OhioBWC - Basics: (Policy library) - File

 

Policy Name:

Other States Coverage Policy (OSCP)

Policy #:

EP-15-02

Code/Rule Reference:

ORC 4123.292; OAC 4123-17-17, 4123-17-24.

Effective Date:

July 1, 2019

Approved:

Ronald L. Suttles, Chief Employer Services

Origin:

Employer Policy

Supersedes:

N/A

History:

New policy issued July 30, 2019.

Review Date:

July 1, 2024

 

 

I.       Policy Purpose

 

Other States Coverage Policy (OSCP) is the policy offered by the Ohio Bureau of Workers’ Compensation (BWC) under ORC 4123.292 to provide optional coverage to eligible Ohio employers for workers’ compensation exposures in states other than Ohio.

 

II.     Applicability

 

This policy applies to the BWC Other States Coverage Unit, private employers (PA employers) and public employer taxing districts (PEC employers) who have obtained an OSCP from Zurich American Insurance Company through BWC, and their authorized representatives.

 

III.    Definitions

 

A.     ACORD 130: A standard workers’ compensation application form. An employer may obtain an ACORD 130 from BWC or an insurance agent.

B.     Certificate of coverage: A document issued by an insurance company or agent that is used to verify the existence of insurance coverage.

C.    Contracting carrier: The insurer providing an OSCP through BWC. The current contracting carrier is Zurich American Insurance Company.

D.    Declaration page: A page in an insurance policy which provides a summary of the coverage.

E.     Limited other states coverage: Insurance coverage for eligible Ohio employers who have employment relationships localized in Ohio, but whose employees have incidental exposures in jurisdictions outside Ohio.

F.     Other states coverage: Insurance coverage for eligible Ohio employers who have regular or full-time employment exposure in jurisdictions outside of Ohio.

G.    Optional coverage: BWC is not required to provide OSCP to Ohio employers. Each employer will be individually underwritten for eligibility. If denied, Ohio employers can get coverage out of state through the voluntary market or the residual market.

IV.   Policy

A.     Eligibility criteria.

1.     An employer must:

a.     Be headquartered, primarily located, or have a history of predominant business operations in Ohio;

b.     Have active coverage with BWC;

c.      Not have cumulative lapses in workers’ compensation coverage in excess of forty (40) days within the prior twelve (12) months; and

d.     Not have past-due balances at the time of application or renewal.

2.     BWC will establish additional underwriting guidelines to determine whether to approve or deny an employer’s application. BWC’s underwriting guidelines may consider the following:

a.     The applicant’s history with BWC including compliance with applicable workers’ compensation laws and rules, payment of premiums and assessments, claims history, safety record and experience modification history; and

b.     The applicant’s history with coverage through any insurer for workers compensation in any jurisdiction other than Ohio, including premium payment records, claims history, safety record and experience modification history, if any.

3.     The following employers are not eligible for an OSCP:

a.     Self-insuring employers;

b.     Temporary employment agencies or other staffing entities;

c.      Professional employer organizations (PEOs) as defined in ORC Chapter 4125 and each of the PEOs’ client employers; and

d.     Employers with certain high-risk manual classifications as outlined by the contracting carrier.

B.     Application requirements.

1.     The employer must submit an ACORD 130 to BWC to apply for an OSCP.

2.     The employer must submit the declaration page or the certificate of coverage of any existing other states coverage policy if the employer currently has a policy covering exposure in other states.

3.     Declaration pages or certificates of coverage for previous policies may be requested as deemed appropriate by BWC.

4.     Five years of loss runs must be submitted on any previous or existing other states policy.

5.     An employer with trucking operations must also submit an Other States Coverage – Trucking Supplemental Application (U-159).

6.     An employer with operations at heights must also complete the Fall Protection in Construction Supplemental Questions (U-160).

7.     BWC will request missing or incomplete information from the employer. An application will not be considered complete until all information requested by BWC in connection with the application is supplied.

8.     BWC may make reasonable inspections of the employer’s place of business, and of any records applicable, to ensure proper classification code assignment to the OSCP.

9.     BWC may review loss prevention or safety programs prior to reaching a decision regarding the OSCP.

10.  BWC will not process an incomplete application.

11.  If BWC is unable to obtain complete information, the application will be denied.

12.  BWC will determine if the employer meets the eligibility criteria and underwriting guidelines set forth in this policy.

a.     If an employer is denied an OSCP, BWC will provide the employer written documentation of the reason for the denial.

b.     The employer may reapply once the reason for the denial is remedied.

