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OhioBWC - Basics: (Policy library) - File

Transitional Work Performance Bonus

 

Policy Name:

Transitional Work Performance Bonus

Policy #:

EP-20-02

Code/Rule Reference:

OAC 4123-17-55, 4123-6-01, 4123-6-02.2, 4123-17-15, 4123-17-75 and Appendix; 4123-17-74, Appendices A, B, C; 4123-17-14, 4123-17-16. ORC 4125.01.

Effective Date:

July 1, 2016

Origin:

Employer Policy

Supersedes:

Transitional Work Performance Bonus dated July 1, 2012.

History:

Revised December 29, 2016; May 12, 2015. New policy issued October 25, 2013.

Review Date:

July 1, 2021

 

 

I.       Policy Purpose

 

The Ohio Bureau of Workers’ Compensation (BWC) will provide a Transitional Work Performance Bonus to eligible employers that meet program requirements in accordance with the applicable laws and rules.

 

II.     Applicability

 

This policy applies to employers, authorized representatives, BWC Employer Programs, Transitional Work Unit, Field Operations, and transitional work developers.

 

III.    Definitions

 

A.     Client employer: A sole proprietor, partnership, association, limited liability company, or corporation that enters into a Professional Employer Organization (PEO) agreement and is assigned shared employees by the PEO. ORC 4125.01, OAC 4123-17-15(A)(2)

B.     Professional employer organization (PEO): A sole proprietor, partnership, association, limited liability company or corporation that enters into an agreement with one or more client employers for the purpose of co-employing all or part of the client employer’s workforce at the client employer’s work site. PEO does not include a temporary service agency. ORC 4125.01, OAC 4123-17-15(A)(1)

C.    Program period: Generally, the policy year an employer participates in the Transitional Work Performance Bonus. For a private employer who participates in the program beginning January 1, 2015, the program period is January 1, 2015, to June 30, 2015. BWC will transition such employer to a policy year program period effective July 1, 2015.

D.    Pure premium: The employer’s calculated premiums before any administrative costs or Disabled Workers’ Relief Fund (DWRF) assessments are added.

E.     Transitional work (TW): A work-site program that provides an individualized interim step in the recovery of an injured worker (IW) with job restrictions resulting from the allowed conditions in the claim. Developed in conjunction with the employer and the IW, or with others as needed, including, but not limited to the collective bargaining agent (where applicable), the physician of record, rehabilitation professionals, and the managed care organization (MCO), a transitional work program assists the IW in progressively performing the duties of a targeted job. OAC 4123-6-01(AA)

F.     Transitional work developer: The provider who develops the employer’s transitional work program. OAC 4123-17-55(A)(6)

IV.   Policy

A.     Eligibility Criteria: To qualify for the program the employer must be a state-fund private employer (PA) or a public employer taxing district employer (PEC). The employer must meet the following eligibility criteria:

1.     At the time BWC reviews the employer’s application, the employer must:

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

b.     Be in an active policy status. “Active policy status” does not include an employer with a coverage status of “no coverage” or “lapsed.”

2.     The employer cannot have cumulative lapses in workers’ compensation coverage in excess of forty (40) days within the twelve (12) months preceding the application deadline for the Performance Bonus. OAC 4123-17-55(B)(1)(b)

3.     As of the application deadline, the employer must timely report actual payroll for the preceding policy year and pay any premium due upon reconciliation of estimated premium and actual premium. An employer will be deemed to have met this requirement if BWC receives the payroll report and the employer pays premium associated with such report before the expiration of any grace period. See the Payroll True-Up policy for additional information.

4.     The employer must continue to meet all eligibility requirements as listed in section IV.A of this policy during the program period.

5.     The employer must provide documentation that it has developed and implemented a transitional work program. BWC will accept the following documentation:

a.     A transitional work plan developed with a previous BWC grant that BWC has reviewed and approved for updates, or

b.     A company-created transitional work plan that has been reviewed by BWC, or

c.      A copy of the company’s transitional work policy from its human resource manual or employee handbook, or

d.     A transitional work plan developed under the Transitional Work Grant Program that began on July 1, 2012, or

e.     A signed letter from a company officer stating the employer has a transitional work plan or is in the process of developing a BWC Transitional Work Grant plan.

6.     BWC must receive documentation of the employer’s transitional work program no later than thirty (30) days after the application deadline. An employer previously approved to participate in the Transitional Work Performance Bonus is not required to submit transitional work plan documentation for subsequent program periods.

7.     The following employers are not eligible for the Transitional Work Performance Bonus program:

a.     State agencies.

b.     Self-insuring employers.

c.      Employers paying only the minimum administrative charge for the applicable payroll period. OAC 4123-17-16

8.     An employer who is determined to be ineligible for the program may apply for a subsequent program period if the employer becomes eligible.

B.     A PEO may participate in the Transitional Work Performance Bonus program as follows.

1.     For performance bonus calculation purposes, BWC will assign eligible transitional work bonus claims to the employer of record on the date of injury, regardless of a subsequent PEO contract termination or change.

