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OhioBWC - Employer:  (Quarterly claim costs) - Details

Quarterly claim costs provides a summary of claim costs and reserves for each claim listed. BWC will use the new Micro Insurance Reserving Analysis (MIRA II) system to calculate the claim reserves for all claims as of the June 30, 2008, quarter end date. The definitions below will help you better understand the contents of the report.

Quarter end date – information displayed will default to the most recent quarter. You'll see a drop-down menu you can use to view up to 20 quarters of past claim costs and reserve information.
Note: MIRA I calculations were used for the claim reserves with quarter end dates prior to June 30, 2008.

Reserves — the estimated future cost of a claim

  • MIRA reserves — BWC bases the estimated future costs of a claim on an analysis of 20 individual claim characteristics identified as cost drivers. Micro Insurance Reserving Analysis (MIRA) reserves are more accurate and are intended to be an effective claims-management tool.

Risk costs

  • Claim — Identifies the claim to which the payments/charges have been authorized
  • Medical risk cost — Authorized risk medical payments as of the quarter date
  • Indemnity risk cost — Authorized indemnity (compensation) risk payments as of the quarter date
  • MIRA reserves risk — Sum of authorized MIRA Reserves as of the quarter date
  • Total unlimited risk charge — Sum of the authorized risk charges as of the quarter date, adding Medical risk cost, Indemnity risk cost and MIRA risk reserves.

Surplus costs

  • Medical surplus cost — Authorized medical surplus payments as of the quarter date
  • Indemnity surplus cost — Authorized indemnity (compensation) surplus payments as of the quarter date
  • MIRA reserves surplus — Authorized surplus reserves as of the quarter date
  • Total unlimited surplus charge — Sum of the authorized charges as of the quarter date, adding Medical surplus cost, Indemnity surplus cost and MIRA reserves surplus.

Miscellaneous costs

  • Subrogation amount — The recovery amount collected by BWC. BWC credits the employer’s policy for rate making purposes based on the recovery amount. BWC uses the subrogation amount in the experience calculation which helps to reduce claim costs.
    Subrogation amount/total unlimited claims cost = percentage of reduction
    BWC will reduce claims costs, which can be reduced, by that percentage. You will not see that reduction here.

    Click here to learn more about subrogation.

  • Handicap percent — The percentage of the claim’s costs charged to the statutory surplus fund instead of the employer’s experience. BWC reduces claims closts, which can be reduced, by the handicap percent awarded. You'll see the separation of claims costs to the risk and surplus fund as a result of the handicap award here.
    Click here to learn more about handicap reimbursement.

  • Appeal - The appeal indicator reflects if someone has appealed this claim to the Industrial Commission of Ohio. Pursuant to the 2004 Ohio Supreme Court decision, the medical costs associated with a claim in appeal status shall not be used in the employer's experience calculation. If the claim and/or additional conditions in the claim is subsequently allowed, the medical costs will be placed back into the experience calculation for all years in which medical costs were previously omitted or removed. Also, BWC will recalculate the experience calculation according to the addition of the medical costs.