13.  BWC has the authority to approve or deny an OSCP application. The decision is final.

C.    Premium payment and policy issuance.

1.     An employer whose application for coverage is approved will receive a quote for the cost of the coverage.

2.     If the employer elects to obtain coverage, BWC will issue an OSCP only after the following:

a.     BWC receives the premium payment required for the OSCP; and

b.     If the employer previously had a policy covering its exposure out of state, submission of proof of cancellation of the existing policy or the expiration date of the previous policy.

3.     Coverage under an OSCP is not effective until the OSCP is issued.

a.     If the employer provided cancellation notices and all other required information, BWC will issue the policy within five business days of receipt of premium.

b.     Coverage is effective per the effective date of the policy as issued by the contracting carrier.

4.     The policy is valid for one year and is subject to renewal one year from the date of issuance.

D.    Policy renewal.

1.     To renew an OSCP, the employer must complete the renewal application provided by BWC.

2.     BWC will establish a deadline for the employer’s renewal based on the rules and laws of the applicable states.

3.     BWC will non-renew an employer’s OSCP if the employer does not meet eligibility criteria, or underwriting guidelines, at the time of renewal.

4.     The premium for the OSCP must be received by BWC prior to the expiration of the previous policy period.

5.     Renewal premium received after the expiration of the previous policy will be considered late and may result in a lapse. If the payment is received late, BWC may:

a.     Reinstate coverage as of the date of receipt of the payment; or

b.     Require the employer to submit a new OSCP application.

6.     BWC will not grant retroactive coverage on the OSCP with respect to any lapse period.

7.     BWC has the authority to non-renew an employer’s OSCP. BWC’s decision is final.

E.     Audits and inspections.

1.     An OSCP will expire per the terms of the policy issued by the contracting carrier, unless otherwise cancelled as set forth in this policy.

2.     An employer with an OSCP must complete a final audit at the end of each coverage period, and upon cancellation, as required by the terms of the OSCP.

3.     In the event a claim occurs outside of Ohio jurisdiction, BWC may inspect the employer’s place of business, and of any records necessary, to determine the claim’s compensability.

4.     Any audit conducted will be conducted in accordance with OAC 4123-17-17.

5.     Adjustments to premium may be made based on the results of any audit. The employer must pay any balance due within the timelines set by BWC.

6.     An employer’s refusal or failure to cooperate with a BWC audit may result in BWC estimating the employer’s payroll. Any estimated payroll may result in an adjustment of premium.

7.     In the event of an audit dispute, BWC will make reasonable efforts with the employer to resolve the disputed findings.

8.     If resolution between BWC and the employer cannot be made, the audit findings can be appealed to the extent allowable under the laws and procedures of the jurisdiction for which coverage is being provided.

F.     Policy cancellation.

1.     An OSCP may be cancelled for any of the following reasons:

a.     At the written request of the employer;

b.     Employer misrepresentation of its operations;

c.      Employer fraud;

d.     Employer failure to complete a final audit or pay any amounts due because of a final audit;

e.     Any past due balance owed on the OSCP;

f.       Refusal by the employer to permit reasonable audits or inspections; or

g.     Any reason the contracting carrier is authorized to cancel a policy, as established by the terms of the policy or the laws of the jurisdiction for which coverage is provided.

2.     In the event an OSCP is cancelled, then the following applies:

a.     Notice of cancellation will be provided as required by the laws and procedures of the jurisdiction for which coverage is being provided.

b.     A policy cancellation can be appealed by an employer to the extent allowable under the laws and procedures of the jurisdiction for which coverage is being provided.

3.     Upon cancellation, an employer will complete a final audit to compile actual payroll information.

4.     Adjustments to premium are made based on the results of the final audit.

G.    Assignment of payroll.

1.     If an employer is issued an OSCP for limited other states coverage, BWC may assign payroll in the event of a claim to the jurisdiction where the claim is filed. The payroll amount will not exceed one hundred percent (100%) of the injured worker’s wages for one year.

2.     The assignment of payroll may result in a premium adjustment for the OSCP. The employer will pay any balance due within the timelines established by BWC.