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Policy Name:
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Employer Authorized Representatives
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Policy #:
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EP-05-01
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Code/Rule Reference
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Ohio Administrative Code (OAC) 4123-17-67,
4123-17-73,
and 4123-3-09(E).
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Effective Date:
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November 5, 2018
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Approved:
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Ronald L. Suttles, Chief Employer Services
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Origin:
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Employer Policy
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Supersedes:
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All policies and procedures regarding employer
representation that predate the effective date of this policy.
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History:
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Revised July 18, 2019; June 27, 2014. New policy
effective March 1, 2010.
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Review Date:
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November 5, 2023
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I.
Policy Purpose
The Ohio Bureau of Workers’
Compensation (BWC) protects confidential employer information and recognizes
the proper authorized representative when appointed by an employer.
II.
Applicability
The policy
applies to BWC Employer Services, employers, sponsoring organizations,
affiliated organizations, and employer authorized representatives.
III. Definitions
A. Affiliated
organization: An organization whose members are brokered, borrowed, shared,
or co-opted for inclusion in a certified sponsoring organization's group. All
affiliated organizations are required to be certified sponsoring organizations.
B. Authorized
representative: A person, company, or firm that has been retained by an
employer to represent the employer's interests before BWC or the Industrial
Commission (IC).
C. Claim
Management Representative (CLM): The employer's authorized representative
designated as the employer's representative on claims related issues.
D. Employer
Risk/Claim Representative (ERC): The employer's authorized representative
designated as the employer's representative on claims and risk related issues.
E. Group
Risk/Claim Representative (GRC): The authorized representative that is
responsible for management of group plans. The GRC is authorized by the
sponsoring organization. The GRC is designated as the authorized representative
of each employer in the group for claims and risk related issues.
F. Payroll
Service Vendor (PSV): A vendor who provides payroll services including
reporting, withholding, and remittance services for workers' compensation
premium payments.
G. Risk
Management Representative (RISK): The employer's authorized representative
designated as the employer's representative on risk related issues.
H. Sponsoring
organization: An entity with governing members, which has been certified by
BWC to sponsor and market group programs through BWC. Certification
requirements for sponsoring organizations are outlined in OAC 4123-17-61.1.
IV. Policy
A. BWC recognizes
several different types of representatives. The type determines the issues that
a representative may handle. BWC distinguishes between risk and claims issues.
1.
The GRC will:
a.
Be copied on risk and claims correspondence;
b.
Have full access to each employer's risk and claims information and
authority to access such information on www.bwc.ohio.gov;
and
c.
Be considered the authorized representative in handling claims related
issues unless a CLM has been designated by the employer.
2.
The ERC will:
a.
Be copied on claims and risk correspondence;
b.
Have access to the employer's risk and claims information and authority
to access information on www.bwc.ohio.gov;
c.
Be considered the authorized representative in handling risk related
issues for an employer if a GRC has not been designated; and
d.
Be considered the authorized representative in handling claims related
issues for the employer if no GRC or CLM has been designated.
3.
The RISK will:
a.
Be copied on risk correspondence;
b.
Have authority to access risk information on www.bwc.ohio.gov; and
c.
Be considered the authorized representative in handling risk related
issues for an employer only if a GRC or ERC has not been designated.
4.
The CLM will:
a.
Be copied on claims correspondence;
b.
Have access to only the information that pertains to workers'
compensation claims filed against the employer and will have access to that
information on www.bwc.ohio.gov; and
c.
Be considered the authorized representative in handling claims related
issues for an employer.
5.
The PSV will have authority to access risk information on www.bwc.ohio.gov.
6.
Employer Authorized Representatives Summary Chart:
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Type
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Rep Risk Issues
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Rep Claims Issues
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Risk Corresp
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Claims Corresp
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Access to Claims Info
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Access to Risk Info
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How auth is granted
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GRC
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Yes
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Yes
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Yes
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Yes
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Yes
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Yes
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AC-24, U-151
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ERC
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Yes
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Yes
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Yes
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Yes
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Yes
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Yes
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AC-2
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RISK
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Yes
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No
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Yes
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No
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No
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Yes
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AC-2
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CLM
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No
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Yes
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No
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Yes
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Yes
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No
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AC-2
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PSV
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No
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No
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No
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No
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No
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Yes
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AC-2
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7.
BWC Employer Programs Unit updates GRC information, based on the
designation made by the group's sponsor. Employer Programs Unit updates ERC,
RISK, CLM, and PSV information based on an individual employer's request.
8.
BWC Self-Insured Department updates ERC, RISK, and CLM information for
self-insuring employers.
9.
The Temporary Representative obtains authorization from the employer by
using the Temporary Authorization to Review Information (AC-3).
