OhioBWC - Basics: (Policy library) - File

 

Policy Name:

Employer Authorized Representatives

Policy #:

EP-05-01

Code/Rule Reference:

Ohio Administrative Code (OAC) 4123-17-67, 4123-17-73, and 4123-3-09(E).

Effective Date:

November 5, 2018

Origin:

Employer Policy

Supersedes:

All policies and procedures regarding employer representation that predate the effective date of this policy.

History:

Revised July 18, 2019; June 27, 2014. New policy effective March 1, 2010.

Review Date:

November 5, 2023

 

 

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

 

This 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:

Type

Rep Risk Issues

Rep Claims Issues

Risk Corresp

Claims Corresp

Access to Claims Info

Access to Risk Info

How auth is granted

GRC

Yes

Yes

Yes

Yes

Yes

Yes

AC-24, U-151

ERC

Yes

Yes

Yes

Yes

Yes

Yes

AC-2

RISK

Yes

No

Yes

No

No

Yes

AC-2

CLM

No

Yes

No

Yes

Yes

No

AC-2

PSV

No

No

No

No

No

Yes

AC-2

 

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.

 

GRC

ERC

RISK

CLM

Risk Rep(s)

Claim Rep(s)

Notes*

Yes

No

No

No

GRC

GRC

N/A for SI, BL, MF, & PES

Yes

No

No

Yes

GRC

CLM, GRC

N/A for SI, BL, MF, & PES

Yes

No

Yes

No

GRC, RISK

GRC

N/A for SI, BL, MF, & PES

Yes

No

Yes

Yes

GRC, RISK

CLM, GRC

N/A for SI, BL, MF, & PES

Yes

Yes

No

No

GRC, ERC

GRC, ERC

N/A for SI, BL, MF, & PES

Yes

Yes

Yes

No

GRC, ERC, RISK

GRC, ERC

N/A for SI, BL, MF, & PES

Yes

Yes

Yes

Yes

GRC, ERC, RISK

CLM, GRC, ERC

N/A for SI, BL, MF, & PES

No

No

No

No

None

None

 

No

No

No

Yes

None

CLM

 

No

No

Yes

Yes

RISK

CLM

 

No

No

Yes

No

RISK

None

 

No

Yes

Yes

Yes

ERC, RISK

CLM, ERC

 

No

Yes

No

No

ERC

ERC

 

No

Yes

Yes

No

ERC, RISK

ERC

 

No

Yes

No

Yes

ERC

CLM, ERC

 

* SI: Self-Insured; BL: Black Lung; MF: Marine Fund; PES: Public Employer State

 

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.      A Handicap Reimbursement application (CHP-4A) has been filed by the employer’s claim representative. Can this application be processed?

Answer: Yes, BWC can process the application. Handicap reimbursements have both claims and risk implications. Therefore, BWC can process an application for handicap reimbursement, regardless if the handicap reimbursement application is filed by an employer’s risk or claim authorized representative. This scenario recognizes the unique nature of handicap reimbursement 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.