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OhioBWC - Basics: (Policy library) - File

 

Policy Name:

One Claim Program (OCP)

Policy #:

EP-15-01

Code/Rule Reference:

ORC 4123.29(A)(4)(e); OAC 4123-17-71; 4123-17-74, Appendices A, B, and C; 4123-17-16.

Effective Date:

July 1, 2016

Origin:

Employer Policy

Supersedes:

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

History:

Revised: August 8, 2016; December 7, 2015; April 6, 2015; July 3, 2012.

Review Date:

July 1, 2021

 

 

I.       Policy Purpose

 

The Ohio Bureau of Workers’ Compensation (BWC) will provide a program to lessen the impact of a significant claim that comes into an employer’s experience. BWC will permit such employers to participate in the One Claim Program (OCP) as outlined in the applicable laws and rules.

 

II.     Applicability

 

This policy applies to employers, authorized representatives, BWC Employer Programs, and Field Operations.

 

III.    Definitions

 

A.     Industry-specific training course: Safety course specifically identified by BWC as applicable to a specific industry group. Private employer industry groups are identified in OAC 4123-17-05, Table 1, Part A.  Industry-specific safety courses are listed in the Division of Safety & Hygiene (DSH) Safety Services Catalog.

B.     One Claim Program (OCP): BWC’s voluntary rate program which offers a private, state fund employer (PA) or a public employer taxing district employer (PEC) the opportunity to mitigate the impact of a significant claim entering the employer’s experience for the first time.

C.    Online safety training class: Training course offered by the DSH through the Internet (as opposed to a classroom course).

D.    Program eligibility period: The four or five policy years in which an employer has a significant claim in its experience period.

E.     Significant claim: A claim whose total value or maximum claim value, whichever is lower, will be greater than the employer’s total limited losses (TLL) as defined in OAC 4123-17-03.  Once a claim has been designated as the significant claim, that designation cannot be changed during the program eligibility period.

F.     Total limited losses (TLL): Total expected losses for an employer multiplied by the limited loss ratio. Total expected losses are determined by applying expected loss rate to the payroll of each classification in the employer’s experience period. (OAC 4123-07-03)

IV.   Policy

A.     Eligibility requirements: As of the initial application deadline, the employer must be enrolled in the Group Experience Rating Program. At the time of initial application and each renewal application, the employer must:

1.     Be current with respect to all payments due BWC, as defined in OAC 4123-17-14.

2.     Be current on the payment schedule of any part-pay agreement into which it has entered for the payment of premiums or assessments.

3.     Not have cumulative lapses in workers’ compensation coverage in excess of forty (40) days within the prior twelve (12) months, except:

a.     For the policy year starting July 1, 2015, a PA employer must not have cumulative lapses in workers’ compensation coverage in excess of forty (40) days within the prior nine months.

b.     For the policy year starting January 1, 2016, a PEC employer must not have cumulative lapses in workers’ compensation coverage in excess of forty (40) days within the prior nine months.

4.     As of the application deadline, the employer must have reported actual payroll for the preceding policy year and paid any premium due upon reconciliation of estimated premium with actual premium no later than the due date as set forth in OAC 4123-17-14. An employer will be deemed to have met this requirement if BWC receives the payroll report and the employer pays premium associated with the payroll report before the expiration of the grace period, if any as provided in OAC 4123-17-16(B).

B.     Application requirements / BWC evaluation of application.

1.     BWC will automatically identify and send notice to employers of their initial and continuing eligibility for the OCP. BWC has the final authority to approve participation.

2.      The employer must complete and submit the Application for One Claim Program (OCP-1) to request participation in the OCP for each year of the program eligibility period.

3.     The OCP-1 must be signed by the Chief Executive Officer or designated management representative of the employer.

4.     Application deadlines:

a.     For a PA employer, the application must be filed by the last business day of January preceding the policy year beginning July 1.

b.     For a PEC employer, the application must be filed by the last business day of July preceding the policy beginning January 1.

c.      If the application is received after the application deadline, BWC will reject the application and notify the employer by letter.

5.     An employer may participate in the OCP for a maximum of:

a.     Four years in which the employer has a significant claim in its experience period, or

b.     Five years in which the employer has a significant claim in its experience period.

