Policy Name:
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One Claim Program (OCP)
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Policy #:
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EP-15-01
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Code/Rule Reference
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ORC 4123.29(A)(4)(e);
and OAC 4123-17-05.1,
Appendix A; 4123-17-16; 4123-17-33.1, Appendix A; 4123-17-71; 4123-17-74, Appendices A, B,
and C.
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Effective Date:
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July 1, 2023
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Approved:
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Rex Blateri, Chief of Employer Services
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Origin:
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Employer Policy
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Supersedes:
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All policies and procedures regarding the OCP that predate
the effective date of this policy.
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History:
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Revised: January 4, 2024; August 12, 2021; August 20,
2020; May 15, 2018; August 8, 2016; December 7, 2015; April 6, 2015; July 3,
2012.
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Review Date:
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July 1, 2028
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I.
Policy Purpose
The Ohio Bureau of Workers’
Compensation (BWC) provides a program to lessen the impact of a significant
claim that comes into an employer’s experience. BWC permits such employers to
participate in the One Claim Program (OCP) as outlined in all applicable laws
and rules.
II.
Applicability
This policy
applies to employers, authorized representatives, BWC Employer Programs, and
Employer Management Services.
III. Definitions
A. Industry-specific
training course: Safety course specifically identified by BWC as applicable
to a specific industry group. Private employer industry groups are identified
in OAC 4123-17-05, Table 1,
Part A. Industry-specific safety courses are listed in the Division of Safety
& Hygiene (DSH) Safety
Services Catalog.
B. Minor
claim: A medical-only or lost-time claim whose total value or maximum claim
value, whichever is lower, will be less than the employer’s total limited
losses (TLL) as defined in OAC 4123-17-03,
subject to the TLL provisions of a significant claim that became effective July
1, 2020.
C. One
Claim Program (OCP): BWC’s voluntary rate program which offers a private
employer (PA employer) or a public employer taxing district employer (PEC
employer) the opportunity to mitigate the impact of a significant claim
entering the employer’s experience for the first time.
D. Online
safety training class: Training course offered by the DSH through the
Internet (as opposed to a classroom course).
E. Program
eligibility period: The four policy years in which an employer has a
significant claim in its experience period.
F. Significant
claim: A claim whose total value or maximum claim value, whichever is
lower, will be greater than the employer’s TLL as defined in OAC 4123-17-03. Effective July 1,
2020, for PA employers whose expected losses fall below the minimum expected
loss provided in OAC 4123-17-05.1,
Appendix A, a TLL of $300 shall be used; for PEC employers whose expected
losses fall below the minimum expected loss provided in OAC 4123-17-33.1, Appendix A, a
TLL of $550 shall be used. Once a claim has been designated as the significant
claim, that designation cannot be changed during the program eligibility period.
G. Total
limited losses (TLL): Total expected losses for an employer multiplied by
the limited loss ratio. Total expected losses are determined by applying
expected loss rate to the payroll of each classification in the employer’s
experience period. See OAC 4123-17-03.
IV. Policy
A. Eligibility
requirements. As of the initial application deadline, the employer must be
enrolled in the Group Experience Rating Program. At the time of initial
application and each renewal application, the employer must:
1.
Be current with respect to all payments due BWC, as defined in OAC 4123-17-14;
2.
Be current on the payment schedule of any part-pay agreement into which
it has entered for the payment of premiums or assessments;
3.
Not have cumulative lapses in workers’ compensation coverage in excess
of forty (40) days within the prior twelve (12) months; and
4.
Report actual payroll for the preceding policy year and pay any premium
due upon reconciliation of estimated premium and actual premium for that policy
year no later than the application deadline set forth in OAC 4123-17-74.
See the Payroll
True-Up policy for additional information.
B. Application
requirements and BWC evaluation of application.
1.
BWC will automatically identify and send notice to employers of their
initial and continuing eligibility for the OCP.
2.
BWC has the final authority to approve participation.
3.
The employer must complete and submit the Application for One Claim
Program (OCP-1)
to request participation in the OCP for each year of the program eligibility
period.
4.
The OCP-1 must be signed by the Chief Executive Officer or designated
management representative of the employer.
5.
Application deadlines:
a.
For a PA employer, the application must be filed by the last business
day of January preceding the policy year beginning July 1.
b.
For a PEC employer, the application must be filed by the last business
day of July preceding the policy beginning January 1.
c.
If the application is received after the application deadline, BWC will
reject the application and notify the employer by letter.
6.
An employer may participate in the OCP for a maximum of four years in
which the employer has a significant claim in its experience period.
7.
BWC will evaluate the employer’s eligibility each year of the program
eligibility period and provide a renewal application.
C. General
program requirements.
1.
In signing the application form, the chief executive officer, or
designated management representative of the employer, is certifying to BWC that
the employer will comply with all program requirements.
2.
The employer may have a maximum of three minor claims at any time, in
addition to the one significant claim, in the employer's experience period.
a.
As a minor claim exits the employer's experience period, the employer
may include a new minor claim.
b.
The combined total costs of the three minor claims must be below the
employer's TLL.
3.
The employer may participate in the OCP with no more than one
significant claim within the program eligibility period from the date of the
employer's initial participation in the program.
4.
Once a claim has been designated as the significant claim in initial
enrollment, the employer is not permitted to change this designation during the
program eligibility period.
5.
Settled and subrogated claims are included in the employer's total claim
count.
6.
The employer must meet training requirements outlined in section IV.D
below.
D. Training
requirements.
1.
