OhioBWC - Basics: (Policy library) - File

 

Policy Name:

Excess Insurance Requirements and Recovery

Policy #:

SI-04-02

Code/Rule Reference

Ohio Revised Code (ORC) 4123.82; Ohio Administrative Code (OAC) 4123-19-03 & 4123-19-14.

Effective Date:

New

Approved:

Rex Blateri

Origin:

Self-Insured Department/Employer Services

Supersedes:

N/A

History:

New

Review Date:

03/01/2026

 

I.       Policy Purpose

 

The Ohio Bureau of Workers' Compensation (BWC) requires self-insuring (SI) employers to provide information regarding elective excess insurance, and BWC pursues recovery of eligible claims costs from defaulted SI employers through these excess insurance policies.

II.     Applicability

This policy applies to SI employers, excess insurance carriers, the Self-Insured Department (SI Department), Central Claims, and the Finance Division.

III.   Definitions

A.      Defaulted SI Employer: An SI employer that has stopped meeting the financial obligations of self-insurance.

B.      Excess Insurance: Insurance obtained by an SI employer to cover claims costs that exceeds the employer’s retention level and complies with ORC 4123.82 and OAC 4123-19-03.

C.      Excess Insurance Carrier: An insurance carrier that provides excess insurance coverage for an SI employer.

D.     Retention Level: The amount of claims costs resulting from any one disaster or event that must be paid before an excess insurance carrier reimburses an SI employer, or in the event of default, BWC. Pursuant to ORC 4123.82, a retention level must be greater than, or equal to, fifty thousand dollars ($50,000). Depending on wording contained in the excess insurance contract, the retention level may apply to an individual claim or multiple claims arising from the same disaster or event. Additionally, the retention level may apply only to a portion of claims costs, such as only indemnity costs.

E.      Self-Insured Review Panel (SIRP): A three-person panel appointed by the Administrator to provide SI employers with hearings on matters referred to the panel or as requested by the employer.

F.      Self-Insuring Employer: An employer that BWC has granted the privilege of paying compensation and benefits directly.

IV.   Policy

A.      If an SI employer elects to secure excess insurance as permitted in ORC 4123.82, the SI employer must:

1.      Name BWC as a beneficiary to the excess insurance contract;

2.      Provide a complete copy of the excess insurance contract, including declaration page to BWC; and

3.      Notify BWC of any material changes to the excess insurance contract.

 

BWC may require additional information based on terms contained in, or changes made to, the excess insurance contract. Excess insurance coverage information must be updated during the self-insuring employer’s annual renewal of self-insurance. See Self-Insuring Employer Annual Renewal Policy for more information.

B.      When There Is A Default Notification:

1.      BWC will contact any excess insurance carrier of the SI employer to ensure that policy coverage is in effect, and other requirements of the excess insurance contract are met;

2.      BWC will identify claims currently eligible, or that may become eligible, based on the information provided by the defaulting SI employer, its authorized representatives, and the excess insurance carrier; and

3.      BWC will pursue reimbursement for all payments made on all eligible claims, that exceed the retention level, made directly by BWC.

C.      BWC may consider payments made by the SI employer prior to default when determining whether the retention level has been met. The excess insurance contract should be reviewed when making this determination.

D.     Reimbursements from excess carriers are applied to cover claims cost under the defaulted employer’s policy.

V.     Resolution of Complaints

A.      Any complaints or disputes related to this policy must be submitted in writing to the SI Department, via mail or email, as detailed in the Self-Insured Employer Dispute/Protest Policy.

Ohio Bureau of Workers' Compensation

Self-Insured Department

30 W. Spring St., 22nd Floor

Columbus, Ohio 43215-2256

Email: siinq@bwc.ohio.gov

B.      The SI employer may file a written appeal of the SI Department’s decision to the SIRP.