The Temporary Representative may request limited risk or claims information.
See Temporary Authorization to Review Employer Information section of this
policy.
10. An employer
may designate an authorized representative on an individual claim. See the
Claims Policy Authorized
Representatives.
B. Representative
Identification Number (RIN).
1.
The employer authorized representative must file an Application for
Representative Identification Number (R-4)
with BWC.
2.
BWC requires an RIN in order to add the authorized representative to the
employer's policy on BWC systems.
C. Recognized
representatives. BWC will recognize authorized representative(s) for risk
related issues and claims related issues.
1.
The chart below determines the representative(s) for risk issues and
claims issues.
2.
The same representative can be recognized for both risk and claims
related issues.
3.
All representatives have access to information as determined by their
representative type (claims, risk, or both).
4.
How to use the chart: Place the employer on the row of the chart that
describes its situation. "Yes" means the employer has that
representative type. For example: an employer with an ERC and a CLM marked as
"Yes" (and "No" marked for the other types), will have the
ERC as the representative for risk issues and the CLM and ERC as
representatives for claims issues.
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GRC
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ERC
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RISK
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CLM
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Risk Rep(s)
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Claim Rep(s)
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Notes*
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Yes
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No
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No
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No
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GRC
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GRC
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N/A for SI, BL, MF, & PES
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Yes
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No
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No
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Yes
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GRC
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CLM, GRC
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N/A for SI, BL, MF, & PES
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Yes
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No
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Yes
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No
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GRC, RISK
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GRC
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N/A for SI, BL, MF, & PES
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Yes
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No
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Yes
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Yes
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GRC, RISK
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CLM, GRC
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N/A for SI, BL, MF, & PES
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Yes
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Yes
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No
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No
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GRC, ERC
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GRC, ERC
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N/A for SI, BL, MF, & PES
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Yes
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Yes
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Yes
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No
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GRC, ERC, RISK
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GRC, ERC
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N/A for SI, BL, MF, & PES
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Yes
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Yes
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Yes
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Yes
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GRC, ERC, RISK
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CLM, GRC, ERC
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N/A for SI, BL, MF, & PES
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No
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No
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No
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No
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None
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None
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No
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No
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No
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Yes
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None
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CLM
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No
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No
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Yes
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Yes
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RISK
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CLM
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No
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No
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Yes
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No
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RISK
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None
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No
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Yes
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Yes
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Yes
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ERC, RISK
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CLM, ERC
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No
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Yes
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No
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No
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ERC
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ERC
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No
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Yes
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Yes
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No
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ERC, RISK
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ERC
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No
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Yes
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No
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Yes
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ERC
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CLM, ERC
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* SI: Self-Insured; BL: Black Lung; MF: Marine Fund;
PES: Public Employer State
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D. Temporary authorization
to review employer information. Third party administrators (TPAs) obtain
temporary authorizations from employers in order to provide quotes for Group
Experience and Group Retrospective Rating plans.
1.
TPAs are required to use form AC-3 to obtain temporary authorization.
a.
Completion of the temporary authorization provides a TPA limited
authority to view an employer's payroll, National Council on Compensation
Insurance (NCCI) classifications, and loss experience.
b.
Additionally, the TPA may request data from BWC's Policy Information
Request System (PIRS). The PIRS system provides the following information.
i.
Claim demographics;
ii.
Claim reserve and cost information;
iii. Claim
to ICD (International Classification of Diseases) information;
iv. Policy
to NCCI manual re-class information;
v.
Policy combinations & partial transfer information;
vi. Employer
experience exhibit information; and
vii. Risk
and accounts receivable information.
2.
If the TPA is obtaining temporary authorization from an agent of the
employer, such as a certified public accountant (CPA), the agent must have
written approval from the employer client. This written approval must be
verifiable by the TPA or BWC.
3.
An authorized AC-3 is valid for a nine month period, unless specified
for a shorter period on the AC-3 form. BWC requires the TPA to keep an approved
AC-3 on file and available for review by BWC for a period of one year from the
expiration of the AC-3.
4.
The employer may withdraw the temporary authorization prior to its
expiration date by contacting the TPA or BWC. In cases where BWC is contacted
by the employer, BWC will communicate the employer's withdrawal to the TPA.
5.
A TPA may obtain temporary authorization from an employer by:
a.
Written authorization.
i.
A signed authorization may be sent via mail or fax. Additionally, a
signed authorization may be sent as a PDF attachment to an email.
ii.
Written authorization is the preferred method of authorization.
b.
Electronic authorization.
i.
BWC permits a TPA to obtain AC-3 approval from an authorized employee or
agent of the employer via email or electronic submission through the TPA's
website.
ii.