2.     Transitional work services may be provided under a transitional work program of either the PEO or the client employer.

C.    Application Requirements / BWC evaluation of application.

1.     An employer must file an Application for Transitional Work Bonus Program (TWB-1) to participate in the program.

2.     The application must be signed by the chief executive officer (CEO) or a designated management representative who will certify to BWC that the employer will comply with all program requirements.

3.     BWC will automatically renew the employer for each subsequent program period provided the employer meets all eligibility requirements.

4.     Application deadlines are outlined in OAC 4123-17-74, Appendix A and B:

a.     For private employers the application deadline is the last business day of May prior to the July 1 program period.

b.     For public employer taxing districts the application deadline is the last business day of November prior to the January 1 program period.

5.     An employer who opts out, voluntarily withdraws, or is removed by BWC from the program, must file a new application to participate in a future program period.

D.    Operation of program.

1.     To successfully implement a transitional work plan, the employer must:

a.     First obtain documentation from the physician of record or treating physician releasing the IW to return to work (RTW) with restrictions.

b.     Utilize the transitional work service offering on BWC’s web site to complete its section of the Transitional Work Offer and Acceptance Form (TWB-2) online or use a document equivalent to the TWB-2.

c.      Print the completed TWB-2, or equivalent document, sign and date it, and submit the form to the IW for his or her signature and date.

d.     Fax the TWB-2 form, or equivalent document, signed and dated by the employer and IW to the MCO utilizing the MCO’s medical information fax number.

2.     Calculation and payment of the Transitional Work Performance Bonus.

a.     To qualify for the bonus an employer must:

i.       Have coverage that is in an active status at the time of calculation.

ii.      Timely report actual payroll for the preceding policy year and pay any premium due upon reconciliation of estimated premium and actual premium. An employer will be deemed to have met this requirement if BWC receives the payroll report and the employer pays premium associated with such report before the expiration of any grace period.

b.     BWC will evaluate all claims with injury dates that occur during the applicable program period to determine transitional work potential and utilization. See the Medical Policy Transitional Work Developer; Transitional Work Grant & Transitional Work Bonus policies for additional information.

c.      The actual performance bonus calculation date, or “snapshot,” will occur six months after the end of the applicable program period. This delayed review will provide the employer the opportunity to utilize transitional work in claims that occur late in the program period.

d.     The employer’s bonus will be based on how successfully it utilized transitional work in claims that had the potential for transitional work services.

e.     BWC will calculate the employer’s performance bonus based upon the percentage of claims eligible for transitional work services in which transitional work services were utilized.

i.       This percentage will be multiplied by a percentage of the employer’s pure premium for the applicable program period, as outlined in the Appendix of OAC 4123-17-75.

ii.      The employer may receive a bonus of up to ten percent (10%) of its pure premium. BWC will post the bonus as a credit to the employer’s account. The bonus will be refunded to the employer after any account balance is absorbed.

f.       The Transitional Work Performance Bonus and the discounts earned through participation in other Destination: Excellence programs cannot reduce an employer’s premium due below the amount of the minimum administrative charge as set forth in OAC 4123-17-26.

g.     BWC will not issue a bonus to an employer paying only the minimum administrative charge for the applicable program period.

h.     Rate adjustments made to an employer’s account after the issuance of the bonus may result in recalculation of the bonus.

3.     BWC will require an employer to repay any bonus it was not entitled to receive.

4.     An employer may, during its participation in the Transitional Work Performance Bonus, participate in other compatible BWC programs. Employer program compatibility is outlined in OAC 4123-17-74, Appendix C.

E.     Exit or removal from program.

1.     An employer may voluntarily withdraw from the Transitional Work Performance Bonus during the program period by notifying BWC in writing.

2.     BWC will remove an employer from the program who fails to timely report actual payroll for the preceding policy year and pay any premium due upon reconciliation of estimated premium and actual premium. BWC will not remove an employer if BWC receives the payroll report and the employer pays premium associated with such report before the expiration of any grace period.

3.     An employer who voluntarily withdraws or is removed from the program will not be eligible for a bonus for that program period and must repay the Transitional Work Performance Bonus as set forth in OAC 4123-17-75(D).

4.     An employer who elects to opt out of the program for the subsequent policy year must notify BWC in writing by the application deadline as set forth in OAC 4123-17-74.

F.     Resolution of complaints.

1.     Employer complaints filed due to program eligibility issues (e.g. lapse days, coverage status) will be addressed by the Employer Programs Unit. Employer complaints filed due to transitional work plan issues (e.g. employer believes it did not get appropriate credit for a RTW) will be addressed by the Transitional Work Unit

2.     An employer, whose application for the transitional work bonus has been denied, or who disagrees with BWC’s performance bonus determination, may file an appeal to BWC’s Adjudicating Committee pursuant to ORC 4123.291 and OAC 4123-14-06.

3.     BWC has not identified any program-specific extenuating circumstances that apply to the Transitional Work Performance Bonus program. Employer complaints should be processed under the General Employer Complaint Policy.


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