6.     BWC will evaluate the employer’s eligibility each year of the program eligibility period and provide a renewal application.

a.     The application is available online.

b.     Applications may be faxed to BWC Employer Programs Unit at (614) 621-1405.

c.      Applications may be mailed to:

The Ohio Bureau of Workers’ Compensation

Employer Programs Unit, Level 22

30 West Spring Street

Columbus, Ohio 43215-2256

C.    General program requirements.

1.     In signing the application form, the chief executive officer or designated management representative of the employer is certifying to BWC that the employer will comply with all program requirements.

2.     The employer may have a maximum of three medical-only claims at any time in addition to the one significant claim (either lost time or medical-only) in the employer’s experience period.

a.     As a medical-only claim exits the employer’s experience period, the employer may include a new medical-only claim.

b.     The combined total costs of the three medical claims must be below the employer’s total limited losses (TLL).

3.     The employer may participate in the OCP on no more than one significant claim within the program eligibility period from the date of the employer’s initial participation in the program.

4.     Once a claim has been designated as the significant claim in initial enrollment, the employer is not permitted to change this designation during the program eligibility period.

5.     Settled and subrogated claims will be included in the employer’s total claim count.

6.     The employer must meet training requirements outlined in section IV.D below.

D.    Training requirements.

1.     Employers must complete training requirements by the following deadlines:

a.     PA employers:

i.       For policy years prior to July 1, 2015, the deadline is the last day of the policy year.

ii.      For policy years starting on or after July 1, 2015, the deadline is the last business day of March.

b.     PEC employers:

i.       For policy years prior to January 1, 2016, the deadline is the last day of the policy year.

ii.      For policy years starting on or after January 1, 2016, the deadline is the last business day of September.

2.     The employer must meet safety requirements as prescribed by the DSH for the initial year of participation and subsequent years of the program eligibility period.

3.     First year participants:  Attend one half-day (classroom) industry-specific safety course offered by the DSH.

4.     Second, third, fourth, and fifth year participants:  Attend/complete any one of the following:

a.     One half-day (classroom) industry-specific safety course offered by the DSH.

b.     Three hours of online safety training courses offered by the DSH.

c.      Three one-hour training sessions at the All-Ohio Safety Congress and Expo.

d.     A training class or seminar developed by BWC and approved by DSH for satisfying OCP safety requirements.

5.     Training requirements must be satisfied by the employer on a policy number basis because each policy number is considered its own separate entity.

a.     An employer with one policy number who is participating in multiple programs may use one training to fulfill the requirements for multiple programs because each policy number:

i.       May participate in multiple compatible programs.

ii.      May attend classes relevant to multiple safety disciplines, thus multiple programs.

b.     An employer with multiple policy numbers who is participating in a single program may use one training credit to fulfill the requirement for one policy number because each policy number:

i.       Has separate responsibilities to complete the requirements set forth in the programs chosen.

ii.      Receives discounts separately.

E.     Operation of program.

1.     BWC will credit the employer with a discount from the employer’s base rate as follows:

a.     First year of the program eligibility period: A 20% discount (EM = 0.80). 

b.     Second year of the program eligibility period: A 15% discount (EM = 0.85).

c.      Third year of the program eligibility period: A 10% discount (EM = 0.90).

d.     Fourth year of the program eligibility period: A 5% discount (EM = 0.95).

e.     Fifth year of the program eligibility period: A 5% discount (EM = 0.95).

2.     The discount will only be applied to the premium rate including administrative costs, not to the Disabled Workers’ Relief Fund (DWRF). DWRF is calculated by strictly using the base rate.

3.     Since the OCP rate is a fixed discount rate that cannot be changed, no adjustments will be applied to the employer’s account.  For instance: if an employer has a 90% handicap on a claim during the time the employer is in the program, the handicap will not be applied to the OCP discount.

4.     An employer participating in the OCP may participate in other compatible BWC discount programs during its participation in the OCP as outlined in OAC 4123-17-74, Appendix C.

F.     Removal/exit from program.

1.     BWC will remove an employer from participation in the OCP at the beginning of the next policy year and, upon removal, will return the employer to its individual EM if:

a.     The employer fails to meet all eligibility and general requirements of the OCP set forth in OAC 4123-17-71(C) and (D).

b.     The employer has more than four claims in its experience period.

c.      The employer has more than one significant claim in its experience period.

d.     The combined claims costs of the three medical-only claims increase past the TLL.

e.     The employer did not complete the required training.

