OhioBWC - Basics: (Policy library) - File

Complaint Policy


Professional Employer Organization (PEO) Complaint Policy


Unit Responsible for Program: PEO Unit

Policy Effective Date: June 1, 2008

Policy Revision Date: October 17, 2011



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


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

·        PEO Unit Supervisor

·        Chief of Employer Services



Description / Background


Legal Background: Legal references for this policy are found in Ohio Revised Codes (ORC) 4125.01 to 4125.09 and ORC 4125.99 and Ohio Administrative Code (OAC) 4123-17-15.


A Professional Employer Organization (PEO) is required to provide security in the form of a bond or letter of credit assignable to the Ohio Bureau of Workers’ Compensation (BWC) not to exceed an amount equal to the workers’ compensation premiums and assessments incurred for the two most recent payroll reporting periods.  As an alternative to providing security, the administrator shall permit a PEO to make advance payments of premiums and assessments to the bureau.


A PEO electing to make advance payments of premiums and assessments shall make such payments by utilizing the bureau’s online payment system (FlexPay).  The PEO electing to make advance payments must report the estimated payroll and pay the premiums for the month by the fifth day of that month.  If the PEO fails to report payroll and pay premiums timely through the FlexPay program, the PEO may be required to post bond or a letter of credit.


The purpose of this procedure is to outline the specific processing steps for accepting as timely an advanced payment of premium and assessments received after the fifth day of the month.


The specific scenarios listed in this procedure contain details on the conditions under which BWC will accept as timely the advance payment of premium and assessments after the fifth date of the month, without requiring the PEO to go through the BWC Adjudication process.  When the PEO Unit is recommending the acceptance of a late payment, due to extenuating circumstances, as timely, the recommendation requires management approval prior to accepting the payment as timely.



Steps in Process


The steps listed below should be followed when determining if a late premium and assessment payment will be considered timely.




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. 



Transaction Update Processing


The complaint process empowers field staff to make decisions on issues and complaints brought by employers.  A component of the process is for field staff to recognize when it is appropriate to update a transaction status in WCIS from Open (OP) to Appeal (AP).  Field staff should only utilize the appeal status update to ensure an open transaction is not certified to the Attorney General in error. 



When the PEO has requested that premium and assessment paid after the fifth day of the month be accepted as timely, the PEO Unit, after reviewing the documentation provided and determining if the reason provided for the late payment is acceptable, shall complete the Complaint Tracker explaining the rational for the recommended acceptance, and explaining the documentation supporting the recommendation. 



Evaluate Scenarios with Extenuating Circumstances


When researching and evaluating a PEO’s request that a late premium and assessment payment be accepted as timely, you will encounter situations having unusual or extenuating circumstances that resulted in the premium and assessment payment being made after the fifth day of the month.


·        Document the facts


·        Outline a recommended solution to resolve the PEO’s late payment


·        Obtain management approval as outlined in this policy


·        Send approval recommendation to the PEO Unit for processing.



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 or 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 prevents the employer from filing appropriate paperwork in a timely manner.  Situations falling under this scenario may include the following:


·        Acts of nature such as 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 pay the premium and assessments by the fifth day of the month.



Scenario 2: 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 PEO 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 PEO 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 3: 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.


·        There must be a direct correlation between the absence of the essential personnel and the reason the PEO failed to pay the premium and assessments by the fifth day of the month.



Scenario 4: Scenarios where the BWC web site or the FlexPay option was not available for use


·        This scenario deals with situations where the PEO attempted to pay premium by the fifth day of the month and experienced difficulty with the BWC web site.  Such difficulties may include:


·        BWC web site unavailable


·        FlexPay option within the BWC web site was unavailable


·        Employer experienced a power outage



Scenario 5: Scenarios where the manual classification necessary for proper reporting of payroll is not assigned to the PEO policy


·        This scenario deals with situations where the PEO attempts to pay the premium and realizes the manual classification necessary to properly report the payroll is not assigned to the PEO’s policy.



Scenario 6: Scenarios Involving Fraud or Gross Negligence


·        Event: Fraudulent or illegal action, or gross negligence, of an employee or agent representing or working on behalf of the employer.  This employee or agent must have been directly involved with or overseeing the functions related to the protested issue.  Employer relief is limited to those situations in which the employer can verify through documentation that is has attempted to initiate legal action against the employee or agent.


·        Supporting documentation


·        For criminal or civil fraud or other illegal acts:  Proof that the employer has filed formal criminal charges or actively pursued legal action for civil fraud or other illegal acts.  A conviction is not required.


·        For gross negligence:  Proof that the employee has filed a civil complaint against the employee or agent for recovery in any court.  The employer is not required to prevail in the civil action.  Acceptable documentation may also include rulings from other state or federal governmental agencies attesting that the action is considered gross negligence.


BWC staff receiving employer complaints alleging fraud or gross negligence should work through their supervisor to seek advice from BWC Legal Division to determine if the documents presented by the employer are valid legal documents as specified by this scenario.



Obtain Supporting Documentation


·        When a recommendation is being made to approve an employer’s request to accept as timely a payment received after the fifth day of the month, supporting documentation must be provided to validate the accuracy of the reason for the late payment 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.


·        Death certificate or statement from treating physician.


·        Military order / call to active duty notice.


·        Verification from BWC IT of problems with the BWC web site/FlexPay option at time PEO indicates an attempt to pay premium.


·        Verification from electric power company of power outage.


·        A record of the PEO contacting BWC to request the manual classification necessary to complete the proper reporting of payroll.



Document Facts


·        Complete the Complaint Tracker.  Documentation must include:


·        Summary (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 Recommendation


·        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 Protest


·        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.