Unit Responsible: Classification
Unit in Columbus
Policy Effective Date: June 1, 2008
Policy Revision Date: October 17,
Complaint Assignment: Manual
complaints are assigned to the Classification Unit in Columbus.
Management Approvals: The following
management level sign-offs are required.
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.
The steps listed below should be
followed when determining the accuracy of a classification of an employer.
is general in nature and cannot address all potential situations.
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
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
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:
the Employer to obtain additional information about the change in operations,
their new product, process, operations, etc.
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.
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?
– Has the account ever been audited and if so what were the findings?
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
– Look at all the classification options and read each scope.
necessary discuss the Employer’s operations and classification options with the
Classification Unit’s Supervisor.
the Employer’s classification change?
It is determined the Employer’s
classification needs changing.
changes in WCIS and notepad why the classification changed.
the Employer and explain the new classification that applies to their
operations and provide them with the new rate.
how long the operations have been different. Refer for an audit if
It is determined the Employer’s
classification is correct.
Employer and explain why the classification is correct.
the Employer copies of the Scope if necessary.
WCIS regarding the Employer’s inquiry and why the classification did not change.
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.
for NCCI Coding Assessment
according to National Council on Compensation Insurance (NCCI).
Rule describes how BWC classifies under NCCI guidelines.
& Audit Procedure Updates.
Search Engines for information about the employer and their operations,
equipment, tools, processes, etc.
Reviewers or Premium Audit or NCCI Classification Unit Staff.
recommendation to allow manual complaint. Complete the Complaint
Tracker. The tracker should contain the following information:
information (i.e., background and other related facts).
state your recommendation and rationale for same.
Approval For Your Recommendations
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).
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.
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.
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
WCIS notepad entry to document the result of the
out the Complaint Tracker entry.
all documentation in the UDS Employer Electronic File