2.     An employer removed from OCP for failure to report actual payroll for the preceding policy year and pay any premium that is due upon reconciliation of estimated premium with actual premium will be rerated for the full policy year at the employer’s base rate or experience modified rate as determined by the employer’s expected losses for the policy year.

3.     BWC will notify an employer in a letter when a requirement is not met and give justification for removal.  For example: The employer did not meet the OCP’s annual educational training requirements.

4.     An employer may withdraw from the program at any time by notifying BWC in writing.

a.     An employer that withdraws from the OCP during the policy year will be reassigned its individual experience modifier for the entire policy year.

b.     If an employer withdraws from the program and has any remaining years in the program eligibility period, the employer may reapply for the OCP using the same significant claim as its one designated claim.  (e.g., an employer enrolls in OCP for the first year, and then withdraws the second year.  It may reapply for the third, and/or fourth year remaining on its original program eligibility period).

G.    Resolution of complaints.

1.     Employer complaints should be processed under the General Employer Complaint Policy.

2.     Specific extenuating circumstances that apply to the OCP:

a.     Circumstance involving employer’s denial into the OCP as a result of not meeting the claim eligibility requirements.

i.       Extenuating Circumstance: Employer protests the eligibility criteria for participating in the OCP.  Situations falling under this scenario may include the following:

a)     Claims assigned to wrong risk.

b)     Claims originally allowed, reversed on appeal and not updated to disallowed status.

c)     Claim costs exceeding TLL due to payments made in error.

ii.      Supporting documentation: BWC or IC orders detailing reversals of previous claim decisions that specifically impact the employers’ eligibility requirements.

b.     Circumstance involving employer in full combination where the predecessor policy was enrolled in the OCP with eligibility years remaining in the program.

i.       Extenuating Circumstance: The successor policy desires to maintain eligibility and retain the discount.  The successor may be granted OCP participation provided all criteria for program eligibility are met.

ii.      Supporting documentation: Documentation showing the predecessor policy completed all requirements for policy years in which it actively participated in the OCP.

iii.     Resolution: The following conditions must be met for the employer’s request to be granted:

a)     The total combined number and types of claims from the predecessor and the successor must meet the claim requirement for participation in the OCP.

b)     The successor policy is not participating in any other BWC program that is incompatible with OCP.

c)     Depending on the effective date of the combination, BWC will either:

i)       Require the successor to file an OCP-1, or;

ii)      Use the predecessor’s OCP-1 to transfer program participation to the successor.

iv.    Action: The successor policy will be granted OCP discount effective with the start of the next applicable policy year.  (The predecessor will receive the OCP discount through the end of the policy year in which the combination took place.  The successor will receive the discount beginning with the start of the next policy year).  The successor policy discount is only for the remaining years of the original program.

c.      Circumstance involving the change in credibility table for 2010 that established level of expected losses to be a base rated employer at $2,000.

i.       Extenuating Circumstance: An employer that was base rated and in the OCP continues to meet the program eligibility criteria established during the policy year of enrollment and will be permitted to continue in the program and retain the discount

ii.      Resolution: The following conditions must be met for the employer’s request to be granted.

a)     The claim cost of the claims involved in the evaluation remains consistent with the OCP eligibility of the previous year.

b)     Policy was base rated in the previous policy year and the change in maximum credibility caused the policy to become experience rated.

iii.     Policy only eligible for discount for the remaining years of the original program.

iv.    Policy must maintain all eligibility criteria for the program.

H.    Scenarios.

1.     An employer attends two local safety council seminars lasting two hours each and considers that as meeting the requirement for one training course for the OCP.  Are these seminars valid?

Answer: No.  An employer must attend either a DSH sponsored course/on-line class or attend the All-Ohio Safety Congress & Expo.  Safety council meetings are not considered DSH-sponsored training courses.

2.     An employer has two significant claims and two medical only claims, but settles one of the significant claims.  Is the employer now eligible for the OCP?

Answer: No.  Settled claims are included in the claim count; hence, the employer still has two significant claims on its record.


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