confirm if the Employer was contacted when the application was received?  What information was provided and who provided the information?  Has the Employer’s classification ever changed and if so why?

 

·        Audits – Has the account ever been audited and if so what were the findings?

 

·        Website and/or internet – Does the Employer have a website to help explain their operations?   If not are there any other websites where the operations may be like the Employer’s in question to help understand processes and operations?

 

·        Scopes – Look at all the classification options and read each scope.

 

·        If necessary discuss the Employer’s operations and classification options with the Classification Unit’s Supervisor.

 

 

Does the Employer’s classification change?

 

It is determined the Employer’s classification needs changing.

 

·        Make the changes in WCIS and notepad why the classification changed.

 

·        Call the Employer and explain the new classification that applies to their operations and provide them with the new rate.

 

·        Determine how long the operations have been different.  Refer for an audit if needed.

 

 

It is determined the Employer’s classification is correct.

 

·        Call the Employer and explain why the classification is correct.

 

·        Send the Employer copies of the Scope if necessary.

 

·        Document WCIS regarding the Employer’s inquiry and why the classification did not change.

 

·        Update the Complaint Tracker

 

 

If the request was not from Legal, what options does the Employer have?

 

After you have provided the employer with information supporting the classification assigned to their operations and the employer is in disagreement with your findings, request a field visit for a rating inspection or audit.  It is not always necessary to send an auditor out.  If the Employer is fairly new and has not reported payroll a rating inspection is acceptable.  An audit is only necessary if it appears there will be additional premiums due BWC or a premium refunded to the Employer.

 

If the Employer insists he does not want to go through the process of a BWC employee going to their location and doing an actual walkthrough of the operations and/or looking at their payroll records, that is their right.  The Employer’s only option is to file an appeal with the Adjudicating Committee.

 

Remember our GOAL is to correct as many classification issues we can by working with the Employer.  The absolute last option is referring them to the Adjudicating Committee.

 

 

Tools for NCCI Coding Assessment

 

·        NCCI Scopes Manual

 

·        Rule 4123-17-08 Classifications according to National Council on Compensation Insurance (NCCI).    Rule describes how BWC classifies under NCCI guidelines.

 

·        Bulletins & Audit Procedure Updates.

 

·        Web Search Engines for information about the employer and their operations, equipment, tools, processes, etc.

 

·        Audit Reviewers or Premium Audit or NCCI Classification Unit Staff.

 

 

Document Facts

 

·        If recommendation to allow manual complaint.  Complete the Complaint Tracker.  The tracker should contain the following information:

 

·        NCCI classifications (Scopes)

 

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

 

·        Clearly state your recommendation and rationale for same.

 

 

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.


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