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OhioBWC - Basics: (Policy library) - File

Policy Name:

Self-Insured Employer Dispute/Protest Policy

Policy #:

SI-03-04

Code/Rule Reference:

Ohio Administrative Code (OAC) 4123-19-03, 4123-19-06, 4123-19-07 and 4123-19-14

Effective Date:

New

Origin:

Self-Insured Department/Employer Services

History:

New

Review Date:

December 1, 2020

 

I.                Policy Purpose

The purpose of this policy is to define the guidelines the Self-Insured Department will utilize to address a self-insuring employer protest or dispute.

 

 II.              Applicability

This policy applies to self-insuring employers and the Self-Insured Department.

 

  III.            Definitions

A.    SI: Self-Insured.

B.    SI Employer: Self-insuring employer.

C.    SIRP: Self-Insured Review Panel.

D.    Dispute/Protest: An employer dispute/protest of a BWC decision, or application of a rule or policy, that requires additional research and analysis to determine proper resolution.

E.    Extenuating circumstance: A substantial reason, or mitigating factor, that justifies granting the employer’s request for relief.

 

IV.        Policy

A.    A 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

Email: SIINQ@bwc.state.oh.us.

B.    The SI department staff will investigate the employer’s dispute/protest prior to issuing a decision to determine:

1.     The resolution that the employer is requesting to resolve the protest or dispute.

2.     The reason the employer is requesting relief.

3.     Whether the employer has met eligibility criteria and program requirements as outlined in the ORC, OAC and BWC policy.

4.     Any new information received after the initial decision (i.e., financial information, claim status information, claim reserve information, etc.) that may impact the original decision.

5.     Whether the employer meets the criteria for granting relief under an extenuating circumstance detailed in this policy.

C.    The SI department utilizes the following guidelines for granting relief.

1.     The SI department will not grant relief where the employer fails to meet program requirements as outlined in the ORC, OAC and BWC policy. 

2.     Relief may be granted if the protest and supporting documentation establish that the initial decision made by BWC is incorrect, for example:

a.     Incorrect risk assignment of a claim;

b.     Updated financial information that may impact SI Financial Rating and/or security requirements;

c.     Updated claim reserve information that may impact security requirements;

d.     Verification of SI-40 Paid Compensation reporting or amounts;

e.     UA-3SI Agreements between a PEO and client employer;

f.      Any other situation approved by the SI Director;

3.     Relief 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 example:

a.     Error made by BWC or the office of the Ohio Attorney General.

b.     The employer timely notified the Self-Insured Department of a contact change but BWC systems were not updated.

c.     Payment was credited to an incorrect risk number.

d.     Payment was received timely but not posted to BWC systems.

e.     Any technical difficulties that make www.bwc.ohio.gov unavailable and prevent an employer from completing a required filing (i.e. SI-7 report, SI-40 report).

f.      Any other situation as determined by the SI Director.

4.     The following scenarios do not qualify as extenuating circumstances:

a.     Changes 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.

 

D.    The 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.

 

 

 

 


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