Self-Insured Employer Dispute/Protest Policy
Ohio Administrative Code (OAC) 4123-19-03,
Self-Insured Department/Employer Services
December 1, 2020
of this policy is to define the guidelines the Self-Insured Department will
utilize to address a self-insuring employer protest or dispute.
applies to self-insuring employers and the Self-Insured Department.
A. SI: Self-Insured.
B. SI Employer: Self-insuring employer.
Self-Insured Review Panel.
An employer dispute/protest of a BWC decision, or application of a rule or
policy, that requires additional research and analysis to determine proper
Extenuating circumstance: A substantial
reason, or mitigating factor, that justifies granting the employer’s request
SI employer may submit a dispute/protest, in writing, to the Self-Insured Department
via mail or email.
Ohio Bureau of Workers’ Compensation
Attn: Self-Insured Department – Level 22
30 West Spring Street
Columbus, OH 43215
SI department staff will investigate the employer’s dispute/protest prior to
issuing a decision to determine:
resolution that the employer is requesting to resolve the protest or dispute.
reason the employer is requesting relief.
the employer has met eligibility criteria and program requirements as outlined
in the ORC, OAC and BWC policy.
new information received after the initial decision (i.e., financial
information, claim status information, claim reserve information, etc.) that
may impact the original decision.
the employer meets the criteria for granting relief under an extenuating
circumstance detailed in this policy.
SI department utilizes the following guidelines for granting relief.
SI department will not grant relief where the
employer fails to meet program requirements as outlined in the ORC, OAC
and BWC policy.
may be granted if the protest and supporting documentation establish that the
initial decision made by BWC is incorrect, for example:
Incorrect risk assignment of a claim;
Updated financial information that may
impact SI Financial Rating and/or security requirements;
Updated claim reserve information that
may impact security requirements;
Verification of SI-40 Paid Compensation
reporting or amounts;
UA-3SI Agreements between a PEO and
Any other situation approved by the SI
may be granted if the SI department identifies an extenuating circumstance,
outside of the employer’s control, that would establish a need for relief, for
made by BWC or the office of the Ohio Attorney General.
The employer timely notified the
Self-Insured Department of a contact change but BWC systems were not updated.
Payment was credited to an incorrect
d. Payment was received timely but not posted to BWC systems.
Any technical difficulties that make www.bwc.ohio.gov unavailable
and prevent an employer from completing a required filing (i.e. SI-7 report,
Any other situation as determined by the SI Director.
following scenarios do not qualify as extenuating circumstances:
in the Ohio Administrator or mailing/phone contact
information where the SI department was not notified.
b. Changes in third party administrator (TPA), authorized
legal representative or any other vendor utilized by the employer where the SI
department was not notified.
c. The lack of competency and/or knowledge of the designated
Ohio Administrator for the employer.
d. Action or lack of action made, on behalf of the SI
employer, by a third party administrator, authorized legal representative or
any other vendor utilized by the employer.
e. Confusion over Ohio workers’ compensation laws or rules.
SI department will issue a formal response to any dispute. If the dispute is
not resolved as a result of the formal response issued by the SI department, a
written request that the issue be referred to the Self-Insured Review Panel
(SIRP) may be submitted by the SI employer.