The electronic version of the AC-3 must contain all of the employer data
and verbiage that is on the paper version of the AC-3. The employer may provide
an electronic signature on the AC-3.
iii. If
the electronic AC-3 does not contain the same employer data as the AC-3, the
TPA must complete a written AC-3 form by entering the employer's information,
including printing the authorized employee or agent's name and the date the
electronic approval was received.
iv. The
TPA representative must print the AC-3 form and legibly print his/her name next
to the authorized employee or agent's name.
v.
In all cases, the TPA must mail or distribute a printed copy of the AC-3
with the authorization information to the employer with a letter explaining the
electronic approval obtained.
c.
Verbal authorization.
i.
BWC permits a TPA to obtain AC-3 verbal approval from an authorized
employee or agent of an employer.
ii.
The TPA must clearly explain to the employer that the TPA will use the
authorization to request the employer's claims and risk information from BWC.
iii. The
TPA must print the authorized employee or agent name, and date of approval, on
the AC-3. The TPA representative must legibly print his/her name next to the
authorized employee or agent's name.
iv. The
TPA must print the words "verbal authorization" in the signature box
of the AC-3.
v.
The TPA must mail or distribute a completed copy of the AC-3 to the
employer with a letter informing the employer that verbal authorization has
been obtained, and risk and claims information will be requested from BWC.
vi. The
letter must outline that the employer should contact the TPA within fourteen
(14) days if the employer wishes to revoke the temporary authorization.
vii. The
TPA must wait fourteen (14) days after the letter and AC-3 copy is sent to the
employer before requesting confidential information from BWC.
viii. The TPA must
request the confidential information from BWC's PIRS system.
6.
BWC review of the temporary authorization process. If a TPA obtains
experience data without a valid AC-3, BWC will require the TPA to provide a
written explanation. BWC will evaluate the written response and determine if
the TPA violated the guidelines of this policy. If BWC determines the TPA
violated this policy, BWC may:
a.
Make recommendations to the TPA to change its AC-3 procedures;
b.
May require the TPA to use only written authorizations for a period of
one year; or
c.
May take other action as deemed appropriate, including, but not limited
to, requiring the TPA to provide a copy of an AC-3 with each request for
employer data.
7.
BWC recommends that TPAs communicate the AC-3 and temporary
authorization requirements annually to all TPA staff who market group programs.
8.
TPA revision of AC-3 form. To assist in limiting confusion over who is
requesting the AC-3 form from the employer, TPAs are required to revise the
AC-3 form that will be sent in mass mailings to employers, as follows:
a.
The TPA must remove the BWC logo and return address from the AC-3 and
replace it with the sponsoring organization/TPA logo and return address.
b.
No other changes to the form are permitted.
c.
The statements in 8.a. and 8.b. apply only to AC-3 forms that will be
mass mailed to prospective employers.
E. Group
program employer representation. For Group Experience Rating, the Application
for Group-Experience-Rating Program (AC-24) establishes the GRC. For Group
Retrospective Rating, the Application for Group Retrospective Rating Program
(U-151) establishes the GRC.
F. Employer
risk and claim representation. An employer may designate an authorized
representative to handle risk and/or claims matters on its behalf by using the
Permanent Authorization (AC-2).
1.
For a Group rated employer:
a.
If the employer is a group participant, the GRC will represent the
employer on all risk related and claims related matters.
b.
The employer may designate a CLM. If the employer has a CLM, the CLM
will represent the employer on all claims related matters.
c.
The employer may designate an ERC for risk and claims related matters.
d.
The employer may designate a RISK for all risk related matters.
e.
If the employer is not accepted into group rating the next policy year
and does not have an ERC designated, the GRC will automatically become the ERC
for the employer.
2.
For a non Group rated employer, the employer may designate:
a.
An ERC for risk and claims related matters;
b.
A CLM for claims related matters; or
c.
A RISK for risk related matters.
3.
Employer representatives may fill out AC-2 forms online via www.bwc.ohio.gov. This online process allows
the employer representative to be added as an authorized representative on the
employer's policy. To use this online process, the employer representative must
have a properly signed and dated AC-2 form from the employer. The employer
representative must maintain the copy of the AC-2 as long as the employer is
represented.
G. Updating, changing,
and dismissing employer authorized representatives.
1.
Only the sponsoring organization can change the GRC for the group and
the individual employers in the group.
2.
To change a GRC, the sponsoring organization that submitted group
applications for the current policy year must submit:
a.
A letter outlining the specific request that includes:
i.
Name of the current TPA;
ii.
Name of new TPA; and
iii. A
listing of all group rating plans (group number and name);
b.
A completed AC-2 authorizing the new TPA; and
c.
A completed AC-24, or a completed U-151, indicating the new authorized
representative, with all groups listed on the employer roster.