Employers must complete training requirements by the following deadlines:
a.
For PA employers, the last business day of March of the policy year.
b.
For PEC employers, the last business day of September of the policy
year.
2.
The employer must meet safety requirements as prescribed by the DSH.
3.
During each policy year of the program eligibility period, participants
must attend or complete any one of the following offered by the DSH:
a.
One half-day in-person classroom course;
b.
Three hours of e-courses;
c.
Three one-hour in-person training sessions at the All-Ohio Safety
Congress and Expo;
d.
Three one-hour webinars; or
e.
One half-day virtual training class.
4.
Training requirements must be satisfied by the employer on a policy
number basis because each policy number is considered a separate entity.
E. Operation
of program.
1.
BWC will credit the employer with a discount from the employer's base
rate as follows:
a.
For the first year of the program eligibility period, a 20% discount (EM
= 0.80);
b.
For the second year of the program eligibility period, a 15% discount
(EM = 0.85);
c.
For the third year of the program eligibility period, a 10% discount (EM
= 0.90); and
d.
For the fourth year of the program eligibility period, a 5% discount (EM
= 0.95).
2.
The discount is only applied to the premium rate including
administrative costs, not to the Disabled Workers' Relief Fund (DWRF). DWRF is
calculated by strictly using the base rate.
3.
Since the OCP rate is a fixed discount rate that cannot be changed, no
adjustments will be applied to the employer's account. For example, if an
employer has a 90% disability relief on a claim during the time the employer is
in the program, the disability relief will not be applied to the OCP discount.
4.
An employer participating in the OCP may participate in other compatible
BWC discount programs during its participation in the OCP as outlined in OAC 4123-17-74, Appendix C.
F. Removal/exit
from program.
1.
BWC will remove an employer from participation in the OCP at the
beginning of the next policy year and, upon removal, will return the employer
to its individual EM if the employer:
a.
Fails to meet all eligibility and general requirements of the OCP set
forth in OAC 4123-17-71(C)
and (D);
b.
Has more than four claims in its experience period;
c.
Has more than one significant claim in its experience period;
d.
Has combined claims costs of the three minor claims exceed the
employer's TLL; or
e.
Did not complete the required training.
2.
An employer removed from OCP for failure to report actual payroll for
the preceding policy year and pay any premium that is due upon reconciliation of
estimated premium with actual premium will be rerated for the current policy
year at the employer's base rate, or experience modified rate, as determined by
the employer's expected losses for the policy year.
3.
BWC will notify an employer by letter when a requirement is not met and
give justification for removal.
4.
An employer may withdraw from the program at any time by notifying BWC
in writing.
a.
An employer that withdraws from the OCP during the policy year will be
reassigned its individual experience modifier for the entire policy year.
b.
If an employer withdraws from the program and has any remaining years in
the program eligibility period, the employer may reapply for the OCP using the
same significant claim as its one designated claim. For example, an employer
enrolls in OCP for the first year, and then withdraws the second year. The
employer may reapply for the third, or any subsequent, year remaining on its
original program eligibility period.
G. Resolution
of complaints.
1.
Employer complaints are processed under the General
Employer Complaint Policy.
2.
Specific extenuating circumstances that apply to the OCP.
a.
Circumstance involving employer's denial into the OCP as a result of not
meeting the claim eligibility requirements.
i.
Extenuating Circumstance. Employer protests the eligibility criteria for
participating in the OCP. Situations falling under this scenario may include
the following:
a)
Claims assigned to wrong risk;
b) Claims
originally allowed, reversed on appeal, and not updated to disallowed status;
or
c)
Claims costs exceeding TLL due to payments made in error.
ii.
Supporting documentation may include, but is not limited to, BWC or IC
orders detailing reversals of previous claim decisions that specifically impact
the employers' general program requirements.
b.
Circumstance involving an employer's policy that is fully combined into
a successor's policy where the predecessor policy was enrolled in the OCP with
eligibility years remaining in the program.
i.
Extenuating Circumstance. The successor policy desires to maintain
eligibility and retain the discount. The successor may be granted OCP
participation provided all criteria for program eligibility are met.
ii.
Supporting documentation: Documentation showing the predecessor policy
completed all requirements for policy years in which it actively participated
in the OCP.
iii. The
following conditions must be met for the employer's request to be granted:
a)
The total combined number and types of claims from the predecessor, and
the successor, must meet the claim requirement for participation in the OCP.
b) The
successor policy is not participating in any other BWC program that is
incompatible with OCP.
c)
Depending on the effective date of the combination, BWC will either:
i)
Require the successor to file an OCP-1; or
ii)
Use the predecessor's OCP-1 to transfer program participation to the successor.
iv. The
successor policy will be granted the OCP discount effective with the start of
the next applicable policy year. The predecessor will receive the OCP discount
through the end of the policy year in which the combination took place, and the
successor will receive the discount beginning with the start of the next policy
year. The successor policy discount is only for the remaining years of the
original program.
H. Scenarios.
1.
An employer attends two local safety council seminars lasting two hours
each and believes that satisfies the requirement for one training course for
the OCP. Are these seminars valid?
Answer: No,
safety council meetings are not considered DSH-sponsored training courses. An
employer must attend, depending on year of participation, a DSH sponsored
course, online class, or attend the All-Ohio Safety Congress & Expo.
2.
An employer has two significant claims and two minor claims but settles
one of the significant claims. Is the employer now eligible for the OCP?
Answer: No.
Settled claims are included in the claim count. The employer still has two
significant claims on its record.