3.
The following steps must be completed when an affiliated organization
requests a change to its TPA. Since the affiliated organization is not the
sponsoring organization for groups submitted for the current rating year, the
GRC cannot be updated. However, BWC will add the new TPA as the ERC for each
employer who is a member of the affiliated organization, if all requirements
are met.
a.
The new TPA must:
i.
Send a letter of explanation to all impacted employers. This letter must
be submitted to BWC for review and approval prior to sending to employers. The
letter must include:
a)
BWC approved verbiage;
b) Contact
information for the affiliated organization's new TPA; and
c)
A timeframe for the employer to notify the affiliated organization's new
TPA that the employer does not want the new TPA to be added as the ERC on its
policy. The holding period is a minimum ten business days from the mail date.
ii.
Provide BWC with a final copy of the letter referenced in section 3.a.i.
above;
iii. Upon
request, provide BWC with the name, individual contact information, and
relevant documentation for any employer who declined to add the new TPA as an
ERC;
iv. Provide
BWC with written confirmation and agreement signed by the sponsoring
organization and the current GRC that includes the following:
a)
Signatures from all parties;
b) Details
regarding the rating year and sponsoring organization;
c)
Name of current sponsoring organization's GRC;
d) Name
of affiliated organization's new ERC;
e)
Effective date (must be after the date all employers are notified and
the minimum holding period); and
f)
A final list of all employers who agreed to the ERC change that includes
BWC policy number and policy name.
b.
BWC will not process the affiliated organization's request without
agreement from all parties (i.e., sponsoring organization and current
authorized group TPA/GRC). If all parties are not in agreement, each employer
must complete and submit an AC-2 to add the affiliated organization's new TPA
as an ERC on its policy.
c.
BWC will only add the new TPA as an ERC for the employer if the employer
is listed on the group roster as a governing member of the affiliated
organization.
d.
The affiliated organization must submit a completed AC-2 authorizing the
new TPA.
e.
BWC will process requests meeting all requirements within seven working
days.
4.
An employer may update, change, or cancel an ERC, RISK, or CLM for its
policy or claims. However, these changes may be limited if the employer is a
group program participant. Specifically, the GRC will also represent the group
rated employer on all risk related matters and claims related matters.
5.
An employer must use an AC-2 to add an authorized representative to its
policy. The AC-2 can be used to add an ERC, RISK, CLM or a PSV. The AC-2 should
be submitted to BWC Employer Programs or BWC Self-Insured Department. The most
recently submitted AC-2 supersedes any prior permanent authorizations on file
for the type of representative indicated on the AC-2. Previously authorized
representatives of the same type on the recently submitted AC-2 will be placed
in a dismissed status.
6.
An employer or authorized representative may use the online AC-2
service offering on BWC's website to add, change, or terminate an
authorized representative. There must be a written copy of the AC-2 at the
employer's or representative's site before an online AC-2 may be processed.
7.
If the employer wishes to dismiss an authorized representative without
adding an authorized representative of the same type, the employer must submit
a letter to BWC. The letter must indicate the specific authorized
representative being dismissed and be signed by an authorized employee of the
employer. The letter must include the employee's signature, name, and title.
8.
The authorized representative may submit a signed letter withdrawing as
the employer's representative. This letter must include specific employer
information and be signed by the authorized representative. The authorized
representative may also send an email to BWC with a list of employers, and the
effective date(s) that the authorized representative will no longer be
representing these employers.
9.
If an employer representative is acquired by another entity, BWC will
not recognize the new entity as an employer's representative without proper
authorization. An employer impacted by the acquisition must sign an AC-2 if the
employer wishes to authorize a new employer representative.
H. Scenarios.
1.
A subsidiary company of an employer’s authorized representative requests
data on the employer’s policy. Can the data be released?
Answer: No,
only the authorized representative, as listed on the AC-2 or AC-3, can be given
data for an employer.
2.
An Application for Disability Relief (CHP-4A)
has been filed by the employer’s claim representative. Can this application be
processed?
Answer: Yes,
BWC can process the application. Disability relief has both claims and risk
implications. Therefore, BWC can process an application for disability relief,
regardless if the disability relief application is filed by an employer’s risk
or claim authorized representative. This scenario recognizes the unique nature
of disability relief as an issue that touches both claims and risk issues.
3.
How do successorship situations impact the ability of a TPA to request
risk data from BWC on a predecessor or successor?
Answer: The
successor’s TPA may obtain predecessor employer risk data for any employers
that were fully combined into the successor’s policy. For partial transfers,
the successor TPA may obtain risk data that pertains to the partial transfer to
the successor employer.
A
predecessor TPA may not obtain any data from the successor’s policy, regardless
of the successorship being full or partial.